Patient Education Patient Information

img-responsive

Patient Education

Crohn’s Disease

What is Crohn’s Disease?

Crohn’s disease is a chronic illness that affects the intestine (bowel).  In patients with Crohn’s disease, the bowel becomes inflamed which can cause fatigue, diarrhea, and abdominal pain. Together with ulcerative colitis, they make up a group of conditions called inflammatory bowel disease.

There is no cure for Crohn’s disease, but some treatments can significantly reduce symptoms.  This allows many with Crohn’s disease to live symptom-free for long periods of time.

Crohn’s Disease

Crohn’s Disease compared to Ulcerative Colitis
Crohn’s Disease compared to Ulcerative Colitis

Crohn’s Disease Symptoms

Crohn’s disease can affect different parts of the digestive tract for each patient.  The most common areas are the ileum and the colon. The ileum is the last part of the small intestine and the colon is the last part of the large intestine.

Symptoms of Crohn’s disease can vary from patient to patient and can be mild to severe.  Symptoms often come on gradually but could develop quickly without warning in some patients. Some may experience extended periods of times without symptoms.  This is known as remission.

Symptoms of Crohn’s disease include:
  • Abdominal pain / cramping
  • Fatigue
  • Diarrhea
  • Fever
  • Bloody stools
  • Mouth sores
  • Appetite or weight loss
  • Pain, discharge, or bleeding from the rectum
In severe cases, Crohn’s disease symptoms may include:
  • Eye, skin, or joint inflammation
  • Inflammation of the liver or bile ducts
  • Delayed growth and puberty in children

Crohn’s Disease Causes

The exact cause of Crohn’s disease is unknown. What is known is that the disease tends to run in families and affects certain groups more than others, suggesting that genetic factors are important.  However, many people with Crohn’s disease do not have a family history.

Crohn’s Disease Diagnosis

The signs and symptoms of Crohn’s disease are similar to more common illnesses.  Your doctor will only diagnosis Crohn’s disease after ruling out other causes of your symptoms.  Because there is no single test for Crohn’s disease, your doctor will use a combination of tests and procedures to confirm the diagnosis.

Blood Tests
  • Test for Anemia – Blood tests can look for anemia, a condition in which the blood doesn’t have enough healthy red blood cells.  Doctors look for a high white blood cell count which can indicate inflammation or infection in the body.
  • Fecal Occult Blood Test (FOBT) – Doctors will test a stool sample for microscopic or invisible blood.
Procedures
  • Colonoscopy – A long flexible tube with a camera is placed through the rectum and large intestine.  This allows your doctor to inspect the entire colon and the end of the ileum (terminal ileum).  Small tissue samples (biopsies) may be removed for further testing. If small bunches of inflamed tissue (granulomas) are present, it can help confirm a Crohn’s diagnosis.
  • CT Scan – A special type of X-ray that produces higher quality images.  A CT Scan allows the doctor to inspect the entire bowel and surrounding tissues.
  • MRI – Magnetic Resonance Imaging uses a powerful magnet to create detailed images of the bowel and surrounding tissues and organs. MRI is helpful in evaluating fistulas in the small intestine or anal area.
  • Capsule Endoscopy – A tiny wireless camera travels through your digestive tract and takes pictures. The capsule is similar in size to a vitamin and is swallowed. As the capsule works its way through the digestive tract, thousands of images are transmitted to a recorder you wear around your waist.  Your doctor will then look for signs of Crohn’s disease among the images.

Patients who have not responded to “first line” therapy with drugs such as antibiotics, sulfasalazine, and 5-aminosalicylates, particularly those who depend upon steroids to control symptoms. These drugs are also very helpful for maintaining remission.

Immunomodulator drugs take a long time (three to six months) to produce a maximal effect and are often prescribed for long-term therapy. The major side effects of these drugs include lowering of the white blood cell count (the cells that help fight off infection in the body), hepatitis (inflammation of the liver), and pancreatitis (inflammation of the pancreas). As a result, blood testing is performed regularly to monitor for these side effects.

Crohn’s Disease Treatment

Treatment of Crohn’s disease will vary depending on the location of the disease and the severity. Crohn’s can go into remission on its own, making it difficult to know for sure if a particular treatment is working.

