Regional enteritis - crohn's disease
Overview, Causes, & Risk Factors
Crohn's disease causes chronic inflammation of the gastrointestinal tract. It is one form of a condition known as inflammatory bowel disease.
What is going on in the body?
The cause of Crohn's disease is unknown. It is thought to be an autoimmune disorder. This means that the body's immune system attacks itself. The immune attack results in chronic inflammation of the gastrointestinal tract and other parts of the body.
What are the causes and risks of the disease?
The cause of Crohn's disease is not known, but it is thought to be an autoimmune disorder. Inherited factors also may play a role, since 20% to 25% of the people who have Crohn's disease have a close relative with this disease or a similar disease. Crohn's disease is more common among whites than blacks. Men and women are affected equally. The disease usually starts between 15 and 35 years of age.
New research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the fetus and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more fetal cells in their blood decades after a pregnancy than women who don't have scleroderma. While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men.
Symptoms & Signs
What are the signs and symptoms of the disease?
The first symptom of Crohn's disease is pain in the abdomen at or below the navel. Diarrhea often accompanies the pain, which usually follows a meal.
Crohn's disease may cause a wide variety of symptoms, such as:
- abdominal distress and cramping
- anemia, or low red blood cell counts
- arthritis, with joint pain and swelling
- liver damage
- loss of appetite
- malnutrition, as a result of damage of the intestines
- rectal bleeding
- skin rashes
- visual impairments
- weight loss
Diagnosis & Tests
How is the disease diagnosed?
Crohn's disease is diagnosed through medical history, physical examination, and laboratory tests. There is no one test or feature of the disease that confirms the diagnosis. Sigmoidoscopy is a procedure to examine the rectum and part of the large intestine. It involves passing a small telescope through the anus so that the rectum and large intestine can be seen directly. This procedure is very important if a person has long-term diarrhea or bloody diarrhea.
A blood test called a complete blood count, or CBC, may show anemia, a low level of red blood cells. Lab studies may also show abnormal liver function and low levels of certain vitamins and minerals. There may also be evidence of poor food absorption.
Another common test is the barium enema. In this test, a contrast agent called barium is injected into the intestine and X-rays are taken. Sometimes the diagnosis is made during surgery that is performed to find the cause of severe abdominal pain.
Prevention & Expectations
What can be done to prevent the disease?
There are no effective ways to prevent Crohn's disease. An individual may be able to reduce flare-ups by managing stress and eating a soft, bland diet.
What are the long-term effects of the disease?
The course of Crohn's disease varies. Because it has a tendency to come and go, it includes periods without any symptoms. Both gastrointestinal and arthritis symptoms of Crohn's disease tend to recur.
Chronic bowel problems include the development of fistulas. A fistula is an abnormal passage or duct formed by the disease. It can connect two different areas of bowel or connect the bowel to the outer skin. Other long-term effects include anal fissures, which are small tears, and pockets of pus near the rectum. A bowel obstruction or a hole or perforation in the intestines is also possible.
Mostly due to sepsis , an infection in the bloodstream, 5% to 10% of Crohn's patients will die from the disease. There is a slightly increased risk of colorectal cancer in people who have Crohn's disease.
What are the risks to others?
Crohn's disease is not contagious and poses no risk to others. There is some tendency for the disease to run in families.
Treatment & Monitoring
What are the treatments for the disease?
Medications used to treat Crohn's disease include the following:
- aminosalicylates, such as sulfasalazine and mesalamine
- corticosteroids, such as prednisone and methylprednisolone
- medications that alter the body's immune response, such as azathioprine, 6MP, and methotrexate
- antibiotics, such as metronidazole, ampicillin, and ciprofloxacin, for infections
Some persons need extra vitamins, minerals, and salts. A healthy diet is essential for maintaining body weight. A soft, bland diet may be better tolerated than a diet with spicy foods. Milk products may be restricted if the person has lactose intolerance. In severe cases, a person may need to be fed through an intravenous tube to improve his or her nutritional status.
Seventy percent of the people with Crohn's disease will have surgery at least once. A recent study showed that the surgery significantly improves the quality of life in individuals with Crohn's disease. Surgery may be done for one or more of the following effects of the disorder:
- A section of the intestines that is severely damaged or obstructed may be removed with a procedure called a resection and anastamosis. The damaged portion is cut out, and the bowel is sewn back together.
- If the rectum is diseased, an ileostomy may be done. This procedure involves taking a portion of the bowel to the outside through a hole in the abdomen and attaching a drainage bag.
- An incision and drainage may be done to drain abscesses, or pus pockets, near the rectum.
- A fistula repair may be done to close abnormal openings caused by the disease.
What are the side effects of the treatments?
Many of the medications used to treat Crohn's disease can cause stomach upset, allergic reactions, and an increased susceptibility to infection. Persons taking metronidazole may have severe vomiting and abdominal pain if they drink alcohol. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
What happens after treatment for the disease?
Crohn's disease is a long-term disease with occasional flare-ups. There can be periods without any symptoms. However, the symptoms usually reappear.
How is the disease monitored?
There is no specific test for monitoring Crohn's disease. Affected persons need to monitor their symptoms carefully. Any new or worsening symptoms should be reported to the healthcare provider.