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Crohn's Disease

Crohn's disease is one of the two most common forms of inflammatory bowel diseases. This condition causes inflammation that can occur anywhere in the digestive tract, from the lips to the anus. This is different than ulcerative colitis in that UC only occurs in the colon. Also, Crohn’s inflammation is different from UC inflammation as UC only causes inflammation on the inside surface of the colon, a thin layer known as the mucosa; Crohn’s disease, on the other hand, can cause inflammation that goes through the thickness of the bowel wall. Another difference is that the areas of inflammation in Crohn’s can appear in patches throughout the intestines with patches of healthy intestines in between; UC spreads in connected portions of the intestines. 

Crohn’s can happen to anyone, even if you have no family history of the disease. It is most common in developed countries, however, and among certain groups, including those who are of Jewish descent and Caucasians; about 700,000 Americans have been diagnosed with the disease. If you do have a relative with either Crohn’s disease or ulcerative colitis, you have an increased risk of developing either disease. The most common time of life for the diagnosis to occur is between the ages of 15 and 35; that said, there has been an increase in the number of pediatric patients, with about 10 percent of patients being diagnosed before the age of 18. 

Symptoms of Crohn's Disease

Generally, the symptoms of the disease include abdominal pain that can range from persistent cramps to sharp, localized pains; a change in bowel movements, such as diarrhea or constipation; blood in the stool, the color of which depends upon where it is released in the intestines and ranges from bright red to black; vomiting; nausea; lack of appetite; fever; fatigue; painful abscesses and resulting fistulas (abnormal channels that develop between the intestine and other internal organs or the intestines and the skin); and weight loss. 

The disease can also affect other areas of the body such as the eyes, the kidneys, the liver, the joints, the gall bladder and the skin through related conditions. Because of this, occurrences such as strange bumps on the skin, a reddened or itchy eye, kidney stones, gallstones, swollen and painful joints can at times be related to Crohn’s. Usually, these conditions are present only when the disease is active, less so when the disease is in remission.

There is no known cause of Crohn’s disease. It has been thought in the past that stress or certain foods could cause the condition. While stress can make any condition worse, it does not cause Crohn’s. Certain foods – including fatty or fried foods, high-fiber items, carbonated beverages – can make symptoms worse but have not been found to cause the condition.

Instead, scientists believe that the condition is caused by a combination of genes, environmental factors and immune systems that react inappropriately by attacking the intestines. For now, there is no cure for the condition.

Diagnosing Crohn's Disease

Crohn’s symptoms are different depending on where the disease is located along the digestive tract. For some, the first sign will be mouth ulcers or swollen joints. For others, bloody diarrhea or unexplained fevers become bothersome and lead them to the doctor. In pediatric patients, a lack of normal growth could be a point of concern.

There are several tests that can be used to determine whether the condition is Crohn’s disease. Doctors may do blood tests to check for inflammatory markers in the blood or to rule out glutten intolerance. Radiology tests, such as a small bowel X-ray series or a CT scan, may be ordered. Sometimes, a patient is required to have endoscopic procedures such as swallowing a tiny camera pill or having a colonoscopy, the latter of which is usually confirmed with pathological findings from a biopsy.  

In a small percentage of patients, it is difficult to tell if the inflammation is related to Crohn’s disease or ulcerative colitis. As the diseases are treated with similar drugs, this usually is not an issue. If a patient develops inflammation that burrows through the bowel wall, develops and abscess or fistula or begins having small bowel symptoms, the diagnosis usually becomes Crohn’s disease.

Treatment of Crohn's Disease

In the past two decades, the science of medically treating Crohn’s disease has advanced rapidly. Where steroids and sulfa drugs used to be the mainstay of treatment, gastroenterologists now rely on sophisticated biologic medications, drugs that suppress the immune system, targeted steroids and new generations of salicylates to reduce or eliminate symptoms. You can learn more about these medications here.

The good news about these medications is that they have helped more people with Crohn’s go into remission and stay in remission. However, the majority of Crohn’s patients will require surgery, especially when medical therapies fail to control the disease, when scar tissue causes blockages in the intestines, when a fistula occurs or when cancer develops.