Crohn’s Disease

Crohn’s disease at a glance

• Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal (GI) tract.
• The most common symptoms include abdominal pain and diarrhea.
• Most people are diagnosed with the disease before 30 years of age.
• There is no known cure for Crohn’s disease, but we provide treatments that can reduce the symptoms, result in long-term remission and enable women with the condition to function well.

What is Crohn’s disease?

Crohn’s disease is an inflammatory bowel disease (IBD). This disease causes an inflammation of the digestive, or gastrointestinal (GI), tract, which includes the mouth, esophagus, stomach and intestines. Different areas of the tract, from the mouth to the anus, can be inflamed for different people with the disease. This can cause abdominal pain, severe diarrhea, fatigue, malnutrition and weight loss. It can also lead to life-threatening complications.

Crohn’s disease typically varies between periods when the disease is active, or flaring up, and when it is in remission (few or no symptoms). Crohn’s varies from person to person and may change over time.

Men and women are equally affected by this disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than half a million people in the United States have Crohn’s disease.

There are five different types of this diseases, identified by what part of the GI tract is inflamed.

• Ileocolitis (most common, the end of the small intestine).
• Crohn’s (Granulomatous) colitis (only the colon).
• Ileitis (only the ileum, part of the small intestine).
• Gastroduodenal (stomach and beginning of the small intestine).
• Jejunoileitis (upper half of the small intestine).

Risk factors

The cause of Crohn’s disease is unknown. Risk factors for getting it include the following.

• Family history. Crohn’s is more common in people who have family members with the disease. As many as 1 in 5 people who have it also have a close relative with Crohn’s disease.
• Age. The condition is more likely to develop in adolescents. Most people are diagnosed before they are 30 years old.
• Ethnicity. White people are at the highest risk of developing Crohn’s disease, especially those of Eastern European Jewish descent. Incidents of the disease are increasing among blacks who live in the United Kingdom and North America.
• Cigarette smoking. Smoking is the most important controllable risk factor. Smoking can lead to more severe symptoms.
• Location of residence. People in urban areas or industrialized countries are more likely to develop Crohn’s disease. This suggests that environmental factors may play a role.
• Infections. Bacteria linked to Crohn’s includes Mycobacterium avium paratuberculosis. This bacteria causes a similar condition in cattle.
• Nonsteroidal anti-inflammatory medications. These include naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, etc.), diclofenac sodium (Voltaren) and others. While these do not cause the disease, they can lead to inflammation of the bowel making the disease worse.

Signs and symptoms for Crohn’s disease

Signs and symptoms can be different for each person. When the disease is active, a person may experience the following:

• Diarrhea.
• Abdominal cramping and pain.
• Blood in the stool.
• Urgent need to poop.
• Sensation of incomplete bowel evacuation.
• Constipation.
• Pain or drainage near or around the anus.
• Fatigue.
• Fever.
• Reduced appetite and weight loss.
• Mouth sores.
• Night sweats.
• Loss of normal menstrual cycle in women.

People with severe cases of Crohn’s disease may also experience inflammation of the eyes, skin, joints, the bile ducts or liver. In children, severe cases can result in delayed growth or sexual development.

A person should consult a doctor if there are persistent changes to the bowel movements or if experiencing the signs and symptoms listed above.

Complications

Complications from Crohn’s disease may include the physical conditions listed below.

• Bowel obstruction.
• Ulcers.
• Fistulas.
• Anal fissure.
• Malnutrition or anemia.
• Colon cancer.
• Kidney stones.
• Osteoporosis.
• Arthritis.
• Gallbladder or liver disease.
• Skin disorders.

Complications caused by medications

Drugs that act by blocking functions of the immune system and help with Crohn’s disease side effects bring additional complications. These include a small risk of developing cancers such as skin cancer or lymphoma. They also increase the risk of infection.

Corticosteroids used for Crohn’s disease are associated with a risk of bone fractures, osteoporosis, cataracts, glaucoma, high blood pressure and diabetes.

Diagnosis

There is no one test to diagnose Crohn’s disease. A gastroenterologist will work with the patient to rule out other possible causes for the symptoms, as well as use the following tests to confirm the diagnosis.

• Blood test.
• Stool sample.
• Colonoscopy.
• Computerized tomography (CT).
• Magnetic resonance imaging (MRI).
• Capsule endoscopy.
• Balloon-assisted enteroscopy.
• Chromoendoscopy.

Meet our Crohn’s disease expert

Dr. Elisa Birnbaum has a clinical focus on pelvic floor abnormalities including treatments for Crohn’s disease. Her philosophy of care is to address the symptoms a woman relates then come up with a management plan together. She specializes in the hard cases that need surgery.

Treatments for Crohn’s disease

There is no cure for Crohn’s disease, but there are treatments to help reduce the inflammation that triggers the symptoms. These treatments also limit complications and may result in long-term remission.

Patients frequently start their care with a gastroenterologist to explore lifestyle changes and medications the patient can make to bring Crohn’s symptoms under control. Dr. Birnbaum specializes in surgery for Crohn’s disease when other treatment options do not provide relief. In some cases, a patient may use multiple treatment options in combination to increase the effectiveness.

Lifestyle changes

Diet and lifestyle changes can help control symptoms and lengthen the time between flare-ups.

Stress has been shown to make symptoms worse and trigger flare-ups. While a person cannot entirely avoid stress, it is important to learn to manage it with exercise, biofeedback machines, regular relaxation and breathing exercises.

Recommended diet changes include:

• Limit dairy products.
• Try low-fat foods.
• Avoid spicy food.
• Limit fiber.
• Don’t drink alcohol or caffeine.
• Eat small meals.
• Drink plenty of water.
• Take multivitamins.

Medications for Crohn’s disease

Anti-inflammatory drugs are often the first step in treating an IBD. These can be a corticosteroid or oral 5-aminosalicylates.

Immune system suppressors also help reduce inflammation. They work by targeting the immune system, which produces the substances that cause the inflammation. Immunosuppressant drugs include:

• Azathioprine (brand names Azasan, Imuran) and mercaptopurine (Purinethol, Purixan).
• Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia).
• Methotrexate (Trexall).
• Natalizumab (Tysabri) and vedolizumab (Entyvio).
• Ustekinumab (Stelara).

Antibiotics can reduce the amount of drainage and may heal fistulas and abscesses. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medications may be used to control the inflammation and to relieve symptoms. Our doctors may recommend one of the following:

• Antidiarrheals.
• Pain relievers.
• Iron supplements.
• Vitamin B-12 shots.
• Calcium and vitamin D supplements.

Nutrition therapy

A special diet may be prescribed and given via a feeding tube or injected into the vein. This can improve nutrition and allow the bowel to rest, which can temporarily reduce inflammation. This is commonly used prior to surgery.

Surgery

If medication, diet and lifestyle changes, and other treatments do not relieve the symptoms, we may recommend surgery. According to a 2012 study completed by the Mayo Clinic, 60% of those with Crohn’s disease require at least one surgery.

During surgery, Dr. Birnbaum will remove the damaged portion of the digestive tract and then reconnect the healthy sections. Surgeries may also be completed to close fistulas and drain perianal abscesses, which can be disabling.

Surgery does not cure the disease, which often recurs near the reconnected tissue. The best approach is to use medication after surgery to minimize the risk of recurrence.