Summary

Crohn’s Disease is one of two types of Inflammatory Bowel Diseases that affect the digestive tract. The exact cause of Crohn’s Disease is not known but there are clear risk-factors. The condition is life-long and there is no cure. If left untreated, it can lead to some life-threatening complications. However, with timely diagnosis and treatment, the condition and its symptoms can be managed well, so the person can live a normal life. In this article, we will learn more.

Introduction to IBD

As the name implies, Inflammatory Bowel Diseases (IBD) refers to a pair of conditions that are marked by chronic inflammation of tissues in the digestive tract. While the exact cause is not known, it is suspected that a weakened immune system’s response to a pathogen attack goes haywire in some cases causing unwanted and chronic inflammation of the GI tract. The two types of IBD diagnosed till date are:

• Ulcerative Colitis: In this condition, there is inflammation and sores or ulcers that develop along the lining of the colon or large intestine, and rectum.
• Regional Enteritis or Crohn’s Disease (CD): In this type of IBD, there is inflammation of the lining of the digestive tract, which can extend up to deeper layers of the digestive tract. Crohn’s Disease generally affects the small intestine. However, in some people, CD can also affect the large intestine. Extremely rarely it may affect the upper gastrointestinal (GI) tract.

In both the types of IBD, there are symptoms such as bleeding in the rectum, diarrhoea, pain in the abdomen, weight-loss and constant fatigue. Both these types can be painful and there is no cure. They are lifelong conditions with life-threatening complications in some cases. In this article, we will stay focused on Crohn’s Disease.

Causes of Crohn’s Disease

In 1932, American gastroenterologist Dr. Burrill Crohn described the condition in detail after coming across a few cases. So, the disease is named in his honour. In the initial days, stress and diet were suspected to be the major causes of CD. However, with time, this understanding changed.

Today, some doctors classify CD as one among many auto-immune disorders where the immune system of the body starts attacking the body tissues. When certain pathogens like bacteria or virus enter the body, especially the digestive tract (through food, beverages and water), they trigger an immune system response, like it should normally happen. However, in some people, the immune system response is abnormal. In addition to attacking the pathogens, the immune system starts attacking the tissues in the digestive tract. Why this happens is not clearly understood, but there are certain risk factors as mentioned below.

Risk factors

• Age: In most cases, CD is diagnosed in people who are in their 30s. In the remaining cases, people have developed CD in the 50s, 60s and 70s. The condition is very rare in children, teenagers or young adults.
• Ethnicity: CD is more common among these communities than others: Africans in the UK and North America, Middle Eastern people and those of Jewish, Eastern European (Ashkenazi) descent. In recent years, its increasingly seen in people who migrate to the US. In Asia and India, the instances are rare but do exist.
• Genes: A family history of CD increases the risk. Having a parent, uncle, aunt, cousin, sibling or child with CD can increase the risk. Nearly 20% of all CD cases have a family member with CD.
• Cigarette smoking: This increases the risk by two times. It can lead to a severe form of the disease that will require surgery. Quitting smoking is inevitable for a CD patient.
• NSAID medications: Nonsteroidal anti-inflammatory drugs such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, etc), diclofenac sodium, etc can worsen the symptoms of CD in people who already have it or just developed it.
• Location: In most cases, CD patients live in urban areas (Tier-1 or 2 cities) or very industrialized nations. It is rarer in rural areas and developing countries.
• Diet: A diet high in fat or processed-foods increases the risk
• Infection: Bacteria such as Escherichia coli and Mycobacterium avium paratuberculosis increase the risk of CD.

Types of Crohn’s Disease

• Ileocolitis: This is the most common type of CD. It affects the colon and the last segment of the small intestine called the terminal ileum or just ileum.
• Ileitis: This affects only the ileum.
• Jejunoileitis: This causes inflammation in the upper half of the small intestine which is called the jejunum.
• Granulomatous colitis or Crohn’s colitis: This affects only the colon.
• Gastroduodenal Crohn’s disease: This is rarer. It affects the stomach and first part of the small intestine which is called the duodenum.

