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Crohn’s Disease

Overview

Crohn’s disease is one of the types of inflammatory bowel disease (IBD). It is characterized by chronic inflammation of the gut, resulting in recurrent attacks of diarrhea with/without bloody stools, abdominal pain, fever, or ulcers in the mouth that do not resolve with routine treatment and lead to severe health problems. It can affect any part of our gut, from the mouth up to the anus, and involves all the layers (deep) of the gut lining. It leaves small parts of the intestine unaffected, called the skip lesions, and can cause complications like strictures, obstruction, fistulas, anal ulcers, gut cancer, etc.

 

The main cause is unknown, although genetics, immunity and environmental factors are thought to play a role. It affects cigarette smokers twice more likely than nonsmokers. Apart from the gut, it can affect other body parts like the eye, joints, and skin, resulting in conditions like uveitis, arthritis, skin nodules, rashes, etc.

Causes

Although the main cause is still unknown, an interplay between genetics, immunity, environmental factors, and gut microbial is hypothesized to be involved. The disease is more found in people with a family history of the condition. In genetically susceptible people, the body’s defense mechanism overreacts to simple gut infections or the normal microbes found in the gut, resulting in the inflammation of the intestines. Smoking plays a major role in causing Crohn’s disease. 

Epidemiology

The disease Is found more in developed countries and cold climates. It affects males and females equally. There are two peaks of ages affected by the condition, i.e., 15-30 years and 60-70 years of age. 

Risk Factors

Having one or more of the following risk factors can increase your chances of having the condition;

·         Family history

·         Living in the west: White Americans and Jews are more affected.

·         Gastrointestinal infection with some bacteria like E. Coli.

·         Taking a diet rich in high fats, high sugars, and low fibers can cause IBD.

·         Smoking

·         Stress

 

·         Use of medicines like NSAIDs 

Signs And Symptoms

You may have mild, moderate, or severe symptoms that can come and go, which means you may have flares of condition with alternating periods of complete remission. You may have the following signs and symptoms;

·         Diarrhea which may or may not be bloody

·         Abdominal pain or bloating

·         Passage of mucous from anus without passing stool

·         Fever may be present, especially during the flares

·         Mouth, anal ulcers, or fistulas may be present

·         IBD may also affect the eyes (uveitis), joints (arthritis), skin (nodules and rashes), bile ducts ( cholangitis), etc.

·         Weight loss

·         Malaise, fatigue

 

·         Anemia (deficiency of hemoglobin to carry oxygen due to blood loss)

Diagnosis

Some tests aid in the diagnosis of Crohn's disease along with history and examination. Your doctor may take a detailed history of your current symptoms, previous episodes, family history, etc., after physical examination. You may be advised of the following tests;

Blood tests: Complete blood count (CBC), Erythrocyte sedimentation rate (ESR), and C-reactive protein levels (CRP), iron studies, red blood cell folate, Vitamin B12 evaluation, ANTIBODY testing like; Perinuclear antineutrophil cytoplasmic antibodies (ANCA).

Stool studies: Ova and parasite studies, Fecal calprotectin level, Clostridium difficile infection, Stool culture, bacterial pathogens culture, etc.

Imaging: X-ray abdomen, ultrasound abdomen, CT scan, MRI abdomen and pelvis, Barium double-contrast enema.

Colonoscopy: A thin, flexible tube with a lighted camera is inserted in your colon through the anus, visualizing the interior of the colon and rectum. The doctor may also take out a small piece of tissue to be sent for biopsy.

Flexible sigmoidoscopy: A thin, flexible tube with a lighted camera is inserted in the sigmoid part of your colon only through the anus to see the lining and take the biopsy.

Upper GI Endoscopy: A thin, flexible tube with a lighted camera is inserted through your mouth to see the upper part of your gut including the esophagus, stomach, the duodenum.

 

Capsule endoscopy: You may be given a capsule with a camera to eat that will travel along the gut and the images are recorded throughout. 

Differential Diagnosis

Many other conditions affecting the gut can look like that of Crohn's disease.

·         Ulcerative colitis

·         Celiac disease

·         Irritable bowel disease

·         Infectious colitis

·         Amebic dysentery

·         Lactose intolerance

·         Behcet disease

·         Ischemic colitis

 

·         Intestinal tuberculosis

Treatment

You need to consult your healthcare provider if you feel that you might be suffering from Crohn’s disease. A multidisciplinary approach has to be used to treat Crohn’s disease. It’s a chronic illness with no cure. The treatment goals are to keep the disease in remission, prevent the flares, halt the progression, prevent complications, control the symptoms, and improve the overall quality of life for the patients. The treatment includes the use of medicines, surgeries, and lifestyle modifications.

The following modalities are used;

Medicines are used to control the symptoms and heal the inflammation. The most commonly used medicines are anti-inflammatory.

1-      5-ASA drugs (aminosalicylates): Balsalazide (Colazal), Mesalamine (Apriso, Pentasa), Sulfasalazine (Azulfidine).

2-      Corticosteroids: Budesonide (Uceris), Prednisone (Prednisone Intensol), Methylprednisolone (Medrol).

3-      Immunomodulators: Methotrexate (Trexall), Azathioprine (Imuran), Mercaptopurine (Purixan)

4-      Biologics: Adalimumab (Humira), Golimumab (Simponi), Infliximab (Remicade), Natalizumab (Tysabri).

5-      Antibiotics are more useful in Crohn’s Disease.

6-      Antidiarrheal medicines and laxatives can also be used.

Surgery:

 

Surgical procedures are often performed to treat complications of Crohn’s disease such as fistulas, sinuses, abscesses, etc. 

Prognosis

Crohn’s disease is associated with episodes of remissions and exacerbations. The course depends upon the severity and the anatomic location of the gut. Local surgeries deal with the development of fistulas and sinuses. Some people get complications due to the medicines used in the treatment like steroids. The general condition of the patients is lower than normal people and they are at increased risk of malignancy.

Lifestyle Modifications

You may make the following changes in your lifestyle to cope with the illness;

·         Diet management: Avoid a diet rich in fats, sugars, processed food, and dairy products, and replace them with healthy, nutrient, and fiber-rich foods.

·         Avoid smoking

·         Manage stress with relaxation techniques and breathing exercises

·         Avoid unnecessary use of NSAIDs

·         Ensure food hygiene ( washed and cooked well) to avoid enteric infections.

·         Perform regular exercise.

·         Stay hydrated with optimum intake of fluids.

·         Join support groups

·         Try to be around your loved ones to prevent developing depression or anxiety.

 

·         Learn about your disease as much as possible.