Crohn's disease, also known as ileitis or regional enteritis, is a chronic inflammatory disease of the digestive tract. In Crohn's, the intestine, bowel, or other part of the digestive tract becomes inflamed and ulcerated, marked with sores.
Named after Dr. Burrill B. Crohn, who first described the disease in 1932 along with colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, Crohn’s disease belongs to a group of conditions known as inflammatory bowel diseases (IBD), along with ulcerative colitis.
This shouldn't be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment. However, some people with IBD can also have IBS.
Crohn's disease usually affects the lower part of the small intestine, which is called the ileum, and the beginning of the colon. The disease, though, can occur in any part of the gastrointestinal system. Thus, the disorder may affect the large or small intestine, the stomach, the esophagus or even the mouth.
Crohn's can occur at any age. It is most commonly diagnosed in people who are between the ages of 15 and 30.
Crohn’s disease is often confused with ulcerative colitis. The symptoms are similar, and both involve periods of active flare-ups, followed by times when you don’t have symptoms, which is called remission.
The only way to find out if you have Crohn’s or ulcerative colitis is to see your doctor for tests.
Diagnosing Crohn's Disease
There isn't any one test that can tell you whether or not you have Crohn's disease. It has many possible symptoms that are the same as symptoms for other health problems. So, to make a diagnosis of Crohn's disease, your doctor is likely to gather information from multiple sources. You'll probably go through a combination of exams, lab tests, and imaging studies with these goals in mind:
Rule out other health problems that have similar symptoms
Make a clear diagnosis of Crohn's disease
Determine exactly which part of the digestive tract is affected
The following tests may help in the diagnosis:
Sigmoidoscopy - a short, flexible tube (sigmoidoscope) is used to investigate the lower bowel.
Solonoscopy - a long, flexible tube (colonoscope) is used to investigate the colon.
Endoscopy - this can be used if the patient has symptoms in the upper part of their gut. A long, thin, flexible telescope (endoscope) goes down through the esophagus into the stomach.
Barium enema X-ray - X-ray pictures of the abdomen show the inside of the bowel. Barium appears white on X-rays.
CT scans - X-rays are used to make a 3-dimensional picture of the bowel.
What Causes Crohn’s Disease?
The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause Crohn's disease. A number of factors, such as heredity and a malfunctioning immune system likely play a role in its development.
Immune system. It's possible that a virus or bacterium may trigger Crohn's disease. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
Heredity. Crohn's is more common in people who have family members with the disease, so genes may play a role in making people more susceptible. However, most people with Crohn's disease don't have a family history of the disease.
Risk factors for Crohn's disease may include:
Age. Crohn's disease can occur at any age, but you're likely to develop the condition when you're young. Most people who develop Crohn's disease are diagnosed before they're around 30 years old.
Ethnicity. Although Crohn's disease can affect any ethnic group, whites and people of Eastern European (Ashkenazi) Jewish descent have the highest risk. However, the incidence of Crohn's disease is increasing among blacks who live in North America and the United Kingdom.
Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease.
Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Smoking also leads to more-severe disease and a greater risk of having surgery. If you smoke, it's important to stop.
Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren) and others. While they do not cause Crohn's disase, they can lead to inflammation of the bowel that makes Crohn's disease worse.
Where you live. If you live in an urban area or in an industrialized country, you're more likely to develop Crohn's disease. This suggests that environmental factors, including a diet high in fat or refined foods, may play a role in Crohn's disease.
What Are the Symptoms of Crohn's Disease?
Lots of people have stomach cramps with diarrhoea or constipation. It’s uncomfortable, but you usually get over it and forget about it.
But when you have these symptoms often, and they’re severe, there’s a chance you could have Crohn’s disease. You’ll need to see your doctor to find out for sure.
Although there’s no cure, there are treatments to manage it.
You may have:
Bleeding from your rectum
Sudden and frequent need to go to the bathroom
The symptoms of Crohn's disease depend on where in the bowel the disease occurs. They also depend on its severity. Symptoms can include:
abdominal pain and tenderness (often on the lower right side of the abdomen)
delayed development and stunted growth (in children)
feeling of a mass or fullness in the lower right abdomen
You might not have all these. The disease affects different people in different ways causing symptoms ranging from mild to severe. They may vary over time and from person to person, depending on what part of the gastrointestinal (GI) tract is inflamed. And because symptoms vary from person to person, the way to gauge what you consider a flare-up of symptoms is relative to what is “normal” for you.
At its worst, Crohn’s disease can cause severe complications.
The most serious cases of Crohn’s can cause:
Painful tears called fissures in the lining of the anus, mostly during bowel movements
Fistulas (passages that form between loops of the intestine, or between the intestines and the vagina, skin, or bladder)
Thickening of intestine walls, which makes it hard for food and waste to move
A partly or totally blocked intestine, for which you would need medical care right away
Open sores called ulcers in the intestines, mouth, or anus
Malnutrition, as your body is not able to absorb enough nutrients from food
Pain, swelling, and burning in other parts of your body, such as your skin, eyes, or joints
How is Crohn's Disease Treated?
There is no cure for Crohn's disease. The goals for treatment are:
to reduce inflammation
to relieve symptoms of pain, diarrhoea, and bleeding
to eliminate nutritional deficiencies
Treatment might involve drugs, nutritional supplements, surgery, or a combination of these therapies. Treatment choices depend upon where the disease is located and how severe it is. They also depend on the complications associated with the disease and the way the person has responded in the past to treatment when symptoms recurred.
When to see a doctor
See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn's disease, such as:
Blood in your stool
Ongoing bouts of diarrhoea that don't respond to over-the-counter (OTC) medications
Unexplained fever lasting more than a day or two
Unexplained weight loss
Lifestyle and home remedies
Sometimes you may feel helpless when facing Crohn's disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.
It can be helpful to keep a food diary to keep track of what you're eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try eliminating them. Here are some suggestions that may help:
Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhoea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help.
Try low-fat foods. If you have Crohn's disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhoea worse. Try avoiding butter, margarine, cream sauces and fried foods.
Limit fibre, if it's a problem food. If you have inflammatory bowel disease, high-fibre foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. You may be told to limit fibre or go on a low residue diet if you have a narrowing of your bowel (stricture).
Avoid other problem foods. Spicy foods, alcohol, and caffeine may make your signs and symptoms worse.
Other dietary measures
Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhoea worse, while carbonated drinks frequently produce gas.
Consider multivitamins. Because Crohn's disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
Talk to a dietician. If you begin to lose weight or your diet has become very limited, talk to a registered dietician.
Smoking increases your risk of developing Crohn's disease, and once you have it, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Although stress doesn't cause Crohn's disease, it can make your signs and symptoms worse and may trigger flare-ups. Although it's not always possible to avoid stress, you can learn ways to help manage it, such as:
Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.
Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
Coping and Support
Crohn's disease doesn't just affect you physically; it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:
Be informed. One of the best ways to be more in control is to find out as much as possible about Crohn's disease. Look for information from the Crohn's & Colitis Foundation.
Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with Crohn's disease.
Talk to a therapist. Some people find it helpful to consult a mental health professional that’s familiar with inflammatory bowel disease and the emotional difficulties it can cause.
Although living with Crohn's disease can be discouraging, research is ongoing and the outlook is improving.