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Crohn's Disease

By Apollo 24|7, Published on- 22 November 2022 & Updated on - 28 November 2022

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  • Symptoms: Diarrhoea, fever, fatigue, mouth sores, rectal bleeding, reduced appetite, abdominal pain and cramping, blood in stool, weight loss, pain or drainage near the anus due to inflammation or fistula, inflammation of the skin, joints, bile ducts, liver, or eyes, anaemia or iron deficiency, kidney stones, delayed growth and sexual development among children
  • Causes: Possible presence of a virus or bacterium, weakened immune system, environmental triggers, possible genetic causes
  • Risk Factors: Age, family history, ethnicity, smoking, and nonsteroidal anti-inflammatory medications such as ibuprofen, naproxen sodium, and diclofenac sodium
  • Severity: Mild to severe (with periods of remission with no signs or symptoms)
  • Which doctor to consult: Gastroenterologist

Overview

Inflammatory bowel disease is a type of chronic inflammation that takes place in the digestive tract. Crohn's disease is such a typical disorder that is common in the small intestine area. However, the problem can also affect the large intestine and upper gastrointestinal tract.

Usually, the symptoms of Crohn's disease are characterised by similar symptoms of ulcerative colitis. These include rectal bleeding, pain in the abdomen, diarrhoea, weight loss, and fatigue.

There can be five significant types of Crohn's disease, each with its own separate symptoms. These types are categorised based on which part of the gastrointestinal or GI tract the disease occur.

Ileitis is the most common type of Crohn's disease and occurs in the small intestine or ileum. It is known as ileocolitis when Crohn's disease occurs in the large intestine or colon, along with the small intestine.

Other types include jejunoileitis in the jejunum or middle part of the small intestine, gastroduodenal Crohn’s in the stomach and duodenum, and Crohn’s granulomatous colitis in the colon.

The severity of the illness can differ among people, ranging from mild symptoms in some to fatal complications in others.

There’s no cure available for Crohn's disease but if it is left undiagnosed, the symptoms can become severe. As a result, it can cause further obstructions due to recurring inflammation. Over time, the intestine can become thicker, narrowing the passages called strictures.

It is only by consulting a gastroenterologist that you can get the illness diagnosed. Also, there is no single test to confirm the presence of Crohn's disease, but stool examinations and blood tests need to be conducted.

When to Consult a Doctor?

On Symptoms

It is advisable to observe the early signs and symptoms of Crohn's disease to get diagnosed early. For instance, patients suffering from this illness tend to experience frequent flares. These are known as Crohn's flares and are some of the more prominent signs of the illness. These include bloating, constipation, and diarrhoea. However, an individual should consult a gastroenterologist for rectal bleeding and abdominal cramps, two of the most noticeable symptoms.

Other signs to notice include the following:

  • Consistent pain 
  • Fever with body temperature rising above 100.3-degree Fahrenheit
  • Vomiting
  • Bleeding from the rectum without noticing any blood in stools

After-Home Remedies

In some milder cases, patients can find relief using natural remedies at home. For example, natural herbal remedies and practising being mindful can help optimise the immune system. This can encourage the body to recover itself from the illness. However, it is essential to consult a healthcare professional about practising any such therapy along with medical intervention.

Regular Screening

Crohn's disease is usually more common among the younger population. This includes people currently in their late teens, 20s, and 30s. But the condition can occur at any age among men and women. Even young children are susceptible to the illness. However, heavy cigarette smokers run the highest risk of developing the disease. So, it is recommended to undergo screening like colonoscopy, every 1-2 years, especially for those having developed Crohn's disease in the past eight years.

Diagnosis

Preliminary Discussion

Physical examination is part of the initial diagnosis of Crohn's disease. It helps doctors understand the signs and symptoms better by listening to what the patient is experiencing.

The gastroenterologist will ask the patient about his/her medical history to understand the actual cause of such an occurrence. Other information on lifestyle, dietary practices, toilet habits, and whether he/she has undergone any surgery will further help in better diagnosis.

Physical Examination

After thoroughly discussing the medical condition and lifestyle practises, the doctor will opt for a physical examination. This includes checking for any signs of bloating in the abdomen.

The gastroenterologist may press a stethoscope on the abdomen to check for sounds. They will also tap or gently squeeze the abdomen area to find any signs of pain or tenderness. This helps the doctor determine the possibility of an enlarged liver or spleen.

