Treatment of Crohn's disease

What is Crohn’s disease?

Crohn's disease is a chronic condition that leads to inflammation in the digestive tract, with the small intestine and the beginning of the large intestine being the most commonly affected areas. However, the disease can impact any part of the digestive system, from the mouth to the anus. The disease is considered a type of inflammatory bowel disease (IBD); other forms of IBD include ulcerative colitis and microscopic colitis. Symptoms of Crohn's disease may develop gradually and worsen over time, with periods of remission, where symptoms reduce or disappear, which can occur for weeks or years.

It's important to note that the symptoms and severity of Crohn's disease can vary significantly from person to person, and treatment plans are typically tailored to the individual. It has yet to be fully understood what causes Crohn's disease. It is believed to be a combination of genetic, environmental, and immune system factors. There is no cure for Crohn's disease, but treatment options include medications, dietary changes, and surgery in more severe cases. Therefore, working with a healthcare provider to manage symptoms and create an appropriate treatment plan for your specific needs is important.

How common is Crohn’s disease?

Crohn's disease is a chronic condition that affects the digestive tract, with symptoms such as inflammation and pain. This is one type of inflammatory bowel disease (IBD), along with ulcerative and microscopic colitis. It can affect any part of the digestive tract, with the small intestine and the beginning of the large intestine being the most common sites. The onset of Crohn's disease is usually gradual and may worsen over time, with periods of remission that can last for weeks or years. It is estimated that over half a million people in the United States have Crohn's disease. Studies have shown an increase in the incidence of the disease over time, but the cause is unknown.

Who is more likely to develop Crohn’s disease?

Crohn's disease is a chronic condition that can affect individuals of any age group, but it is more prevalent in people between the ages of 20 and 29. Additionally, those with a family member with IBD, specifically a sibling or parent, are at a higher risk of developing Crohn's disease. Furthermore, individuals who smoke cigarettes are at an increased risk of developing this condition.

What are the complications of Crohn’s disease?

Crohn's disease can also lead to complications such as intestinal obstruction, where the thickened areas of the intestine can narrow and block the movement of food or stool. This can cause problems such as fistulas, which are abnormal passages between two organs or between an organ and the outside body. These fistulas can become infected and lead to abscesses, which are pockets of pus-filled infection. Anal fissures, and small tears in the anus that cause itching, pain, and bleeding, are also common complications. The disease can also lead to ulcers, malnutrition, and inflammation in other areas, such as the eyes, joints, and skin.

What other health problems do people with Crohn’s disease have?

In addition to following the above recommendations for screenings, you should also talk to your doctor about any concerning symptoms or changes you may be experiencing and how your Crohn's disease is being managed in terms of medications, diet, and lifestyle changes. Regular monitoring of your condition and adjusting treatment plans as needed can help mitigate potential complications.

What are the symptoms of Crohn’s Disease?

Symptoms of Crohn's disease can vary widely; some people may have very mild symptoms, while others have severe symptoms. The most common symptoms of Crohn's disease include diarrhea, abdominal pain and cramping, and weight loss. Other symptoms that may be present include anemia, eye redness or pain, fatigue, fever, joint pain or soreness, nausea or loss of appetite, and skin changes such as red, tender bumps under the skin.
In addition, stress can play a role in exacerbating symptoms of Crohn's disease, and certain foods may also trigger flare-ups in some people. These symptoms may differ from person to person and can change over time, so it is important to work closely with a healthcare provider to manage the disease.

What causes Crohn’s disease?

The exact cause of Crohn's disease is not fully understood, but several factors have been identified that may contribute to the development of the condition. These include:

Genetics: Crohn's disease tends to run in families, suggesting a genetic component. Studies have identified certain genetic variations that may increase the risk of developing the disease.

Immune system: Crohn's disease is an autoimmune disorder, which means the immune system mistakenly attacks healthy cells in the body. Experts think that bacteria in the digestive tract can trigger the immune system and lead to inflammation.

Environmental factors: Some studies suggest that certain environmental factors, such as smoking and exposure to certain viruses or bacteria, may increase the risk of developing Crohn's disease.

Lifestyle factors: Some research suggests that a diet high in fat, as well as stress and certain medications (such as nonsteroidal anti-inflammatory drugs), may contribute to the development of Crohn's disease. However, these factors have not been definitively linked to the condition, and more research is needed to understand their role.

It's important to note that the cause of Crohn's disease is likely multifactorial and may involve a combination of genetic, environmental, and lifestyle factors.
However, they can exacerbate symptoms and trigger flare-ups in people who already have the disease.
It's important to note that these risk factors may not be the same for everyone, and the exact causes of Crohn's disease are still not fully understood. The development of Crohn's disease is likely to be a complex interaction of environmental, genetic, and immune factors.

How do doctors diagnose Crohn’s disease?

