Digestive Problems
Diseases: Small Bowel: Crohn's Disease
Find out about the Charleston area Crohn's & Colitis support group.
Crohn's disease appears to be increasing in frequency. It is more common in Caucasians compared to individuals of African of Asian descent. It appears to be most common in some individuals of Jewish descent. Crohn's disease can become evident at any age. However, there appear to be two peaks at which patients develop significant symptoms, in the mid-20s and after 50 years of age.
The cause of Crohn's disease is unknown. An infection may be involved. There appears to be a genetic susceptibility and environmental factors may be involved. Patients who smoke tend to have more active Crohn's disease.
Crohn's disease affect the gastrointestinal tract from the mouth to the anus. It occurs most commonly in the lower part of the small intestine (the terminal ileum), and the colon. It is characterized by inflammation of the bowel wall, which becomes chronic to the extent that fibrosis or scarring occurs. This scarring can cause narrowing (strictures) in the small bowel. During acute phases of inflammation, patients may develop fistulae (abnormal connections between the bowel, other parts of the bowel or other organs such as the bladder, uterus, or skin). Disease activity is very variable; patients may have acute intermittent exacerbations or have low-grade active disease for several years.
Diarrhea is the most common complaint. Stools can be very loose or partly formed, with or without blood. Patients may have abdominal pain which is due to inflammation, cramping, infection or even obstruction. On account of significant diarrhea, patients may have weight loss and dehydration. Onset in childhood may cause growth retardation. Some patients may present with obscure fevers. Fistulae to the skin around the anal area will result in leakage. Fistulae to the vagina can result in stool discharge from the vagina. Fistulae in to the urinary tract can cause urinary tract infections.
Patients may also complain of some of the systemic effects of Crohn's disease which include arthritis, inflammation in the eye, skin changes, hepatitis, and gall stones.
Crohn's disease is diagnosed by obtaining biopsies of the affected intestine. Other helpful methods include barium studies which may show inflammation of the terminal ileum or colon. Blood tests are done to look for B12 deficiency (B12 is absorbed by the terminal ileum), and to assess systemic inflammation (white blood count and sedimentation rate) as signs of disease activity.
Occasionally, extensive imaging of the abdomen is required such as ultrasound or CAT scan to look for abscesses or other significant infections or other perforations.
The treatment of Crohn's disease depends on the symptoms, and the site and activity of disease. Anti-inflammatory medicine are commonly used. Patients may need to take these medications for long periods of time to maintain remission. Occasionally, patients with severe disease, multiple fistulae, perforation, or abscesses will require s07/27/2007
Patients with Crohn's disease are advised to stop smoking and may need to modify their diet (i.e. avoiding lactose containing foods which may exacerbate bloating and diarrhea). Vitamin supplements may be necessary.