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The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.
Causes of Crohn’s Disease
Theories about what causes Crohn's disease abound, but none has been proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine. People with Crohn's disease tend to have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or result of the disease. Crohn's disease is not caused by emotional distress.
Source: National Institutes of Health
Symptoms of Crohn’s Disease
The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.
Source: National Institutes of Health
Exams and Tests For Crohn’s Disease
Testing for Crohn’s disease includes blood tests, diagnostic tests and a physical exam. Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also reveal a high white blood cell count, which is a sign of inflammation or infection somewhere in the body. By testing a sample of a person’s bowel movement, the doctor can tell if there is bleeding or infection in the intestines.
The doctor may do a diagnostic test, such as an upper gastrointestinal (GI) series to look at the small intestine. For this test, the patient drinks barium, a chalky solution that coats the lining of the small intestine, before x-rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine. The doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope—a long, flexible, lighted tube linked to a computer and TV monitor—into the anus (the opening in the bottom) to see the inside of the large intestine. The doctor will be able to see any inflammation or bleeding. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope. If these tests show Crohn's disease, more x-rays of both the upper and lower digestive tract may be necessary to see how much is affected by the disease.
Source: National Institutes of Health
Crohn’s Disease Diagnosis
Crohn’s disease is diagnosed by a history of patient symptoms, thorough physical exam and the results of a series of tests, both blood and diagnostic tests.
Source: National Institutes of Health
Crohn’s Disease Treatment
Treatment for Crohn's disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure.
Most people are first treated with medications that helps control inflammation and may have immunomodulatory effects in the intestinal walls. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on a similar medication called mesalamine that is actually one of the active byproducts or metabolites of sulfasalazine. Mesalamine is also known as 5-aminosalicylic acid or “5-ASA” and is available in different medication formulations as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take corticosteroids to control inflammation. These drugs are the most effective for active Crohn's disease, but they can cause serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person's resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteriods may eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the drug infliximab (brand name, Remicade) for the treatment of moderate to severe Crohn's disease that does not respond to standard therapies (mesalamine products, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab is an anti-tumor necrosis factor (TNF) substance. TNF is a protein produced by the immune system that may cause the inflammation associated with Crohn's disease. Anti-TNF agents such as infliximab removes TNF from the bloodstream before it reaches the intestines, thereby preventing inflammation. Investigators will continue to study patients taking infliximab to determine its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics or a medication from this class of antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine (which will help with the pain but also tends to cause constipation as a side effect). Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.
Source: National Institutes of Health
Managing Crohn’s Disease
Nutritional complications are common in Crohn's disease. Deficiencies of proteins, calories, and vitamins are well documented in Crohn's disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption). Special diets and vitamin supplements may help manage this common complication.
Some alternative or complementary approaches may help a person cope or reduce some of the stress associated with living with a chronic illness. As with any therapy, patients should discuss the benefits and drawbacks with their doctors before beginning an alternative or new type of therapy. If the doctor feels the approach has value and will not be harmful, it can be incorporated into a patient's treatment plan. However, it is important not to neglect regular healthcare.
Source: National Institutes of Health
Self-Care For Crohn’s Disease Patients
Crohn’s disease is a serious chronic disease however; most people continue to enjoy productive lives with periods of time or remissions that are symptom free. Proper nutrition is an important part of general good health and should be included in the treatment plan for Crohn’s disease. During periods when symptoms of Crohn’s disease are at their worst, a bland diet and increased fluid intake may help you maintain your health until symptoms resolve. Due to the chronic nature of the disease, some people may experience emotional stress coping initially with the diagnosis of Crohn’s disease and then later on. Take control of this stress and your disease by relying on family members, members of your health care team including your BioScrip pharmacist, and the support of Crohn’s disease support groups available in your area.
Source: Adapted from National Institutes of Health
Caring For Those With Crohn’s Disease
Friends and family members can help a person with Crohn’s disease manage their disease by learning about the condition and understanding how it affects the patient's life. Friends and family can provide emotional and physical assistance. Their support, as well as support from other people who have the same disease, can make it easier to cope.
Source: Adapted from National Institutes of Health
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