During the physical exam, the doctor may check for signs of inflammation or discomfort in the abdomen, listen to sounds within the abdomen using a stethoscope, and tap on the abdomen to check for tenderness or to see if the liver or spleen is abnormal or enlarged. To help diagnose Crohn’s disease, the doctor may also conduct diagnostic tests such as lab tests, intestinal endoscopy, upper gastrointestinal (GI) series, or computed tomography (CT) scans. These tests can help to rule out other diseases with similar symptoms, such as ulcerative colitis, diverticular disease, or cancer. The doctor may also ask you to keep a food diary to identify foods that may trigger symptoms and recommend a specific diet based on your symptoms or treatment.

Physical exam

During a physical examination, a physician will typically check for signs of bloating and swelling in the abdomen, use a stethoscope to listen for any unusual sounds within the abdomen, and use gentle pressing or tapping to check for any tenderness or pain in the abdomen. They may also check for any abnormalities in the size or shape of the liver or spleen. These techniques are used to assess the general health and condition of the abdomen and can provide insight into the presence of Crohn's disease or other gastrointestinal conditions.

Diagnostic tests

Diagnostic tests for Crohn's disease may include:
Blood tests to check for anemia or inflammation markers
Stool tests to rule out other causes of digestive diseases
Intestinal endoscopies, such as colonoscopy or upper GI endoscopy, allow the doctor to examine the inside of the digestive tract and take biopsy samples if necessary.
Imaging tests such as CT scans, which can provide detailed images of the gastrointestinal tract and detect complications such as abscesses or fistulas
Tests may also be performed to rule out other similar conditions, such as ulcerative colitis, diverticular disease, or cancer.

What tests do doctors use to diagnose Crohn’s disease?

Your doctor may perform the following tests to help with the condition’s diagnosis.

Lab tests

Additionally, doctors may use stool tests to check for blood or inflammation in the stool, which can indicate Crohn's disease.
Imaging tests. Imaging tests can help your doctor see inside your body and find the location and severity of the inflammation.

Endoscopy: an endoscope is a thin, flexible tube with a light and a camera. Your doctor will guide the endoscope through your mouth, down your throat, and into your stomach and small intestine. They will look for signs of inflammation and take small tissue samples (biopsies) for further analysis.

X-ray, CT scans, and MRI: these tests create detailed images of the inside of your body and can show inflammation or other abnormalities in your digestive tract.

Together, these tests can help your doctor diagnose Crohn's disease and determine the best course of treatment for you.

Intestinal endoscopy

Colonoscopy, upper GI endoscopy, enteroscopy, and capsule endoscopy are all methods that doctors may use to diagnose Crohn's disease. Colonoscopy is a procedure that uses a long, flexible, narrow tube with a camera on one end to look inside the rectum and colon. During a colonoscopy, a doctor may also examine the ileum to look for signs of Crohn's disease and take small samples of tissue (biopsies) to test for the presence of the disease. Upper GI endoscopy and enteroscopy involve using an endoscope to look inside the upper digestive tract, including the stomach and small intestine. In capsule endoscopy, a patient swallows a capsule with a tiny camera that allows doctors to see inside the digestive tract; no anesthesia is required. The capsule eventually leaves the body in a bowel movement, after which the doctor can review the images to diagnose.

Upper GI series

An upper GI series is a medical procedure used to view the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and small intestine. During the procedure, a mixture of x-rays and fluoroscopy, along with a chalky liquid called barium, is used to visualize the inside of the upper GI tract. A radiologist and x-ray technician performs this test in a hospital or outpatient center. Patients are instructed not to eat or drink anything beforehand to prepare for the procedure. No anesthesia is required for the process. The process involves standing or sitting in front of an x-ray machine and drinking barium. The barium helps to make the upper GI tract more visible on the x-ray. The patient will then lie on an x-ray table while the radiologist watches the movement of the barium through the upper GI tract on the x-ray and fluoroscopy.

CT scan

A CT scan is a medical imaging technique that combines x-rays and computer technology to create detailed images of the digestive tract. The procedure may involve drinking a solution and receiving an injection of a special dye called a contrast medium. The contrast medium helps to highlight specific structures inside the body, making them easier to see in the images. Next, the patient will lie on a table that is moved into the center of a large, tunnel-shaped machine that takes the x-rays. CT scans are useful for diagnosing Crohn's disease and any complications that may have developed due to the disease.

How do doctors treat Crohn’s disease?

Crohn's disease is managed by a combination of medications, bowel rest, and surgery, depending on the severity of the condition. Since the disease affects individuals differently, there is no one-size-fits-all treatment plan for every patient. The main objectives of treatment for Crohn's disease are to reduce inflammation in the intestines, prevent symptoms from worsening, and maintain remission.

Medicines

Many individuals with Crohn's disease require medication to manage their symptoms, and the specific drugs prescribed will vary depending on the patient's particular needs. While there is no cure for Crohn's disease, medications can effectively reduce symptoms.