The goal of treating Crohn’s is to reduce inflammation and manage symptoms like pain, fever, and diarrhea.  Over time, treatment can help improve long-term prognosis by reducing the chances of complications.

Medications

Usually the first step in inflammatory bowel disease treatment. Doctors may prescribe one or more of the following: corticosteroids, antibiotics, anti-inflammatories, antidiarrheals, pain-relievers, and immune-suppressing medications.

Surgery

Surgery is often seen as a last resort since medical treatment often controls the symptoms and complications of Crohn’s.  Surgery does not cure the disease, but it may be the fastest way to restore health in some patients. It’s used most often to close fistulas, bypass obstructions, stop bleeding, or remove part of the intestine.

Even though surgery can improve the health and wellbeing of patients, it does not cure Crohn’s.  The chance of recurrence is high. Over 85% of patients have no symptoms in the year following surgery.  Up to 20% of patients have no symptoms 15 years after surgery. Use of medication after surgery can decrease the risk of recurrence

Lifestyle

Maintaining a healthy lifestyle can help reduce the symptoms of Crohn’s disease and extend the period between flare-ups.  It’s important to maintain a healthy lifestyle even when Crohn’s disease is in remission.

The lifestyle changes that make the biggest impact are exercising regularly, eating a healthy diet, and quitting smoking.

Crohn’s Disease Diet

The foods you eat aren’t believed to cause inflammatory bowel disease, but some foods and beverages may aggravate your symptoms.

You may consider creating a food diary to keep track of your diet and how you feel.  Some foods may cause symptoms to flare-up, and tracking can make it easier to identify those foods and eliminate them.

Crohn’s disease diet recommendations
  • Avoid Problem Foods – Caffeine, alcohol, and spicy foods may make symptoms worse.
  • Reduce Dairy – Those with inflammatory bowel disease often see declines in abdominal pain, gas, and diarrhea when they limit or eliminate dairy products.  This could be a sign of lactose-intolerance, which means your body has trouble digesting the sugar in dairy products (lactose).
  • Avoid High Fat Foods – Those with Crohn’s disease in the small intestines may not digest fat normally.  Instead of absorbing fat, it passes through your system which can worsen diarrhea. Fried foods, cream sauces, and butter all have high-fat content.
  • Limit Fiber (if necessary) – Fresh fruits, vegetables, and whole grains are part of a healthy diet but can cause discomfort in some people with inflammatory bowel disease.  Steaming or baking vegetables may help reduce symptoms.
  • Avoid Large Meals – Some patients find eating five to six smaller meals a day make them feel better than if they eat the traditional two or three times a day.
  • Drink More Water – Fluids are an important part of digestion, and water is the best choice.
  • Visit a Dietitian – If your diet is too limited or you lose weight unintentionally, visit with a registered dietitian.  GCSA as a registered dietitian on staff – learn more.

Other Crohn’s Disease Treatments

Reduce Stress

Stress doesn’t cause Crohn’s disease, but it can make symptoms worse and can trigger flare-ups.  It’s not reasonable to avoid all stress, but there are ways to help manage it:

  • Exercise – Even mild physical activity can help reduce stress, depression, and aid digestion / bowel function.  Your doctor can help recommend what exercise is most appropriate for you.
  • Relaxation, Breathing, or Meditation Exercises – Deep, slow breathing can decrease stress and anxiety.  Instructional videos on meditation and breathing exercises can be found for free on YouTube. Some may prefer a more social setting like a Yoga class.

Crohn’s Disease Complications

Some of the potential complications of Crohn’s disease include:

  • Ileitis
  • Ileocolitis and colitis
  • Malnutrition
  • Bone complications (like osteoporosis)
  • Liver Inflammation
  • Gallstones
  • Colorectal cancer
  • Skin conditions
  • Eye inflammation
  • Mouth sores
  • Perianal complications (fissures, ulceration, fistulas, abscesses, stenosis)

Clinical Trials

For clinical trials in Crohn’s disease, please visit www.clinicaltrials.gov.


© 2019 Gastroenterology Consultants of San Antonio. Accredited by the Association for Ambulatory Health Care, Inc. All Rights Reserved.
San Antonio Website Design & Development - Backyard Studios