Crohn's Disease (cont.)
First, your doctor will review your medical history. A specialist called a
perform a colonoscopy or sigmoidoscopy to obtain bowel tissue for analysis.
Other tests your health care provider may order include:
- Blood tests, including blood counts (often high white blood cell
counts -- a sign of inflammation -- and low red blood cells
counts a sign of anemia from blood loss -- are present).
- Stool samples to rule out infections
as the cause of diarrhea.
- Special X-ray of both the upper and lower GI tract may be ordered as
well to confirm the location of the inflammation.
Grades of Crohn's Disease
According to the American College of Gastroenterology, Crohn's disease
activity is characterized as:
- Mild-moderate disease:
Being able to eat with no evidence of dehydration, severe illness (fevers,
significant weight loss, abdominal pain, nausea, vomiting) or severe
- Moderate-severe disease:
Those who have failed to respond to treatment for mild-moderate disease or
those with fevers, weight loss, abdominal pain, nausea, vomiting or
disease: Those with symptoms despite taking corticosteroid
treatment (see below), or individuals with high fevers, persistent vomiting,
evidence of obstructed intestines, severe weight loss or major infection.
- Remission: no
symptoms are present
What Triggers a Worsening of Crohn's Disease?
Crohn's disease is characterized by periods of being symptomatic, which can
last for days or weeks, interspersed with periods of remission (no symptoms are
present). Remissions can last days, weeks or even years.
Factors that worsen Crohn's disease include:
- Infections (including the common cold)
- Cigarette smoking
- Certain anti-inflammatory drugs (such as aspirin and
How Is Crohn's Disease Treated?
Though treatments cannot cure Crohn's disease, they can help most people lead
Crohn's disease is treated primarily with medications, including:
- Anti-inflammatory drugs, such as salicylates. Examples include Azulfidine
(sulfasalizine), Dipentum, and Pentasa. Side effects include
gastrointestinal upset, headache, nausea, diarrhea, or rash.
- Corticosteroids, a more powerful type of
anti-inflammatory drugs. Examples include prednisone or Solu-Medrol, and
Entocort. Side effects, if taken for long periods of time, can be severe and
may include bone thinning, muscle loss, skin problems, increased risk of
infection. Entocort has fewer side effects.
- Immune system modifiers such as azathioprine (Imuran)
or methotrexate. It can take up to six months for these drugs to work. These
medications are associated with increased risk for infections that can be
- Antibiotics such as Flagyl, Cipro and others. Flagyl
can cause a metallic taste in the mouth, nausea and tingling or numbness of
the hands and feet. Cipro can cause nausea and has been associated with rupture of the
- Antidiarrheal drugs
- Biologic therapy, such as Remicade. Remicade
neutralizes the activity of a substance called tumor necrosis factor alpha (TNF-alpha). This substance is overproduced by people with
Crohn's and plays an important role in causing the inflammation associated
with Crohn's disease. The drug is given intravenously (through the vein). Side
effects include life-threatening infection, infusion reaction, headache,
fatigue, fever, pain, dizziness, rash, and itching.
Response to therapy is
evaluated within several weeks of starting treatment. Treatment is continued
until remission is obtained (at which time, the health care provider may
consider maintenance therapy).
No improvement calls for more aggressive therapy.
Nutritional supplements may also be recommended by your doctor.
Surgery is required in about one-half of people with Crohn's disease to treat
complications of the disease, such as, fistulas, abscesses, hemorrhage, and
intestinal obstructions. Surgery may also be necessary in people who do not
respond to medications.
In most cases, the diseased part of the bowel is removed and the two healthy
ends of bowel are joined together (anastomosis). This surgery can allow many
people to remain symptom-free for years, but it is not a cure since Crohn's
disease often recurs at the site of the anastomosis.