Crohn’s Disease

By Elizabeth A. Bowers, FNP-BC

What is Crohn’s disease?

Crohn’s disease is an ongoing disorder which causes inflammation of the digestive tract.  It can affect any area of the GI tract, from the mouth to the anus, but is most common at the end of the small bowel (ileum) and the beginning of the large intestine (colon). The damaging inflammation resulting from Crohn’s may cause pain and may make the intestines empty frequently, resulting in diarrhea and other Crohn’s disease symptoms.  It is one of the inflammatory bowel diseases.

Crohn’s disease symptoms are similar to those of other intestinal disorders, such as ulcerative colitis or UC.  Because of this, Crohn’s may be difficult to diagnose. UC, which affects only the large intestine (colon and rectum), Crohn’s can affect the entire digestive tract, with normal, healthy bowel found between sections of diseased bowel. Crohn’s disease affects men and women equally.

Up to 20% of people with Crohn’s have a blood relative with some form of  inflammatory bowel disease.  Crohn’s disease can occur in people of all age groups, but it’s more often diagnosed in people between the ages of 15 and 35.  In addition, more Caucasians than people from other racial groups develop Crohn’s.

What are Crohn’s disease symptoms?

Crohn’s disease symptoms can vary over time and from person to person depending on what part of the gastrointestinal tract is inflamed. Because of it’s location, symptoms may include diarrhea, cramping, or abdominal pain. Potentially if inflammation occurs in the stomach and the first part of the small intestine, loss of appetite, weight loss, and nausea may occur.

Crohn’s disease symptoms may come on suddenly and without warning. It is unpredictable. Just when you think you understand your symptoms, they may change in severity, or change altogether. You may also go through periods of remission with few or no symptoms. Then suddenly, you may have periods of flare-ups with symptoms such as persistent diarrhea, fatigue, or fever. Studies show people with active disease causing inflammation in the tube of the intestine, have a 70% chance of recurrent symptomatic flare during the next year.1

Painful flare-ups occur when the lining of your intestines swells and thickens, obstructing normal movement through your digestive tract.

Potential complications may occur with Crohn’s disease. Along with painful symptoms, Crohn’s disease can lead to complications, including obstruction of the intestines, and the formation of scar tissue.  Other potential complications of Crohn’s include the formation of fissures (small cuts or tears in the anal canal, which may bleed), abscesses (localized infection or collection of pus), and fistulas (abnormal tunnels that form between two structures of the body). You may experience other symptoms, including joint pain, skin lesions or eye inflammation.

What are the causes of Crohn’s disease?

While its exact causes are unknown, what is known is that Crohn’s disease is a chronic, or ongoing, inflammatory disease of the digestive tract.  It appears to be a result of a complex combination of factors, including: genes, your immune system and environmental factors.  Foreign substances in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce inflammation that continues without control. Crohn’s is believed to be an overreaction of the immune system.  Researchers believe people with Crohn’s experience an overactive immune response. As a result, damaging inflammation occurs in the digestive tract and leads to Crohn’s symptoms.

How is Crohn’s disease diagnosed?

A combination of tests may be needed for a Crohn’s disease diagnosis. The symptoms of Crohn’s disease can be similar to those of other illnesses.  To fully evaluate and identify Crohn’s disease, your medical provider may run one or more of the following tests including:

  • Blood Work- where blood samples are tested for anemia or signs of inflammation
  • Stool Tests- to analyze for signs of bleeding, and infection by bacteria, virus, or parasites
  • Barium X-ray-when you drink or have an enema with barium to allow internal organs to be seen clearly on an X-ray
  • Colonoscopy- a procedure using a small tube to view the rectum and the intestines
  • Biopsy- tissue sample of any inflamed area taken for lab analysis
  • Computerized Tomography (CT)- a procedure utilizing computer imaging and X-ray scanning
  • Video Capsule Endoscopy- a pill with a camera is swallowed to examine the small intestine.

Crohn’s Disease Treatment

Crohn’s medication-  fortunately today, there are a wide range of treatment options available. The goals of medical management are controlling inflammation that triggers your symptoms, achieving remission which is defined as few or no symptoms and maintaining remission which is keeping symptoms from returning for longer periods of time.

There is no cure for Crohn’s disease, but there are medications available to treat the disease.  The following are the 5 categories of medications to treat Crohn’s disease:

  • Antibiotics
  • Aminosalicylates (5-ASAs)
  • Corticosteroids
  • Immune modifiers (immunomodulators)
  • Biologic therapies (biologics)

Depending on your Crohn’s disease symptoms, your doctor may recommend OTC medicines for you, such as:

  • Antidiarrheals
  • Pain relievers
  • Nutritional supplements

Crohn’s disease surgery- people with Crohn’s may require surgery at some point to clear an intestinal blockage, repair damage to the intestines, or treat symptoms that may not have been controlled.

Crohn’s diet and nutrition

There’s no evidence that what you eat actually causes Crohn’s. But some foods and beverages can aggravate your Crohn’s symptoms. This is why you may want to talk to your doctor about making certain adjustments to your diet. While everyone is different, when your Crohn’s disease is active, certain foods may cause more discomfort than others.

Here are a few suggestions that could help:

  • Limit dairy products
  • Try low-fat foods
  • Experiment with fiber
  • Consider taking multivitamins
  • Avoid “gassy” foods
  • Eat smaller meals
  • Drink plenty of liquids

Turn a nutritious diet into a delicious meal.  Poor absorption and loss of appetite often associated with Crohn’s disease may deprive your body of essential nutrients. If you’re not getting proper nutrition or not absorbing nutrients, malnutrition may occur.  Because of this eating a nutritious diet is essential. But that doesn’t mean you have to eat only steamed vegetables for the rest of your life. You might want to consider exploring recipes and try to identify the types of foods that work well for you. Plus, consider tracking what you eat in a daily food diary.

Resources for Crohn’s disease