Crohn's Disease

Basic Information

Crohn's disease, known as ileitis or regional enteritis, is a chronic inflammation of the intestines. Crohn's disease is generally progressive and its cause is unknown. If Crohn's disease continues for years, it can cause a gradual deterioration of bowel functioning.

Inflammation occurs in all the layers of the small or large intestine, nearby tissues and lymph nodes. The inflammation can cause holes and sores in the bowel walls. The sores and swollen areas may thicken and eventually block the intestines. The large intestine is inflamed in 65% of the people and the small intestine is inflamed in 35% of people with the disease.

Although Crohn's disease is relatively rare, occurring at a rate of 1 per 50,000 persons, the incidence is increasing. A typical patient is white and between the ages of 15 and 35. Heredity or environmental influences may play a role in the development of Crohn's disease because almost 1 of every 20 patients has a relative with either Crohn's disease or ulcerative colitis.

Symptoms

Symptoms of Crohn's disease include:

abdominal pain or cramping
diarrhea
fever
fatigue
weight loss
rectal fistula (abnormal opening at or near the anus)
rectal fissure (a painful crack in the mucous membrane of the anus).

The diarrhea can be debilitating and cause malnutrition. Episodes of abdominal pain, reflecting bowel obstruction, may even prohibit eating to avoid discomfort. The ability to absorb adequate nutrients often is limited in people with Crohn's disease, particularly if the disease affects significant portions of the small bowel or if the portions of the small bowel have been removed surgically. It is not uncommon for persons with Crohn's disease to have a deficiency of Vitamin B12, which is absorbed in the lower segment of the small bowel.

The complications of Crohn's disease are varied. Progressive obstruction, particularly of the small bowel, is the most common reason for surgical treatment. Obstructive symptoms generally develop gradually over a long period of time. Fistulas and fissures in and around the anal and rectal areas are also common. Often, the progressive obstruction, the inflamed mass of tissue, or the fistula do not respond to medical therapy and may require surgery. Perforation of the bowel or massive bleeding is rare. It is not uncommon to have symptoms unrelated to the bowel including arthritis, particularly of large joints, or inflammation of the eye or skin.

Diagnosis/Treatment

To diagnose Crohn's disease, the physician will review your symptoms and examine you. After an examination, the physician may want X-rays of the digestive tract, using a barium upper gastrointestinal examination and a barium enema. An endoscopy may be needed to locate the inflamed areas. The exam usually includes a sigmoidoscopy or colonoscopy (a procedure that uses a scope to view the inside of your intestine or colon). Often the doctor will take a small piece of bowel tissue for testing. . Samples of blood and stools may also be taken.

There is no cure for Crohn's disease. The best treatment is frequent checkups with your doctor to control the disease. In most cases treatment with diet, rest, and drugs eases attacks of Crohn's disease. Among the medications used are analgesics, antispasmodics, antidiarrheals, vitamin supplements, and drugs to reduce inflammation.

If Crohn's disease is aymptomatic or in remission, treatment may be unnecessary. If the symptoms are mild, perhaps involving several loose stools per day, the physician may prescribe an antidiarrheal pill or a bulk former. If the disease is more active, the physician may consider anti-inflammatory medications such as sulfasalazine and corticosteroids. Sulfasalazine is particularly effective if the colon is involved. If the inflammatory process is confined to the rectum, a corticosteroid enema may be useful in suppressing the inflammation and alleviating symptoms. Corticosteroids are reserved for more significant flare-ups of the disease in both the colon and small bowel. Metronidazole may be effective, particularly if there is evidence of fistulas or fissures in the anal region. Anti-inflammatory agents are used to provide relief from symptoms. The physician may advise replacement of certain vitamins or minerals if there is evidence of a deficiency

Limit or avoid food additives and stimulants such as caffeine (coffee, tea, or chocolate). Avoid eating or drinking milk products. Enzyme supplements may help if you develop intolerance to lactose (a sugar in dairy products). Ask your doctor if you should reduce the amount of roughage in your diet. If there is diarrhea, avoid certain foods that have a laxative effect, such as raw fruits, vegetables, and concentrated fruit juices. You can rest your bowel by not eating solid foods for a while. Drink clear fluids frequently during the day such as electrolytes or rehydrating fluids. It is important to drink often so that you do not become dehydrated. When an attack of diarrhea is over, eat small frequent meals. Then, return to your normal diet gradually.

If you have cramps or abdominal pain, it may help to put a hot water bottle or electric heating pad on your abdomen. If the disease is not kept under control, sores, tears, or abnormal openings in and around your intestines may develop. In that case you may need surgery. Approximately 70 % of patients with Crohn's disease require at least one operation. Although surgical treatment may alleviate the symptoms for several years, it is not a cure and a recurrence of the disease is very common. In people with disease limited to the colon area, the removal of the large intestine may be recommended, particularly, if medical treatment fails. In this operation (an ileostomy), the entire colon, rectum, and anus are removed and the end of the ileum (the last section of the small intestine) is brought out through the abdominal wall for the passage of stool. A pouch into which the stool is evacuated is worn over the opening. When the disease is limited to the small intestine, surgery typically involves removing of the diseased segment of the bowel and rejoining the two ends of the healthy intestine.

Self-Care

It is important to follow the doctor's directions. Inform your physician if the symptoms persist or if you develop new symptoms. The following suggestions are helpful:

Follow the full course of treatment your doctor prescribes.
Be aware of the possibility of the symptoms returning. Otherwise a recurrence may make you feel discouraged, anxious, fearful, or tense.
Develop a healthy, positive attitude.
Learn to use relaxation techniques including mental imaging, muscle relaxation exercises, and deep breathing.
Talk with a mental health professional about how to manage events in your life that trigger anxiety.
Develop a positive support system (family, friends) for discussing the normal stresses of daily life.
Follow a balanced, nutritious diet, but avoid raw fruits, vegetables, and milk products.
Exercise 20 minutes at least three times a week.
Try to rest even if you cannot sleep.
Make time each week for recreation.