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Crohn's disease


Alternative Names:

Inflammatory bowel disease - Crohn's disease; Regional enteritis; Ileitis; Granulomatous ileocolitis; IBD- Crohn's disease

Causes:

The exact cause of Crohn's disease is unknown. It occurs when your body's immune system mistakenly attacks and destroys healthy body tissue (autoimmune disorder).

When parts of the digestive tract remain swollen or inflamed,  the walls of the intestines become thickened.

Factors that may play a role in Crohn's disease include:

  • Your genes and family history (People of Jewish descent are at higher risk.)
  • Environmental factors
  • Tendency of your body to over-react to normal bacteria in the intestines
  • Smoking

Crohn's disease may occur at any age. It most often occurs in people between ages 15 - 35.

Exams and Tests:

A physical exam may show a mass or tenderness in the abdomen, skin rash, swollen joints, or mouth ulcers.

Tests to diagnose Crohn's disease include:

  • Barium enema or upper GI series
  • Colonoscopy or sigmoidoscopy
  • CT scan of the abdomen
  • Capsule endoscopy
  • MRI of the abdomen
  • Enteroscopy

A stool culture may be done to rule out other possible causes of the symptoms.

This disease may also alter the results of the following tests:

  • Low albumin levels
  • High sed rate
  • Fecal fat
  • Low blood count (hemoglobin and hematocrit)
  • Abnormal liver blood tests
  • High white blood cell count
Treatment:

DIET AND NUTRITION

You should eat a well-balanced, healthy diet. Include enough calories, protein, and nutrients from a variety of food groups.

No specific diet has been shown to make Crohn's symptoms better or worse. Types of food problems may vary from person to person.

Some foods can make diarrhea and gas worse. To help ease symptoms, try:

  • Eating small amounts of food throughout the day.
  • Drinking lots of water (drink small amounts often throughout the day).
  • Avoiding high-fiber foods (bran, beans, nuts, seeds, and popcorn).
  • Avoiding fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
  • Limiting dairy products if you have problems digesting dairy fats. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
  • Avoiding foods that you know cause gas, such as beans.

Ask your doctor about extra vitamins and minerals you may need, such as:

  • Iron supplements (if you are anemic)
  • Calcium and vitamin D supplements to help keep your bones strong
  • Vitamin B12 to prevent anemia

STRESS

You may feel worried, embarrassed, or even sad and depressed about having a bowel disease. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can worsen digestive problems.

Ask your doctor or nurse for tips on how to manage your stress.

MEDICINES

You can take medication to treat very bad diarrhea. Loperamide (Imodium) can be bought without a prescription. Always talk to your doctor or nurse before using these drugs.

Other medicines to help with symptoms include:

  • Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel). Ask your doctor before taking these products or laxatives.
  • Acetaminophen (Tylenol) for mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) which can make your symptoms worse.

Your doctor may also prescribe medicines to help control Crohn's disease:

  • Aminosalicylates (5-ASAs) - medicines that help control mild to moderate symptoms. Some forms of the drug are taken by mouth; others must be given rectally.
  • Corticosteroids, such as prednisone - treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum.
  • Medicines that quiet the immune system's reaction.
  • Antibiotics - treat abscesses or fistulas.
  • Biologic therapy- used for severe Crohn's disease that does not respond to any other types of medication.

SURGERY

Some people with Crohn's disease may need surgery to remove a damaged or diseased part of the intestine. In some cases, the entire large intestine is removed, with or without the rectum.

People who have Crohn's disease that does not respond to medications may need surgery to treat problems such as:

  • Bleeding
  • Failure to grow (in children)
  • Fistulas (abnormal connections between the intestines and another area of the body)
  • Infections
  • Narrowing of the intestine

Surgeries that may be done include:

  • Ileostomy
  • Removal of part of the large bowel or small bowel (link to surgery)
  • Removal of the large intestine to the rectum.
  • Removal of the large intestine and most of rectum
Support Groups:

The Crohn's and Colitis Foundation of American offers support groups throughout the United States.

Outlook (Prognosis):

There is no cure for Crohn's disease. The condition is marked by periods of improvement followed by flare-ups of symptoms. Although Crohn's disease cannot be cured even with surgery, treatment can offer significant help to most patients.

Possible Complications:

You have a higher risk for small bowel and colon cancer if you have Crohn's disease. At some point, your doctor may recommend tests to screen for colon cancer.

Those with more severe Crohn's disease may have these problems:

  • Abscess or infection in the intestines
  • Anemia, a lack of red blood cells
  • Bowel blockage
  • Fistulas in the bladder, skin, or vagina
  • Slow growth and sexual development in children
  • Swelling of the joints
  • Lack of important nutrients, such as vitamin B12 and iron
  • Problems with maintaining a healthy weight
When to Contact a Medical Professional:

Call your health care provider if:

  • You have very bad abdominal pain
  • You cannot control your diarrhea with diet changes and drugs
  • You have lost weight, or a child is not gaining weight
  • You have rectal bleeding, drainage, or sores
  • You have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F without an illness
  • You have nausea and vomiting that lasts for more than a day
  • You have skin sores that do not heal
  • You have joint pain that prevents you from doing your everyday activities
  • You have side effects from medicines you are taking for your condition
References:

Cheifetz AS. Management of active Crohn disease. JAMA. 2013 May 22;309(20):2150-8.

Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104(2):465-483.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 111.

Lichenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 143.


Review Date: 10/13/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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