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Understanding Crohn's disease
INFLAMMATORY BOWEL DISEASE (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. It should not be confused with irritable bowel syndrome.
The main forms of IBD are Crohn's disease (CD) and Ulcerative colitis (UC).
Understanding Crohn's disease
What is Crohn’s disease?
Crohn’s disease is an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.
Other symptoms of Crohn’s include:
  • Loss of appetite
  • Rectal bleeding
  • Weight loss
  • Fever
  • Joint pain
  • Fatigue
  • Sores around the anal area
Some people may also develop fistulizing Crohn's, in which the intestinal wall develops fistulas or tunnels that connect the intestine to adjacent areas, including the skin, bladder, vagina, intestine, and perianal areas.

Conditions with similar symptoms

Sometimes other conditions can cause abdominal symptoms that appear to be similar to those of Crohn’s. These conditions include:
  • Intestinal tuberculosis
  • Ulcerative colitis
  • Irritable bowel syndrome
  • Appendicitis
  • Diverticulitis
  • Peptic ulcer disease
How is Crohn’s disease diagnosed?
An accurate professional diagnosis is the first step in treating Crohn’s. Proper diagnosis is particularly important with a condition like Crohn's, because its symptoms may mimic those of other conditions and its effects are chronic, progressing over time.
Diagnostic tests
To confirm his or her diagnosis — and to rule out other conditions that can cause similar symptoms, such as other inflammatory bowel diseases, colitis, celiac disease, or irritable bowel syndrome — your physician will probably perform a complete physical examination and order medical tests.
These diagnostic tests may include:
  • Blood tests: Although a complete blood count cannot provide a positive diagnosis of Crohn's, physicians usually order the test in suspected cases because it may reveal intestinal bleeding, an infection, or an inflammatory condition.
  • Radiologic examinations: These exams help your physician see inside your body to determine whether you have Crohn’s. Different types of tests include:

    • Barium enema: This test helps physicians visualize the colon and rectum.

    • Upper GI and small bowel follow-through:
      In this test, x-rays help examine the esophagus, stomach, duodenum, and small intestine after a patient drinks a barium-based liquid.

    • Enteroclysis:
      In this test, a tube is inserted into the nose and guided through the stomach to the duodenum, which is where the small intestine begins. A barium-based liquid is then infused through the tube, and x-rays are used to reveal abnormalities within the small intestine.

    • Computerized tomography (CT) scan:
      This extremely precise x-ray is used to detect abnormalities in the liver, kidneys, and intestines after a dye is ingested, administered intravenously, or inserted through the rectum.

    • Ultrasound:
      By using sound waves, this test examines organs of the pelvis and abdomen without exposure to radiation.

    • Magnetic resonance imaging (MRI):
      By using radio waves and superconducting magnets, this test can help detect fistulas and abscesses within a person’s body without exposure to radiation.

      Stool Tests: These noninvasive tests examine stool samples to determine whether a patient has Crohn’s disease, ulcerative colitis, or a bacterial infection.

      Urine Tests: Also called urinalysis, these tests are used to detect the presence of bacteria, red blood cells, and white blood cells in your urine. When bacteria and white blood cell levels are raised, it may indicate a urinary tract infection, which can be a complication of Crohn’s.