Diagnostic Tests

  • Imagine Tests

The gastroenterologist can further recommend a visual examination to understand the condition. CT enterography is a type of CT scan that allows this. With the help of this special X-ray method, more details on the inside of the patient’s abdomen can be obtained. To do this, the patient is made to drink an oral contrast material to get intravenous contrast images of the intestine. Another method is magnetic resonance imaging or MRI, which sends radio waves to create a detailed visual representation. MR enterography also reduces radiation exposure compared to CT enterography. This is the reason an MRI is prescribed for younger patients.

  • Blood Tests

A blood test is necessary for diagnosing Crohn's disease. It helps the gastroenterologist determine the presence of anaemia in the body. The doctor can also examine any inflammation, the status of liver function, and the presence of any existing infection, like tuberculosis, before proceeding to treatment. A blood test is also necessary for realising the immunity status of the patient against infections.

  • Stool Studies

The doctor will also advise a stool test to determine the presence of any occult blood or organisms. A stool test also helps find bacteria or parasites that may cause infection.

Advanced Tests

  • Colonoscopy

In the case of Crohn's disease, the gastroenterologist may also prescribe a colonoscopy. This test provides a detailed view of the entire colon up to the very end of the terminal ileum. A thin and highly flexible tube, with a camera at the end, is entered into the GI tract. The doctor might even collect a small tissue sample from the area to send for biopsy analysis.

  • Capsule Endoscopy

A capsule endoscopy test requires an individual to swallow a capsule with a camera. This allows taking pictures of the small intestine from within while the patient wears a recorder on his/her belt. These images are then downloaded to a computer for further examination and to detect Crohn's disease.

  • Balloon-Assisted Enteroscopy

In some cases, the gastroenterologist may prescribe a balloon-assisted enteroscopy. In this test, a scope and an overtube are used that allows the doctor to view the bowel. A doctor prescribes this test to diagnose areas where the conventional endoscopes fail to reach. Doctors usually recommend this test when they notice some anomaly in the capsule endoscopy, but with questionable results.

Treatment

  • Home Care

An individual can try many home remedies to ease the signs and symptoms of Crohn's disease.

1. Probiotics

People with Crohn's disease may have an imbalance of the naturally good bacteria in their guts. Consuming probiotics can restore this balance. The doctor may prescribe food like "live culture" yoghurt, miso, and sauerkraut.

2. Prebiotics

Another substance that aids in the growth of helpful bacteria in the GI tract are prebiotics. Consuming foods like bananas, leeks, unions, and asparagus regularly can provide relief from Crohn's disease.

3. Fish oils

Fish oils are a popular source of omega-3 fatty acids. This substance is essential in healing many inflammatory diseases. Eating fish rich in omega-3, like salmon and herring, can benefit patients with Crohn's disease.

4. Resting the bowel

It might also do some good to go on a liquid diet and give the digestive system some rest. Depending on the severity of the condition, a doctor may prescribe drinking nutrient-rich fluids for up to a few weeks.

5. Aloe Vera

The gel found in the leaves of aloe vera is known for its anti-bacterial and antiseptic properties. Drinking juice made with the gel can solve many bowel problems as well. Aloe vera is also known to boost immunity and help people deal better with Crohn's disease. However, consuming it in large quantities can cause diarrhoea.

6. Yoga

Making lifestyle changes may be necessary if a person has been diagnosed with Crohn's disease. Investing some time for daily physical activities can help improve the condition. An individual can also perform yoga as it focuses on breathing and posture, which significantly helps the body relax and prevents illness from flaring up.

  • Medication

If these natural remedies fail to bring about any positive outcome, the doctor may suggest medication. Although there is no permanent cure for this life-long problem, medicines can significantly ease the symptoms. Common medications for Crohn's disease are vedolizumab, infliximab, ustekinumab, adalimumab, risankizumab, and certolizumab pegol.

  • Surgical Treatment

Even after making dietary and lifestyle changes if the medications fail to relieve symptoms, the doctor may prescribe surgery. This is not uncommon, as most patients of Crohn's disease have undergone at least one surgery in their lifetime due to the illness.

Now there are quite a few surgical treatments available for dealing with Crohn's disease.

