What is Crohn’s disease?
Crohn’s disease is an inflammatory bowel disease featuring chronic inflammation of the inner of the gastrointestinal (GI) tract.
Patients experience periods of symptomatic relapse and remission.
The presentation of the disease is variable; some stay symptom-free most of their lives, while others may have severe, chronic symptoms that don’t resolve.
The first peak age of patients with the disease usually occurs between the ages of 15 and 30 years (most common) and the second peak age occurs between the ages of 60 and 70 years. Crohn’s disease is more common in women.
The disease can cause life-threatening complications but usually does not shorten life expectancy. It is a lifelong, progressive disease with no cure. With appropriate treatment, however, the symptoms and progression can be controlled.
What causes Crohn’s disease?
What initiates the autoimmune reaction in Crohn’s disease is unclear, but genetic and environmental factors play roles. Eventually there is chronic inflammation of the intestines from a misdirected immune system. This leads to tissue injury in the GI tract.
Some likely culprits in instigating Crohn’s disease are
- Microbial infection
- Immunologic problems
- Environmental agents
- Dietary issues
- Problems with blood supply to the intestine
- Psychosocial factors like psychological stress
- Smoking tobacco
- Oral contraceptives
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
What are the early signs of Crohn’s disease?
The early signs and symptoms of Crohn's disease may include:
- Low-grade fever
- Prolonged diarrhea (usually not bloody and often intermittent)
- Abdominal pain
- Weight loss
- Generalized fatigue
- Cramping in the lower-right abdomen
- Pain may be partially relieved by defecation
- Nausea and vomiting
- Painful oral ulcers
If the large intestine is involved, patients may report diffuse abdominal pain accompanied by mucus, blood and pus in the stool. Crohn’s disease of the small intestine usually presents with evidence of malabsorption, including diarrhea, abdominal pain, weight loss, and anorexia.
What are the late signs of Crohn’s disease?
- Bowel obstruction: Inflammatory swelling (edema) and spasms cause transient bowel obstruction. Over time, inflammation can cause scarring, thickening and narrowing in parts of the bowel, which may block the flow of digestive contents.
- Ulcers: Chronic inflammation may lead to erosion (ulcers) anywhere in the lining of the digestive tract.
- Fistulas: Sometimes, ulcers extend completely through the intestinal wall, creating an abnormal connection between different body parts (fistula). Fistulas can develop between the intestine and skin, or between the intestine and another organ. Fistulas can become infected.
- Anal fissure: A tear in the tissue that lines the anus or in the skin around the anus. This causes painful bowel movements.
- Malnutrition and nutritional deficiency: This is due to poor absorption of nutrients, diarrhea, and the inability to eat due to abdominal pain, nausea and vomiting.
- Colon cancer: Crohn's disease increases your risk of colon cancer. A regular colon cancer screening may be required.
- Musculoskeletal symptoms: Crohn’s disease causes
- Fibromyalgia (muscle pain and weakness).
- Skin symptoms:
- Erythema nodosum (raised, red, tender nodules that usually appear in the lower leg)
- Pyoderma gangrenosum (rare condition presenting with large, painful sores and ulcers commonly on the legs)
- Sweet syndrome (rare condition characterized by a sudden onset of fever and painful rash anywhere in the body)
- Acrodermatitis enteropathica (skin inflammation on the face and genitals)
- Alopecia (baldness)
- Stomatitis (inflammation in or around the mouth)
- Ophthalmologic (eye) manifestations: Inflammation of eye causing redness of one or both eyes, irritation, burning, pain or decreased vision.
- Involvement of other organ systems: Gall bladder and kidney stones as well as liver, pancreas or kidney injury.
- Thromboembolic disease: Increased blood clotting (hypercoagulable state).
- Complications due to medication: Complications due to long-term use of a certain medication used in the treatment of Crohn’s disease.
How is Crohn’s disease diagnosed?
- Physical assessment by the doctor
- X-ray, CT and MRI
- Blood investigations
- Stool studies
What is the treatment for Crohn’s disease?
Crohn’s disease is a lifelong, progressive disease with no cure. But with appropriate treatment, the symptoms, progression and episodes of remission can be controlled. The treatment usually involves
- Lifestyle changes
- Anti-inflammatory drugs
- Immune system suppressors and immune system modulator drugs
- Anti-diarrhea medication
- Nutritional supplements for:
- Vitamin D
- Vitamin B
- Nutritional therapy: Special diet given through feeding tubes or injected.
- Surgery: Removal of damaged parts of the digestive tract. The benefits of surgery for Crohn's disease are usually temporary because the disease recurs.
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