Aminosalicylates are a type of medication that contain 5-aminosalicylic acid (5-ASA), which helps to control inflammation. These medications are commonly prescribed to people newly diagnosed with Crohn's disease who have mild symptoms, and examples include balsalazide, mesalamine, olsalazine, and sulfasalazine. Common side effects of aminosalicylates include diarrhea, headaches, heartburn, nausea, and abdominal pain.

Corticosteroids, also known as steroids, are another type of medication used to reduce inflammation by suppressing the activity of the immune system. They are typically prescribed for people with moderate to severe symptoms. Corticosteroids can cause side effects such as acne.

Immunomodulators are another class of medication used to manage Crohn's disease. They work by reducing immune system activity, which leads to less inflammation in the digestive tract. Examples of immunomodulators include 6-mercaptopurine, azathioprine, cyclosporine, and methotrexate. These medications may take several weeks to three months to start working. They are typically prescribed to help the patient enter into remission or if other treatments have been ineffective. Side effects can include a low white blood cell count, increasing risk of infection, fatigue, nausea, vomiting, and pancreatitis.

Biologic therapies are also used to treat Crohn's disease. These medications target proteins made by the immune system, and neutralizing these proteins can decrease inflammation in the intestines. Biologic therapies are often prescribed when other treatments have been ineffective; examples of biologic therapies include anti-TNF-alpha therapies, anti-integrin therapies, anti-interleukin-12, and interleukin-23 therapy. However, these therapies may have side effects, including toxic reactions to the medicine and an increased risk of infections, particularly tuberculosis.

Other medications that may be prescribed for Crohn's disease include acetaminophen for mild pain, antibiotics to prevent or treat complications such as abscesses and fistulas, and loperamide to slow or stop severe diarrhea. In most cases, loperamide is only taken for short periods as it can increase the risk of developing a megacolon. It is important to have open and honest communication with your doctor about the potential risks and benefits of any medication being considered.

Bowel rest

A period of bowel rest may be necessary in cases of severe Crohn's disease symptoms. This involves restricting food and liquids for a certain period, ranging from a few days to several weeks. During this time, a fluid containing nutrients may be consumed, and in some cases, nutrition may be provided through a feeding tube or intravenously through a tube inserted into a vein in the arm. Depending on the case and the treatment plan, this may be done in the hospital or at home. In addition, bowel rest allows the intestines to heal and may help alleviate symptoms of inflammation.

Surgery

Surgery is often necessary to treat Crohn's disease, even with medication. Studies show that up to 60% of individuals with Crohn's disease will require surgery within 20 years of diagnosis. Surgery can improve symptoms and treat complications of the disease, but it does not cure Crohn's. Surgery is typically recommended for fistulas, life-threatening bleeding, intestinal obstructions, side effects from medications, or when symptoms do not improve.
During surgery, general anesthesia will be used, and recovery time ranges from 3 to 7 days in the hospital and 4 to 6 weeks to fully recover.

Several types of surgeries can be performed to treat Crohn's disease:
Small bowel resection, which involves removing a portion of the small intestine
Subtotal colectomy, also known as large bowel resection, involves removing a part of the large intestine
Proctocolectomy and ileostomy, which is the removal of the entire colon and rectum, and an ileostomy, which is an opening in the abdomen that allows the removal of waste from the small intestine outside the body. This surgery requires using an ostomy pouch for the rest of your life.
It's important to note that surgery does not guarantee a cure, and Crohn's disease may recur after surgery. Therefore, the decision to have surgery and the type of surgery is typically made on a case-by-case basis after careful consideration of the individual's symptoms, the potential benefits, and the risks involved.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

Intestinal obstruction. A complete intestinal obstruction is life-threatening. You will need medical attention immediately if you have a complete obstruction. Doctors often treat complete intestinal obstruction with surgery.

Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas others need surgery.

Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.

Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.

Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.

Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.

Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medication.

How can my diet help the symptoms of Crohn’s disease?

Dietary modifications can help manage symptoms associated with Crohn's disease. Your doctor may suggest specific dietary changes, such as avoiding carbonated drinks and high-fiber foods and eating smaller, more frequent meals. It may also be beneficial to keep a food diary to help identify foods that may trigger symptoms.

Depending on individual symptoms or medications, a specific diet may be recommended, such as those high in calories, lactose-free, and low in fat, fiber, or salt. It is important to consult with your doctor to determine the appropriate dietary recommendations for you.

Additionally, if there is malabsorption, nutritional supplements and vitamins may be suggested by a doctor to ensure adequate nutrient intake. However, it is crucial to talk with your doctor before taking dietary supplements, vitamins, or alternative medicines or practices for safety reasons.

Clinical Trials for Crohn’s Disease

The National Institutes of Health (NIH), specifically the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), conducts and supports research on various digestive disorders through basic and clinical studies.

What are clinical trials, and are they right for you?

Clinical trials are an essential aspect of clinical research that plays a crucial role in the advancement of medicine. They explore new methods for preventing, detecting, and treating diseases and investigate ways to enhance the quality of life for individuals with chronic conditions.

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