Crohn's Disease

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.

Types of Chron's disease:

There are five main types of Crohn's disease, each with its own symptoms and location of inflammation:

Ileocolitis: This is the most common type of Crohn's disease. It causes inflammation of the end of the small intestine (ileum) and the colon. Symptoms may include diarrhea, weight loss, abdominal pain, and cramping.
Ileitis: This type of Crohn's disease affects only the ileum. Symptoms are similar to ileocolitis but may also include fistulas (abnormal connections between tissues) or abscesses (pockets of infection) in the lower-right part of the abdomen.
Gastroduodenal Crohn's disease: This affects the stomach and the beginning of the small intestine (duodenum). Symptoms may include nausea, vomiting, loss of appetite, and weight loss.
Jejunoileitis: This type affects the middle part of the small intestine (jejunum). Symptoms may include abdominal pain, cramps, diarrhea, and fistulas.
Crohn's (granulomatous) colitis: This type affects only the colon. Symptoms may include rectal bleeding, diarrhea, skin lesions, joint pain, ulcers, fistulas, or abscesses around the anus.

The type and severity of Crohn's disease may vary from person to person and may change over time. The exact cause of Crohn's disease is unknown, but it may involve genetic, environmental, and immune factors. There is no cure for Crohn's disease, but treatments can help reduce inflammation, relieve symptoms, and prevent complications.

Symptoms:

Crohn's disease can affect any part of the intestine, small or large. It could be in multiple segments or continuous. In some people, the disease only affects the colon, a portion of the large intestine.

Crohn's disease symptoms can vary from mild to severe. They usually develop gradually but can also appear suddenly and without warning. You may also have periods of no signs or symptoms (remission).
Symptoms of an active disease include:
Diarrhea
Fever
Fatigue
Cramps and pain in the abdomen
There is blood in your stool
mouth sores
Loss of appetite and weight loss
Pain or drainage near or around the anus due to inflammation of a tunnel into the skin (fistula).

Other signs and symptoms:

People with severe Crohn's disease may also have symptoms outside of the intestinal tract, such as:
Skin, eye, and joint inflammation
Inflammation of the liver or bile duct
Kidney stones
Anemia (iron deficiency)
Delayed growth or sexual development of children.

Causes:

The exact cause of Crohn's disease is unknown, but it may involve a combination of factors, such as:

Autoimmune reaction: Your immune system may mistakenly attack healthy cells in your digestive tract, causing inflammation and damage.
Genes: You may inherit genes that make you more likely to develop Crohn's disease, especially if you have a family history of the condition.
Environmental factors: Smoking, certain medications, a high-fat diet, and exposure to bacteria or viruses may increase your risk of Crohn's disease.

Crohn's disease is not caused by stress or eating certain foods; these factors may worsen your symptoms or trigger flare-ups.

Risk factors:

Some of the risk factors of Crohn's disease are:

Genetic predisposition: Having a family history of Crohn's disease or certain genes may increase the likelihood of developing the condition.
Immune system dysfunction: An abnormal immune response may cause inflammation and damage to the digestive tract.
Environmental triggers: Smoking, certain medications, a high-fat diet, and exposure to bacteria or viruses may worsen or activate Crohn's disease.
Age: Crohn's disease can occur at any age, but it is more common in people who are younger than 30.
Ethnicity: Crohn's disease is more prevalent in people of Jewish or Caucasian descent.

Possible Complications:

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 wall thickness 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.

Prevention:

There is no sure way to prevent Crohn's disease, but you can reduce your risk and manage your symptoms by making some lifestyle changes. Some of the possible prevention methods are:

Quit smoking: Smoking can worsen inflammation and trigger flares. Quitting smoking can improve your overall health and reduce your need for medication.
Eat a healthy, low-fat diet: Certain foods may aggravate symptoms or cause flares. Avoid foods that are high in fat, spicy, oily, deep-fried, or high in sugar. Eat small, frequent meals and drink plenty of fluids. Include whole fresh foods in your diet and limit processed foods. You may also want to avoid dairy, legumes, wheat, and caffeine if they cause discomfort.
Exercise regularly: Physical activity can help reduce stress, improve mood, and boost your immune system. Aim for at least 30 minutes of moderate exercise most days of the week. Choose activities that you enjoy and that do not cause pain or discomfort.
Manage stress: Stress can worsen inflammation and trigger flares. Find healthy ways to cope with stress, such as relaxation techniques, meditation, yoga, or hobbies. Seek professional help if you feel overwhelmed or depressed.
Take your medication as prescribed: Medication can help reduce inflammation, relieve symptoms, and prevent complications. Follow your doctor's instructions, and do not stop taking your medication without consulting your doctor. Inform your doctor of any side effects or changes in your condition.

When to Consult a Doctor?

On Symptoms

Observing the early signs and symptoms of Crohn's disease is advisable 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 mindfulness can help optimise the immune system. This can encourage the body to recover itself from the illness. However, consulting a healthcare professional about practising any such therapy and medical intervention is essential.

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 better diagnose.

Physical Examination

After thoroughly discussing the medical condition and lifestyle practices, 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 tap or gently squeeze the abdomen to find any signs of pain or tenderness. This helps the doctor determine the possibility of an enlarged liver or spleen.

Lab 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 to determine the patient's immunity 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, highly flexible tube enters the GI tract with a camera. 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 is prebiotics. Regularly consuming foods like bananas, leeks, unions, and asparagus can relieve 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 be good to go on a liquid diet and rest the digestive system. 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 aloe vera leaves is known for its antibacterial 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 in 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

The doctor may suggest medication if these natural remedies fail to produce a positive outcome. 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.

• 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, connecting the healthy ends.

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.

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 worsening.

• Effect of stress on Crohn’s disease

Stress does not directly cause 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 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.