Crohn's Disease
Published on March 3rd, 2021. Information will be updated
Crohn’s disease is an inflammatory bowel disease (IBD) that causes inflammation in the gastrointestinal tract (GI tract). The rash is usually located at the bottom of the GI tract, but it can happen anywhere else in the digestive system. If this disease is not treated, there will be severe to life-threatening complications as Crohn’s disease develops.
Causes
The cause of Crohn’s disease is unknown because researchers debunked that the cause of Crohn’s disease was diet and stress. However, there are broad causes that any other illness could have. One of the reasons is the abnormal response from the immune system. When the immune system is fighting a foreign substance or microorganism, an unusual immune response makes the cells attack the digestive system. Therefore, viruses and bacteria can be a cause of Crohn’s disease. Another reason is heredity which is common in other conditions as well. However, most people (4 in 5 people) with Crohn’s disease don’t have a family history of the disease.
Risk Factors
The risk factors are comprehensive but limited solely on lifestyle changes—risk factors such as age, ethnicity, family history, cigarette smoking, and nonsteroidal anti-inflammatory medications will increase Crohn’s disease. This disease can occur at any age, but the younger the period, the higher the risk; most people get diagnosed with Crohn’s disease before 30. Whites, mostly of Eastern European Jewish descent, are at the highest risk for developing Crohn’s disease. Although family history isn’t a severe risk factor, 1 in 5 people who have Crohn’s disease has a family member who has it as well. The most controllable risk factor is cigarette smoking because smoking makes the disease progress quickly. Lastly, nonsteroidal anti-inflammatory medication will make Crohn’s disease worse because these medications inflame the bowel.
Signs and Symptoms
Crohn’s disease affects the colon and the ileum (the last part of the small intestine) for the symptoms. These symptoms may come and go depending on the severity of this disease (also known as remission and relapse). Symptoms such as diarrhea, fatigue, fever, abdominal pain or cramping, blood present in stool, mouth sores, reduced appetite, weight loss, and pain or leakage in the anus can occur in Crohn’s disease. People with severe Crohn’s disease may have symptoms like kidney stones, iron deficiency, delayed growth in children, and inflammation of the skin, eyes, joints, liver, or bile ducts.
Diagnosis
There is not one fixed diagnosis for Crohn’s diseases because several tests are needed to eliminate other causes for the symptoms above. Lab tests such as blood tests and stool studies are used to find iron deficiency in the blood and parasites in the stool respectively. Procedures such as colonoscopy, CT scan, MRI, capsule endoscopy, and balloon-assisted enteroscopy is used to confirm the diagnosis of Crohn’s disease. Colonoscopy is used to view the entire colon and the end of the ileum which can identify whether or not there are granulomas (inflammatory cells) present. CT scan is used to look at the bowel in detail. MRIs are used to create images of organs and tissues which will help identify a fistula around the anus or in the ileum. Capsule endoscopy is a procedure where the patient swallows a pill with a camera in it to take pictures of the small intestine. The camera will exit out in the stool painlessly, but it’s not advised if the patient has bowel obstructions. As an alternative to capsule endoscopy, balloon-assisted enteroscopy is taken where the physician looks into the small bowel.
Treatment
Unfortunately, there is no cure for Crohn’s disease, so they treat the inflammation to reduce the signs and symptoms. Medications such as anti-inflammatory drugs, immune system suppressors, biologics, antibiotics, and more are used to reduce the symptoms and prevent further complications. Anti-inflammatory drugs are used if the disease recently developed, but these drugs don’t usually work. Immune system suppressors are used to reduce inflammation, but also target the immune system by producing bodily-made chemicals that can cause inflammation. Therefore, doctors must advise the patients to take the amount recommended by the doctor. Biologics such as Tysabri, Remicade, and Stelara target the immune system. Tysabri is one of the most dangerous drugs to be taken because it can cause a severe brain disease called progressive multifocal leukoencephalopathy which will lead to either death or a severe disability. Remicade is used to suppress the tumor necrosis factor (TNF) and later decrease inflammation. Stelara is a relatively new treatment for Crohn’s disease, so clinical trials must be done to continue producing this medication to patients. Antibiotics will reduce the amount of leakage from fistulas around the anus if patients have this symptom.
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If the patient refuses to take medications, then home remedies and/or lifestyle changes are an alternative and the best kind of treatment. It is recommended that the patient limits dairy products, eat 5-6 small meals, drink a lot of liquids, and eat multivitamins. If the patient is lactose-intolerant, tell the patient to limit drinking or eating dairy products because that will interfere with the digestive system. The patient should eat small meals around 5 times a day if he/she has symptoms of weight loss or lack of appetite. For all patients, water is essential to the body, and it won’t disturb the digestive system compared to beverages such as alcohol, coffee, and soda. Lastly, multivitamins should be taken if the patient is losing nutrients; supplements are also good to take.
Complications
If Crohn’s disease is not treated, complications are more likely to occur. Sadly, there are many complications, and if patient’s don’t get diagnosed soon, severe complications would occur. Some common complications are bowel obstruction, ulcers, fistulas, anal fissure, and malnutrition. Bowel obstruction is when the bowel scars trap digestive enzymes or other contents, so part of it must be removed. Ulcers might occur in the GI tract, mouth, anus, or even in the perineum. Fistulas are the developed version of ulcers where they are sticked to the wall of the intestines. Lastly, anal fissure is where there is a tear in the anal tissue in which infections can originate.
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Resources
Crohn’s disease - Symptoms and causes. (2020, October 13). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304#:%7E:text=Crohn’s%20disease%20is%20a%20type,digestive%20tract%20in%20different%20people.