  1. Strictureplasty: Once diagnosed, the gastroenterologist may suggest a surgical procedure like strictureplasty. This method widens the gap between the intestine, preventing blockages. But in this procedure, no part of the intestine is removed.
  2. Fistula removal: A common issue associated with Crohn's disease is developing a fistula, which creates further complexities in the treatment. If medication doesn't offer relief, surgically removing the fistula is the only way. This also helps prevent fistula formation between the intestine and skin, bladder, and vagina.
  3. Colectomy: The gastroenterologist may remove the colon in case of severe Crohn’s flare. Colectomy is the procedure to do this while leaving the rectum intact.
  4. End Ileostomy: The doctor can perform end ileostomy, a type of proctocolectomy, to redirect the small intestine. The intestine is rerouted through a stoma or small hole in the belly. The waste from the body is stored outside in an ostomy bag.
  5. Bowel Resection: If the small or large intestine gets severely damaged due to Crohn's disease, the doctor can perform bowel resection. This surgical method removes the damaged parts, and then the healthy ends are connected.
  6. Abscess Drainage: In this case, a surgical gastroenterologist cuts into the infected belly, anus, or pelvis, and inserts a tube in the area to drain the pus from the body.
  7. Ileostomy: This method allows the doctor to redirect the route of the stool as either a temporary or permanent solution. In both cases, the patient gets sufficient time for the intestine to heal. As the inflammation is reduced, another surgery may be done on the anus or rectum. The stool is stored in an ostomy bag connected to the anus.

Risk and Complications if Left Untreated

  • Ulcers and Fistulas

When left untreated, Crohn's disease can cause ulcers in the open sores in the GI tract. These can occur not just in the anus but also around the mouth and genitals. These ulcers can further aggravate and form a fistula. The most common kind of fistula occurs near the perianal area.

  • Bowel Obstruction

Crohn’s disease can also alter the thickness of the wall within the intestine. This is a common problem among patients with the illness. As the bowel becomes narrow, it blocks the flow of the digestive contents and may require surgery.

  • Anal Fissure

Crohn's disease can also cause infections in the anus, causing small tears in the tissue lining the area. As a result, people suffering from the illness may experience painful bowel movements.

  • Colon Cancer

Suffering from Crohn's disease, in the long run, makes the patient more vulnerable to colon cancer. This is why such patients are recommended a colonoscopy every ten years once they reach the age of 45. Those whose colon has been primarily affected by Crohn's disease need to undergo a colonoscopy every 1-2 years.

Additional Information

  • Stages of Crohn’s disease

Crohn’s disease is a progressive illness that has many stages, like:

  1. Mild
  2. Gradual progress
  3. Moderate
  4. Severe

Early detection, diagnosis, and treatment are the only ways to prevent it from getting worse.

  • Effect of stress on Crohn’s disease

Stress is not directly a cause of Crohn's, but it can indeed worsen the condition, with occasional flare-ups. While treatment can provide remission to the pains, avoiding these flair-ups can be difficult under stress.

So, learning to control stress can help reduce these painful experiences. Moreover, it can help an individual maintain the emotional, mental, and overall physical health.

  • Effect of smoking on Crohn’s disease

When assessing the common causes of Crohn's disease, smoking seems to be one of the most significant factors that need mentioning. Smoking doesn't just cause Crohn’s, but many inflammatory bowel diseases. Also, smoking regularly can impact Crohn’s disease, increasing the risks.

Smokers may need immunosuppressants and steroids and even have to undergo multiple surgeries. So, smoking cessation can be a major factor in improving the condition of Crohn's.
 

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Frequently Asked Questions

Having intestinal obstruction is one of the most common complications due to Crohn's disease. As the passage within the colon narrows down, it results in blockage of bowel movements. In medical terms, this is called the narrowing of the strictures. Patients can also suffer from kidney stones due to Crohn’s, as it disrupts the natural absorption of fat.

No, Crohn’s disease is a life-long health problem that does not go away on its own. Once diagnosed, patients may experience occasional remission, but flare-ups can occur at any time, causing tremendous pain. It can worsen over time without medical intervention, giving birth to numerous other severe complications. So, medication and surgery by a medical professional may be required to keep the problems at bay.

The answer can be no and yes! Although Crohn’s itself is not a fatal illness, it can cause other complications which may be. Only a licensed gastroenterologist can diagnose the severity and location of the disease to examine the complications. So, you must be diagnosed at the earliest to prevent any fatal conditions from developing.