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Crohn's disease, a type of inflammatory bowel disease, has no cure. But there are many treatments, specific to type, and it is possible to keep the symptoms under control.
A gastroenterologist offers some tips for those newly diagnosed with the condition.
“It's important to get a proper diagnosis and see an experienced inflammatory bowel disease (IBD) provider, preferably at a center that specializes in caring for these conditions,” said Dr. Matthew Coates, who treats diseases of the digestive system at Penn State Health Milton S. Hershey Medical Center.
Crohn's disease and ulcerative colitis are two types of IBD, diseases involving chronic inflammation of the gastrointestinal tract.
Crohn's is caused by an overactive immune system. Cases are on the rise, but it's unclear whether that's because doctors are getting better at diagnosing it or if environment and diet play a role.
“There is a genetic component, but genetics alone don't mean you'll develop IBD,” Coates said in a Penn State Health news release. “It takes a certain type of genetic background mixed with an environmental exposure, such as an infection or a change in the microbiome — or the fungi, bacteria and viruses that reside in the gastrointestinal tract.”
Crohn's typically starts in younger people. Early symptoms can include abdominal pain, diarrhea, weight loss and fatigue. Sufferers may have nutritional deficiencies. They may feel anxious or depressed.
The ongoing inflammation can lead to narrowing in the bowel that makes it hard for food to pass through. People with Crohn's also may have abscesses and fistulas, which are abnormal connections between the diseased areas and other parts of the body, Coates explained.
Other symptoms can include skin rashes and problems with eyes or joints.
“A lot of our strategy is focused on keeping the disease under control, and managing the disease activity and complications it's known to cause,” Coates said.
The symptoms mimic a lot of conditions, so it can be hard to pinpoint Crohn's disease.
“Diagnosis is usually based on a mix of symptoms, clinical findings during examination and the results of stool tests, blood tests, endoscopies and imaging,” Coates said.
Treatments typically involve calming the immune system. They may include pills called immunomodulators or small molecules, and infusions or shots called biologics.
“A wide variety of treatments exist, which is why it's so important to make sure your doctor carefully diagnoses and characterizes what type of Crohn's disease you have, including the location, severity and types of complications,” Coates said.
Small molecules target particular aspects of the immune system and are among the newest treatments. The U.S. Food and Drug Administration has approved these for ulcerative colitis. They are being studied for Crohn's disease.
“This is a huge area of active investigation, and there are a large number of medications in the pipeline that are likely to be approved in the coming years,” Coates said.
Diet may also help ease symptoms.
Evidence suggests that something called a low FODMAP diet can make IBD patients in remission less symptomatic, Coates said. FODMAP is an acronym for the fermentable sugars that are found in many types of fruit and artificial sweeteners. The small intestine absorbs them poorly.
Studies haven't proven that one diet is superior to another. Some do well eating whole or unprocessed foods.
Coates said that patients should feel encouraged by the opportunity to live normal, healthy lives after getting appropriate therapy.
“We have medicines that work in a variety of different ways, and more therapies available to us today than ever before,” he said. “These are giving more people the possibility of gaining control over their disease process.”
The U.S. National Library of Medicine has more on Crohn's disease.
SOURCE: Penn State Health, news release, May 4, 2023
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