Symptoms

• Diarrhoea
• Constant fatigue
• Fever
• Pain, tenderness and cramps in the abdomen
• Blood, mucous or pus in the stools
• Mouth ulcers or sores
• Reduced appetite
• Unexplained weight loss
• Pain or fluid leaking from near, or around the anus
• Inflammation of bone joints, skin and eyes
• Inflammation of the bile ducts and/or liver
• Kidney stones
• Anaemia (Iron deficiency)
• Delayed growth and delayed sexual development in children
• Feeling full or bloated
• Abnormal skin tags, especially on the buttocks
• Nausea
• Pain or redness in the eyes

Complications

• Bowel obstruction: Gradually, some parts of the bowel can scar and narrow, which leads to blockages in the flow of food under digestion. This may require surgery to widen the passage or remove the diseased part of the bowel altogether.
• Ulcers: Ulcers or sore in mouth, anus and genital area (perineum).
• Fistulas: A fistula is an abnormal connection between two organs. The ulcers caused by CD can get wide and deep and create fistulas between loops of the large intestine, bowel and bladder, or bowel and vagina. This leads to infection and abscess (collection of pus). This is a life-threatening complication that needs emergency treatment.
• Anal fissure: A small tear develops in the tissue lining the anus or skin around the anus.
• Malnutrition: Diarrhoea, pain and cramps in the abdomen cause the person to skip meals, leading to malnutrition, anaemia and Vitamin-B12 deficiency.
• Colon cancer
• Skin conditions: Hidradenitis suppurativa is a painful skin disorder in which deep nodules, abscess and tunnels develop in the armpits, under the breasts, groin and genital area.
• Liver or gallbladder disease in some patients
• Medication risks: Since medication for CD aims to suppress the immune system, it increases the risk of cancers such as lymphoma and skin cancer, osteoporosis and bone fractures, cataract and glaucoma in the eyes, diabetes, hypertension etc.
• Blood clots: Crohn’s disease increases the risk of blood clots in arteries and veins

Diagnosis

• Medical history: Both the person’s and family medical history are thoroughly checked.
• Physical examination: This looks for bloating, pain and tenderness in the abdomen, along with running a stethoscope on the abdomen to listen to the sounds inside.
• Blood test: This looks for anaemia and immune system parameters
• Other tests: This looks for the liver functions, levels of inflammation in the GI tract and infections such as tuberculosis.
• Stool test: This looks for blood, parasites and bacteria in the stools
• Colonoscopy: An endoscopic procedure in which a lighted tube is passed through the colon, this looks for groups of granulomas (a type of inflammatory cells) that may indicate CD.
• CT scan: This looks at the entire bowel and tissues outside the bowel.
• CT enterography: A special type of CT scan where the patient consumes a special drink containing contrast material. This offers better images.
• MRI scan: This looks for fistula around the anus or small intestine.
• Capsule endoscopy: In this, the person swallows a small capsule which contains a camera. The camera takes photographs of the entire GI tract and relays them to a monitor screen in the room.
• Balloon-assisted enteroscopy: This is done as an adjuvant (in addition to) capsule endoscopy. This uses a scope along with a device called overtube to reach further into the small bowel where a standard endoscope cannot reach.

Treatment

Anti-inflammatory drugs

• Corticosteroids such as budesonide and prednisone
• Oral 5-aminosalicylates such as sulfasalazine, mesalamine and others

Immune system suppressors

• Azathioprine and mercaptopurine
• Methotrexate

Biologics

• Vedolizumab
• Infliximab
• Ustekinumab
• Risankizumab

Antibiotics

• Ciprofloxacin
• Metronidazole

Other medications

• Anti-diarrheals such as psyllium powder and methylcellulose
• Pain relievers such as acetaminophen, naproxen sodium and ibuprofen
• Vitamins and supplements

Nutrition therapy

This involves feeding the patient a special diet through the mouth, a feeding tube or a vein.

Surgery

This is done to remove a damaged part of the GI tract and then reconnect the healthy sections. It can also be done to close fistulas and drain out abscesses.

NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

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