Filed under: Digestive Health
Crohn's disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and even malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.
The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
While there's no known cure for Crohn's disease, therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about long-term remission. With treatment, many people with Crohn's disease are able to function well.
Inflammation of Crohn's disease may involve different areas in different people. In some people, just the small intestine is affected. In others, it's confined to the colon (part of the large intestine). The most common areas affected by Crohn's disease are the last part of the small intestine (ileum) and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula).
Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include:
Other signs and symptoms
People with severe Crohn's disease may also experience:
When to see a doctor
See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn's disease, such as:
The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspected, but now doctors know that although these factors may aggravate existing Crohn's disease, they don't cause it. Now, researchers believe that a number of factors, such as heredity and a malfunctioning immune system, play a role in the development of Crohn's disease.
Risk factors for Crohn's disease may include:
Crohn's disease may lead to one or more of the following complications:
Symptoms of Crohn's disease may first prompt a visit to your family doctor or general practitioner. However, you may then be referred to a doctor who specializes in treating digestive disorders (gastroenterologist).
Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions ahead of time can help you make the most of your visit. List your questions from most important to least important in case time runs out. For Crohn's disease, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
Your doctor will likely diagnose Crohn's disease only after ruling out other possible causes for your signs and symptoms, including irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of Crohn's disease, you may have one or more of the following tests and procedures:
There is currently no cure for Crohn's disease, and there is no one treatment that works for everyone.
The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohn's disease usually involves drug therapy or, in certain cases, surgery.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More-serious side effects include high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.
Also, these medications don't work for everyone with Crohn's disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn't respond to other treatments. A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohn's disease that involves the lower small intestine and the first part of the large intestine.
Corticosteroids aren't for long-term use. But, they can be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids also may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.
Immune system suppressors
These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. By suppressing the immune response, inflammation is also reduced. Sometimes, these drugs are used in combination. For example, a combination of azathioprine and infliximab has been shown to work better than either drug alone in some people. Immunosuppressant drugs include:
Infliximab (Remicade). This drug is for adults and children with moderate to severe Crohn's disease. It may be used soon after diagnosis, particularly if your doctor suspects that you're likely to have more severe Crohn's disease or if you have a fistula. It's also used after other drugs have failed. It may be combined with an immunosuppressant in some people, but this practice is somewhat controversial. Infliximab works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.
Some people with heart failure, people with multiple sclerosis, and those with cancer or a history of cancer can't take infliximab or the other members of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of taking infliximab. Tuberculosis and other serious infections have been associated with the use of immune-suppressing drugs. If you have an active infection, don't take these medications. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.
Adalimumab (Humira). Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn's disease. It can be used soon after you're diagnosed if you have a fistula, or if you have more severe Crohn's disease. It also may be used after other medications have failed to improve your symptoms. Adalimumab may be used instead of infliximab or certoluzimab pegol, or it can be used if infliximab or certoluzimab pegol stop working. Adalimumab may reduce the signs and symptoms of Crohn's disease and may cause remission.
However, adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose, and upper respiratory infection.
Medications and cancer risk
Immune system suppressors also are associated with a small risk of developing cancer such as lymphoma. These include azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab, certolizumab pegol and others. The risk may be due to the immune system suppression that these medications cause. While these medications do increase risk, they may be necessary for people with Crohn's disease to improve quality of life and avoid surgery or hospitalization. Work with your doctor to determine which medications are right for you.
Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn's disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine's immune system, which can trigger symptoms. However, there's no strong evidence that antibiotics are effective for Crohn's disease. Frequently prescribed antibiotics include:
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your Crohn's disease, your doctor may recommend one or more of the following:
New medications are in development and in clinical trial. If your Crohn's disease isn't well controlled with current medications, ask your doctor if there are clinical trials available to you.
If diet and lifestyle changes, drug therapy or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery.
During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. In addition, surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn's is strictureplasty, which widens a segment of the intestine that has become too narrow.
The benefits of surgery for Crohn's are usually temporary. The disease often recurs, frequently near the reconnected tissue or elsewhere in the digestive tract. Up to 3 of 4 people with Crohn's disease eventually need some type of surgery. Many will also need a second procedure or more. The best approach is to follow surgery with medication to minimize the risk of recurrence.
Screening for colon cancer may need to be done more frequently because people who have Crohn's disease that affects the colon have an increased risk of colon cancer. General colon cancer screening guidelines call for a colonoscopy every 10 years beginning at age 50. Ask your doctor if you need to have this test done sooner and more frequently.
Sometimes you may feel helpless when facing Crohn's disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up. If you think eating certain foods make your condition worse, keep a food diary to keep track of what you're eating as well as how you feel. If you discover some foods are causing your symptoms to flare, it's a good idea to try eliminating those foods. Here are some suggestions that may help:
Smoking increases your risk of developing Crohn's disease, and once you have it, smoking can make the condition worse. People with Crohn's disease who smoke are more likely to have relapses, need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Although stress doesn't cause Crohn's disease, it can make your signs and symptoms worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.
When you're stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.
Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:
Many people with digestive disorders have used some form of complementary or alternative therapy. Some commonly used therapies include:
Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care.
The majority of alternative therapies aren't regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don't need to prove it. In some cases that means you'll end up paying for products that don't work. For example, studies done on fish oil and on probiotics for the treatment of Crohn's haven't shown benefits to using these products. What's more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
Some people may find acupuncture or hypnosis helpful for the management of Crohn's, but neither therapy has been well studied for this use.
Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. An initial study on prebiotics had promising results. More studies are under way.
Crohn's disease doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. In some cases, you may barely be able to leave the house. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.
Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. You may also feel hampered by dietary restrictions or embarrassed by the nature of your disease. All of these factors — isolation, embarrassment and anxiety — can severely alter your life. Sometimes they may lead to depression.
Educate yourself, and connect
One of the best ways to be more in control is to find out as much as possible about Crohn's disease. Organizations such as the Crohn's and Colitis Foundation of America (CCFA) have chapters across the country to provide information and access to support groups. Your doctor, nurse or dietitian can locate the chapter nearest you, or you can contact the organization directly at 888-MY-GUT-PAIN (888-694-8872) or on its website.
Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you're going through.
Some people find it helpful to consult a psychologist or psychiatrist who's familiar with inflammatory bowel disease and the emotional difficulties that it can cause. Although living with Crohn's disease can be discouraging, research is ongoing and the outlook is brighter than it was a few years ago.
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