      Endoscopic Examinations: These tests use a tool called an endoscope — a thin, flexible, lighted tube that is linked to a computer and video monitor. In an endoscopic exam, the endoscope is inserted into the rectum, mouth, or small abdominal incision to give gastroenterologists a detailed view of the intestinal tract.
Different endoscopic exams may include:
  • Sigmoidoscopy: This test is the most commonly performed endoscopic exam used to confirm a diagnosis of Crohn’s. By using either a flexible or rigid instrument, a physician can evaluate the rectum and lower end of the colon for signs of inflammation.
  • Colonoscopy: This test examines the full length of the colon, as well as the lower part of the small intestine.
  • Upper endoscopy: In this exam, an endoscope is placed into a patient’s mouth and guided through the stomach to the upper intestine.
Although there is no cure for Crohn's, the sooner Crohn’s is diagnosed, the better chance you have of managing its symptoms and avoiding potentially serious complications of the disease.
Who treats Crohn’s disease?
In most cases, people with Crohn's disease are treated by a gastroenterologist.
Sometimes your gastroenterologist may be an internist or family practitioner.
What are the complications of Crohn’s disease?
The complications that Crohn’s patients experience depend on the location and severity of the disease. Some complications can be life threatening, while others are manageable with the help of treatment plans prescribed by a gastroenterologist.
Serious complications:
Crohn’s may cause serious complications, which can happen over the course of the illness:
  • Obstruction: Obstructions can occur when the intestinal wall swells inward, reducing the capacity for fluids to flow through the intestine.
    • A patient may experience painful cramps or vomiting due to food that is not able to bypass the obstruction.
    • Patients who experience an obstructive episode are usually hospitalized and given intravenous fluids and salts to compensate for fluid losses.
  • Fistula: Sometimes ulcers caused by Crohn's will channel through the gut wall to adjacent areas, including the skin, bladder, vagina, intestine, and perianal areas. These occurrences are known as fistulas and may require medical or surgical therapy.
  • Abscess: An abscess is a localized collection of bacteria that eventually accumulates pus and places painful pressure on adjacent tissues.
    • A fistula that tracks into the abdominal cavity may produce infection and form an abscess. Abscesses may also occur in the pelvic tissues or the perineum, if a fistula fails to drain.
    • Abscesses can be difficult for gastroenterologists to diagnose; however, after they are located, they should be drained. This may require surgery.
    • Patients are usually given a course of antibiotics to reduce the risk of further infection.
  • Free perforation: A free perforation is the formation of a hole in the bowel wall that allows intestinal contents to enter the abdominal cavity.
    • Signs of free perforation include sudden, severe abdominal pain, shock, and excessive abdominal tenderness.
    • The infection that results is called peritonitis and requires emergency surgery in which the leak is sealed and the abdominal cavity is cleansed to stop infection.
  • Hemorrhage: In rare cases, a bleeding ulcer may burrow through the gut wall and shear an artery. This produces a life-threatening hemorrhage that may require blood transfusions and special measures to promote blood clotting. Sometimes emergency surgery is required.
People with Crohn’s may experience chronic or long-lasting complications that require ongoing management:
  • Anemia: Anemia is a condition that results from lack of red blood cells.
  • Anemia in Crohn's may be the result of chronic blood loss; bone marrow depression; or failure to absorb iron and folic acid, which are important in stimulating the production of red blood cells.
  • Certain medications, such as sulfasalazine, may also exacerbate anemia. To combat most cases of anemia, gastroenterologists often prescribe supplements, and recommend a diet rich in iron.
  • Malnutrition: Malnutrition occurs when the body does not receive enough nutrients to grow and develop properly.
    • Loss of protein, tissue breakdown due to steroid use, poor diet and, in some cases, failure to absorb nutrients result in weight loss and nutritional deficiencies.
    • Gastroenterologists often prescribe nutritional supplements to avoid the complications that result from deficiencies in vitamins A, D, E, and K.
Currently, there is no cure for Crohn’s. In the meantime, the goals of treating Crohn’s are to suppress inflammation, enable healing of the intestinal lining, and relieve the symptoms of fever, diarrhea, and abdominal pain.
What are the current treatment options?
Currently available treatments for Crohn’s include:
  • Anti-inflammatory medication: Most people who have Crohn’s receive one or more different types of drugs designed to control inflammation. These may include sulfasalazine, other medications containing mesalamine (known as 5-ASA agents), and corticosteroids.
  • Immunosuppressive medication: These drugs block the body’s immune response, which leads to inflammation. Immunosuppressive medications used to treat Crohn’s include azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine.
  • Biologics: Infliximab (REMICADE) is the first agent approved for moderate to severe Crohn's disease in adults and children who haven't responded well to other therapies. This is useful for both inducing remission as well as maintenance of remission.
  • Antibiotics: Antibiotics, such as metronidazole and ciprofloxacin, may help heal abscesses and fistulas. Other antibiotics may be prescribed to treat bacterial growth in the intestine caused by obstruction or abscesses.
  • Antidiarrheal medication: Antidiarrheal medication offers some relief for the diarrhea that many people with Crohn’s experience. Loperamide, codeine, and even fiber powders can help alleviate symptoms.
  • Nutritional supplements: Nutritional supplements are helpful for people who lose calories and nutrients from diarrhea or decreased appetite. Supplements can help fuel the body and replenish iron, calcium, other minerals, and vitamins.
  • Surgery: If other treatments do not effectively control symptoms, your doctor may recommend surgery to close fistulas or remove the part of the intestine where the inflammation is most severe. Unfortunately, this procedure usually leads to only temporary remission of symptoms. The inflammation often returns near the area where the tissue was removed.
Some people may experience long periods of remission when they are free of symptoms. However, symptoms usually recur at various times over a person's lifetime. It is not possible to predict when a remission may occur or when symptoms will return. Because of the unpredictability of Crohn's, you may need medical care for some time..
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