Crohn's disease
What is Crohn's disease?
Crohn's disease is a chronic inflammatory disease of the intestines. Its manifestations, abdominal pain and diarrhea, come and go over many years. Men and women are equally affected, and most cases begin before the age of 30. The cause is unknown, but stress is believed to aggravate the disease.
How is it diagnosed?
Crohn's disease signs and symptoms
- Crampy abdominal pain especially after eating. The pain is sometimes in the right lower abdomen, mimicking appendicitis.
- Nausea and diarrhea; general ill feeling; fever.
- Appetite and weight loss.
- Abdominal tenderness; abdominal mass that can be felt.
- Bloody stools (sometimes).
- Growth retardation in children.
History includes crampy abdominal pain for more than a month, diminished appetite, diarrhea that may be bloody, and weight loss, especially in a person under 35 years old. A low-grade fever is even more suggestive. Diarrhea is often interspersed with normal bowel movements or constipation.
Physical exam shows abdominal tenderness, mainly in the right lower quadrant. A mass felt in this area is characteristic of the diagnosis. Fistulas and abscesses around the anus are often found.
Tests: Barium contrast x-rays of the small intestine will show changes typical of Crohn's disease. If the colon is involved, colonoscopy can confirm the diagnosis. Some cases may require laparoscopy or surgical exploration of the abdomen to make the diagnosis. Anemia and blood in the stool are possible laboratory findings, along with electrolyte abnormalities and chemical signs of malabsorption and malnutrition.
How is Crohn's disease treated?
Various anti-inflammatory drugs can be used to treat this disease, along with broad-spectrum antibiotics. Steroids might be required in some cases. Immune-suppressing drugs are also used, as Crohn's appears to be an autoimmune disease. Symptomatic treatment of diarrhea and cramps can be carefully done with anticholinergic drugs or mild narcotics.
Nutrition is important in this disease, so a diet adequate in calories, vitamins, and protein is recommended. Three-quarters of individuals with Crohn's disease will need surgery to remove fistulas or an obstructed segment of intestine. Sometimes, ileostomy is needed to manage the complications, but that usually involves a resection of the small intestine, causing impaired absorption of nutrients.In the most difficult cases, it may be useful to rest the intestines by stopping all food intake for several months and using intravenous feeding exclusively (total parenteral nutrition).
Crohn's Disease Medications
- Aminosalicylates.
- Pain relievers.
- Antidiarrhea medication.
- Vitamin supplements.
- Anti-inflammatory drugs and immunosuppressant medication.
- Antibiotics to fight infections.
- Steroids in acute cases.
What might complicate it?
Fistulas (an erosion between the intestine and other tissues) are a serious and frequent complication. Fistulas can form between loops of intestines, between intestine and the skin, between rectum and the skin, between the intestine and bladder, vagina, etc. Intestinal narrowing and obstruction is another common complication. Repeated excision of obstructed segments of intestine can lead to the short bowel syndrome, which exaggerates the symptoms of diarrhea, weight loss, and malnutrition.
Predicted outcome
The disease runs a variable course, and recurrences are quite common. Prognosis is difficult to establish.
Alternatives
Ulcerative colitis, chronic appendicitis with abscess, diverticulitis, amebiasis, intestinal cancer, gynecologic inflammatory disease, or ischemic ileitis in the elderly are other possibilities.
Appropriate specialists
Gastroenterologist, general surgeon, and colorectal surgeon.
Notify your physician if
- You or a family member has symptoms of Crohn’s disease.
- You have black, tarry stools or blood in the stool.
- Your abdomen swells.
- Your temperature rises to 101°F (38.3°C) or higher.
Last updated 3 April 2018