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About Crohn’s Disease

Inflammatory Bowel Disease (IBD) is a generic term for a group of disorders in which the intestines become inflamed. The two major types of IBD are Crohn’s Disease and Ulcerative Colitis. Normally, the immune system protects the body from infections by attacking foreign substances such as bacteria, viruses, and other toxins. Crohn’s Disease is an autoimmune disorder, in which the immune cells mistakenly attack the cells of the intestines and produce chronic inflammation. Crohn’s can involve any location of the gastrointestinal (GI) tract, but it usually affects the small intestine and/or the colon.

The exact cause of Crohn’s is unknown, but there are some environmental and genetic factors that may contribute to the development of the disease. Certain foods such as red meat and alcohol may cause inflammation, and smoking has been shown to worsen Crohn’s. People who have a first degree relative with IBD have an increased risk of developing the disease.

Symptoms
Symptoms include persistent diarrhea, abdominal pain and cramping, fever, rectal bleeding, and weight loss. Crohn’s can also affect parts of the body outside of the GI tract such as the joints, eyes, skin, and liver. Swelling and scar tissue can result from the inflammation and block the intestines, which is the most common complication of Crohn’s. Symptoms of blockage include cramping pain, vomiting, and bloating. Sores or ulcers can also form within the intestinal tract. Sometimes these deep ulcers turn into tracts called fistulas, which can become infected.

Diagnosis and Testing

The symptoms of Crohn’s can resemble other inflammatory disorders, which makes diagnosis difficult. Additionally, Crohn’s presents itself differently in each patient, so there is no single test that can determine the diagnosis with certainty. However, there are physical exams and tests that can help provide an accurate diagnosis.

Tests that can be used include:
● Blood test—This checks the number of red and white blood cells in a person’s body. If the red blood cell count is low, this may indicate bleeding in the intestine. If the white blood cell count is high, this may indicate inflammation somewhere in the body.
● Stool sample—Analysis will show if there is bleeding or infection in the intestine.
● X-rays—Contrast dye is used to view areas of inflammation in the GI tract.
● Endoscopy—A small camera mounted to the end of a lighted tube allows the doctor to visually examine the interior of the colon. There are two types:
○ Colonoscopy—Insertion of flexible tube through the opening of the anus and allows examination of the colon, the lowest part of the large intestine.
○ Upper Endoscopy—Insertion of flexible tube through the opening of the mouth, down the esophagus, into the stomach, and as far as the duodenum, the first part of the small intestine.
● Biopsy—Analysis of a small piece of tissue, which is removed from an affected area in the GI tract.

Treatment
Treatment for Crohn’s can include the use of medication, changes in diet and nutrition, and sometimes surgery. There is no standard treatment that will work for all patients. Each patient’s situation is different and treatment must be individualized.

Medication
Medications are used to suppress the inflammation that causes the symptoms of Crohn’s. They also allow the tissues of the intestine to heal. In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare ups (maintaining remission). Over time, this treatment can help extend periods of remission and reduce periods of symptom flare ups.

The five groups of drugs used to treat Crohn’s Disease are:
● Anti-inflammatory agents
● Antibiotics
● Steroids
● Immunosuppressants
● Biologic therapy

Diet & Nutrition

Common Crohn’s symptoms like diarrhea can reduce the body’s ability to absorb protein, fat, carbohydrates, water, vitamins, and minerals. As a result, it is important to maintain good nutrition because Crohn’s often reduces your appetite while increasing your body’s energy needs. During flare ups, it is recommended to eat soft, bland food and drink plenty of fluids. Foods that are spicy, rich in fiber, and high in fat should be avoided.

Your doctor may make a referral to a dietician to help make sure that your diet includes a variety of foods from all food groups. Having a balanced diet may help reduce symptoms, replace lost nutrients, and promote healing.

Surgery

Two-thirds to three-quarters of people with Crohn’s will require surgery at some point during their lives. Surgery becomes an option when medications no longer control symptoms, or if you develop a fistula, fissure, or intestinal obstruction. While surgery does not cure Crohn’s, it can help conserve the healthy portions of the GI tract and repair or remove the affected sections.

Resources

There are many resources and organizations available that can help provide support, advocacy and information:

Crohn’s & Colitis Foundation of America (CCFA)
National Digestive Diseases Information Clearinghouse (NDDIC)

References

Centers for Disease Control and Prevention. http://www.cdc.gov/ibd/. Accessed May 7, 2015.

Crohn’s and Colitis Foundation of America.
http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed May 7, 2015.

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