Crohn's disease is a serious inflammatory disease of the gastrointestinal (GI) tract. It predominates in the intestine (ileum) and the large intestine (colon), but may occur in any section of the GI tract. Crohn's disease usually causes diarrhea, crampy abdominal pain, often fever, and at times rectal bleeding. Loss of appetite and subsequent weight loss also may occur. Symptoms may range from mild to severe, but in general people with Crohn's disease can lead active and productive lives.
Crohn's disease is chronic. We don't know its cause. Medication currently available decreases inflammation and usually controls the symptoms, but does not provide a cure. Because Crohn's disease behaves similarly to ulcerative colitis, from which it may be difficult to differentiate, the two disorders are grouped together as inflammatory bowel disease (IBD). Unlike Crohn's disease, in which all layers of the intestine are involved, and in which there can be normal healthy bowel in between patches of diseased bowel, ulcerative colitis affects only the innermost lining (mucosa) of the colon in a continuous manner. Depending on where the involvement occurs, Crohn's disease may be referred to as Ileitis, regional enteritis, or colitis, etc. To lessen the confusion, the term Crohn's disease can be used to identify the disease wherever it occurs in the body (ileum, colon, rectum, anus, stomach, duodenum, etc.). It is referred to as Crohn's disease because Burrill B. Crohn was the first name in a three-author landmark paper published in 1932, which described the disease.
How common is inflammatory bowel disease (IBD)?
It is estimated that there may be up to 1,000,000 Americans with IBD. Males and females appear to be affected equally. While Crohn's disease afflicts people of all ages, it is primarily a disease of the young. Most cases are diagnosed before age 30, but the disease can occur in the sixth, seventh, and later decades.
Is Crohn's disease inherited?
We know that Crohn's disease tends to run in families. Studies have shown that about 20 to 25 percent of patients may have a close relative with either Crohn's or ulcerative colitis. There does not seem to be any clear-cut pattern to this familial clustering. Research actively continues in an attempt to establish a link to specific genes governing its transmission. At this time, there is no way to predict which, if any, family members will develop Crohn's disease.
What are the symptoms of Crohn's disease?
In Crohn's disease, abdominal pain and diarrhea are often the earliest signs. The pain is primarily at or below the navel in the abdomen. These symptoms follow a meal. Loss of appetite and weight, joint pains, and fever are common early signs of Crohn's disease can include sores in the anal area, including skin tags mimicking hemorrhoids, fissures (cracks), fistulas (abnormal openings connecting the bowel to the skin surface near the anus), and abscesses.
How is Crohn's disease diagnosed?
The diagnosis is suggested by the history (signs and symptoms). Additional testing to help make the diagnosis may include barium x-rays of the upper and lower GI tract, flexible sigmoidoscopy, and sometimes colonoscopy. (The last two tests permit a direct examination of the colon with a lighted tube inserted through the anus. During these tests, biopsies may be obtained to help make a diagnosis.) Laboratory tests are so helpful and include evaluation of the blood and stool.
Because Crohn's disease often mimics other conditions and symptoms may vary widely, the correct diagnosis of Crohn's disease may take some time.
What medications are used to treat this disease?
Because no medical cure for Crohn's disease exists, the goals of medical treatment are to suppress the inflammatory response, permit healing of tissue, and relieve the symptoms of fever, diarrhea, and abdominal pain.
Several groups of drugs form the mainstay of therapy for Crohn's disease today. They are:
Aminosalicylates: aspirin-like drugs, which include sulfasalazine and mesalamine, given both orally and rectally.
Corticosteroids: prednisone and methylprednisolone, available orally and rectally.
Immune modifiers: azathioprine, 6MP, methotrexate.
Antibiotics: metronidazole, ampicillin, ciprofloxacin, and others.
What is the role of surgery in Crohn's disease?
Surgery becomes necessary in Crohn's disease when medication can no longer control the symptoms, or when there is an intestinal obstruction or other complication. In most cases, the diseased segment of bowel is removed and the two ends of healthy bowel are joined together. This is called resection and anastamosis. While this surgery may allow many symptom-free years, it is not considered a cure for Crohn's disease because the disease frequently recurs at or near the site of anastomosis.
An ileostomy may also be required when surgery is performed for Crohn's disease of the colon, if the rectum is diseased and cannot be utilized for an anastomosis.
Is nutrition important in Crohn's disease?
Good nutrition is essential in any chronic disease but especially in this illness, which is characterized by reduced appetite, poor absorption, and diarrhea, all of which rob the body of fluids, nutrients, vitamins, and minerals. Restoration and maintenance of proper nutrition is a vital part of the medical management of Crohn's.
While foods appear to play no role in causing the disease, soft, bland foods may cause less discomfort than spicy or high-fiber foods when the disease is active. Except for restricting milk in lactose intolerant patients, most gastroenterologists try to be flexible in planning the diets of their Crohn's patients.
Can emotional stress trigger attacks of Crohn's disease?
Because body and mind are so closely interrelated, emotional stress can influence the course of Crohn's disease, or any other illness. Although acute emotional problems occasionally precede the onset or recurrence of Crohn's, this sequence does not imply cause and effect.
It is much more, likely that emotional distress sometimes felt by people with Crohn's is a reaction to the painful and embarrassing symptoms caused by the disease itself. Persons with Crohn's should receive understanding and emotional support from their families and from their physicians. Some patients are helped considerably by a therapist knowledgeable about inflammatory bowel disease or about chronic illness in general. Through CCFA, local support groups exist to help patients and their families cope with IBD.
Is it possible to lead a normal life with Crohn's disease?
While it is a serious chronic disease, Crohn's disease is not considered a fatal illness. Most people with the illness continue to lead useful and productive lives, even though they may be hospitalized from time to time, and may need to take medications. In between exacerbations of disease, most people feel well and are relatively free of symptoms.
Even though no medical cure for this disease exists at this time, research and educational programs funded by CCFA have already improved the health and quality of life of people with Crohn's disease. Through CCFA's continuing research efforts, much more will be learned and a cure will be found.
What causes Crohn's disease?
Researchers do not know what causes this disease. They do not believe it is caused by emotional stress or by food, or that it is transmitted directly from person to person.
Research has shown that in IBD the body's defenses are operating against some substances in the body, perhaps in the digestive tract, which they recognize as foreign. These foreign substances (antigens) may themselves cause the inflammation, or may stimulate the body's defenses to produce an inflammation that continues without control.
A major thrust of CCFA-sponsored research has been carried out in the fields of immunology, the study of the body's immune defense system, and microbiology, the study of microscopic organisms with the power to cause disease. Many scientists now believe that the interaction of an outside agent (such as a virus or bacterium) with the body's immune system may trigger the disease, or that such an agent may cause damage to the intestinal wall, initiating or accelerating the disease process.
The Crohn's & Colitis Foundation of America, Inc. (CCFA), is the only private national organization dedicated to finding a cure for the inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Funding from CCFA is in part responsible for exciting breakthroughs in the study of these diseases.
Research is currently underway to identify the genes associated with these diseases and to continue the understanding of how the immune system is activated to begin and perpetuate the disease process.
Local chapters of CCFA are actively involved in professional and patient education and support. For more information about CCFA:
Crohn's & Colitis Foundation of America, Inc.
386 Park Avenue South
New York, NY 10016-8804