Crohn’s is prevalent amongst many Americans. Men and women are likely to be affected. Mostly adults between 20 to 30 are diagnosed, but it can be diagnosed at any age. Crohn’s is more prevalent amongst individuals that have a family history of Inflammatory Bowel Diseases. There is a genetic component to Crohn’s, but family history of IBD is enough to predict the occurrence of CD. CD can occur in all ethnicities, but is more common in Caucasians.

The cause is unknown for Crohn’s Disease. It is highly suspected that the genetic component of the disease is related to its unknown cause. CD can also be caused by the body’s environment or an overactive immune system.

Crohn’s Disease is chronic, painful, and debilitating. Many symptoms involve the intestinal symptoms, others may not. Non-intestinal symptoms are sometimes more severe and difficult to manage than the intestinal symptoms.

Symptoms include:

• Abdominal cramping or pain
• Constipation
• Diarrhea
• Fever
• Extreme tiredness
• Weight loss
• Delayed growth in younger children
• Anemia
• Bleeding with bowel movements
• Drainage from the skin around the anus
• Abscess infections around the anus (persistent and recurring)
• Anal fissures – tear or ulcer on the anus
• Fistula – abnormal connection or tunnel tracks from one part of the bowel to another

Other non-intestinal symptoms:

• Kidney stones
• UTI
• Colitic arthritis (knees, ankles, hips, wrists, elbows)
• Pericholangitis inflammation – inflamed tissues around the bile ducts

That are several types of Crohn’s Disease, depending on the region it affects. Each subtype of CD has specific symptoms.

1. Ileocolitis is the most common type of CD. It affects the end of the small intestine (ileum) and the large intestine (colon). Symptoms include: diarrhea, cramping, pain in the middle and lower part of the abdomen, weight loss.
2. Ileitis affects only the end of the small intestine (ileum). Symptoms are the same as Ileocolitis, above. In severe cases of ileitis, complications can occur, such as fistulas, inflammatory abscess in the right lower quadrant of the abdomen.
3. Gastroduodenal Crohn’s Disease involves the stomach and the beginning of the small intestine (duodenum). Symptoms are nausea, vomiting, loss of appetite, and weight loss.
4. Jejunoileitis is the inflammation of the middle section of the small intestine (jejunum). The inflammation is typically patchy, meaning some sections are inflamed and some sections are not affected. Symptoms include: mild to severe abdominal pain or cramps after eating meals and diarrhea. In severe cases of jejunoileitis, fistulas can form if there are long periods of uncontrolled inflammation.
5. Crohn’s Granulomatous Colitis involves only the large intestine (colon). Symptoms are diarrhea, rectal bleeding, and disease around the anus, such as abscesses, fistulas, and ulcers. Other symptoms, such as skin lesions and joint pain or arthritis are common in this subtype of CD.

Family history can accurately predict likelihood of occurrence in affected individuals. However, due to advancements in technology, diagnosis of Crohn’s Disease can be quickly done with a full physical examination, imaging scans, stool samples and blood tests.

A physical examination is typically performed to find signs of bloating the abdominal area, different sounds in the abdomen, tenderness or pain in the abdomen, or swelling of the spleen or liver.

There are many types of imaging scan tests that can help take images of the gastrointestinal tract. Tests are traditional X-rays, contrast dye X-rays, CT scans, MRI, white blood cell scan, endoscopy (a colonoscopy with a camera), and endoscopic ultrasound.

Routine blood tests help determine if an infection or anemia is present. Fecal blood tests help detect blood in the stool. Antibody tests help determine if the affected individual has Crohn’s Disease or Ulcerative Colitis.

The most common treatment plan provides medications, bowel rest and lifestyle changes. The goal of the treatment plan is to manage and decrease inflammation, prevent bowel flare-ups, and to remain in remission. Medications prescribed for Crohn’s typically help manage and control symptoms. It does not cure Crohn’s Disease.

Aminosalicylates are commonly used in CD with mild symptoms. They help control inflammation. Aminosalicylates include balsalazide, mesalamine, olsalazine and sulfasalazine.

Corticosteroids, otherwise known as oral steroids, decrease the activity of the immune system and help decrease inflammation. These are typically prescribed in CD with moderate to severe symptoms. Corticosteroids include budesonide, hydrocortisone, methylprednisolone and prednisone. Long term use of steroids are usually avoided due to the high risk of severe side effects from chronic use.

Immunomodulators decrease the activity of the immune system, which in turn decrease the occurrence of inflammation. They do not work instantly in the body and takes several months to start working. Some immunomodulators are azathioprine, cyclosporine or methotrexate. Use is limited to severe cases due to the many side effects of these medications.

Biologic therapies are effective but costly and requires close monitoring. Close monitoring for drug administration techniques and signs of infection. The following biologics are indicated for CD: Humira, Cimzia, Remicade, Tysabri and Stelara.

Additional medications can be used to help with infections (antibiotics), diarrhea (loperamide, lomotil), pain relievers or fever reducers (acetaminophen) and nutritional supplements.

Anti-diarrhea medications should only be used short term. Aspirin and non-steroid anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen, can worsen symptoms.

Surgery intervention is reserved for extreme cases or emergencies.

Bowel Rest is important in the treatment plan of CD. Bowel rests includes resting the bowel for a few days or up to several weeks. It involves only drinking liquids that contain nutrients through a feeding tube inserted into the stomach or intravenous (IV) nutrition inserted in the vein. During bowel rest, the stomach or intestine is allowed to heal on its own.

Lastly, lifestyle modification can help decrease flare ups and remain in remission. Diet should be low fat, low fiber, low sat, lactose free and high in calories. Nutritional supplements and vitamins may be beneficial and appropriate. It is recommended to avoid carbonated drinks, popcorn, vegetable skin, nuts, drinking too much liquid and eating large meals.

Affected individuals with CD are likely to be on medications for life. Medications are essential in controlling symptoms and staying in remission.

If the colon is involved in the type of CD, the risk of colon cancer is higher. The longer the colon is involved, the higher the risk of colon cancer. Routine colonoscopies are required.

Do not stop taking medications. Stopping suddenly can cause a flare up and increase incidence of recurrence.

Do not smoke. Smoking is correlated with recurrence rate.

1. https://www.crohnscolitisfoundation.org/what-is-crohns-disease
2. https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease
3. https://www.crohnsandcolitis.com/crohns
4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/crohns-disease
5. https://www.fascrs.org/patients/disease-condition/crohns-disease-0