Crohn’s Disease

What is Crohn’s disease?

Crohn’s disease is a condition which causes inflammation and ulceration of the intestine.  Different parts of the digestive tract can be affected including the small intestine, colon, rectum, and anus.  The most common areas affected are the last part of the small intestine (ileum) [Figure 1] and the colon.  The inflammation leads to narrowing of the intestine with blockage and/or perforation (a hole in the bowel) with fistula formation and infection.  Some patients can develop inflammation of other parts of the body such as the bone joints, eyes, liver, and skin.  Crohn’s disease can be painful and debilitating and does require life-long treatment.

Figure 1 – Ulcers of the small intestine (ileum) in a patient with Crohn’s disease

 

Nearly one hundred years after its original description, the cause of Crohn’s disease remains unknown.   Malfunction of the immune system and heredity factors play a factor.   It is unclear to what degree environmental exposure, diet, or infection trigger this condition.   Crohn’s disease can occur at any age but is often diagnosed in young people by the age of 30.   It can affect most ethnic groups and it can run in some families.  Smoking worsens the symptoms of Crohn’s disease.

What are the symptoms of Crohn’s disease?

Crohn’s disease may lead to one or more complications such as bowel obstruction, ulcers or open sores from mouth to anus, fistulas (abnormal connection between two different parts of body such as intestine to skin), and colon or small bowel cancer.  The symptoms and clinical findings of Crohn’s disease can vary from mild to severe and include one or more of the following:

• Abdominal pain and cramping
• Anemia
• Blood in the stool
• Delayed growth in children
• Diarrhea
• Eye inflammation
• Fatigue
• Fever
• Inflammation of the liver and bile ducts
• Joint inflammation
• Lack of appetite and weight loss
• Malnutrition, vitamin B12 deficiency
• Mouth sores
• Skin infection and abscess around anus with pus drainage
• Ulcers in the anus

 

How is Crohn’s disease diagnosed?

Dr. Maher Abbas will assess your symptoms and perform a physical examination before recommending specific tests to either diagnose Crohn’s disease or to assess severity of inflammation.  Helpful tests include:

• Blood tests: CBC (complete blood count to test for anemia or infection), CRP (C reactive protein) and ESR (erythrocyte sedimentation rate) to assess degree of inflammation, thyroid function tests, liver and kidney function tests, tests for hepatitis virus and tuberculosis
• Imaging studies: computed tomography scan (CT) and/or magnetic resonance imaging (MRI) are special radiological studies to look inside the abdomen and pelvis. A variation of both scans is enterography which utilizes special techniques to look specifically at the small intestine.  Pelvic MRI can be helpful in patients with fistulas of the anus
• Procedures: Gastroscopy and/or Colonoscopy  are procedures which allow Dr. Maher Abbas to look inside the stomach and colon.  Capsule endoscopy is another type of test that entails swallowing a small camera capsule that travels to the small intestine and takes pictures
• Stool tests: calprotectin level (to assess for degree of inflammation in the intestine), clostridium difficile bacteria toxin, FOBT (fecal occult blood test)

How is Crohn’s Disease treated?

Crohn’s disease is a chronic condition that requires long-term care.  There is no current cure for Crohn’s disease but there are several effective medical treatments that can reduce and control the symptoms.  It is essential that patients with Crohn’s disease work closely with a gastroenterologist and a colorectal surgeon to have the best outcome.  The objective of medical treatment is to control the inflammation and limit the patient’s symptoms.  In some patients, long-term remission (no symptoms) can be achieved.   Patients whose symptoms are not fully controlled on medications or those with complications of the disease such as abscess, fistula, or bowel blockage require surgery.  For a comprehensive approach to the treatment of Crohn’s disease, see Crohn’s Disease Surgical Treatment.