Crohn’s Disease Overview
Crohn’s disease is a chronic disorder which causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling associated with Crohn’s disease extends deep into the lining of the affected organ. This swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.
The most common symptoms of Crohn’s disease are abdominal pain, which often affects the lower right area of the abdomen, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems and a fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Children with Crohn’s disease may suffer delayed development and stunted growth. The range and severity of symptoms vary.
A frequent complication of Crohn’s disease is blockage of the intestine. This blockage occurs because swelling and scar tissue thicken the intestinal wall, narrowing the passage. Crohn’s disease may also cause sores or ulcers that tunnel through the affected area into surrounding tissues, such as the bladder, vagina or skin. The areas around the anus and rectum are often affected. These tunnels, called fistulas, are a common complication and often become infected. Nutritional complications are also common in people who have Crohn’s disease. Other complications include arthritis, skin problems, inflammation of the eyes or mouth, kidney stones, gallstones and other diseases of the liver and biliary system. Some of these complications are resolved during treatment for the disease in the digestive system, but some must be treated separately.
Treatment for Crohn’s disease may include drugs, nutritional supplements, surgery or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies and relieve symptoms. Current medical treatments will help manage the disease by lowering the number of times a person experiences a recurrence; however, there is no cure for Crohn’s disease.
- Anti-Inflammatory Drugs
Most people are initially treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs.
- Cortisone or Steroids
Cortisone drugs and steroids, called corticosteroids, provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications.
- Immune System Suppressors
Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine Infliximab (Remicade). This drug is the first of a group of medications that blocks the body’s inflammation response.
Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas or prior surgery.
- Anti-Diarrheal and Fluid Replacements
Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary.
The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may temporarily need to be fed intravenously through a small tube inserted into the vein of the arm.
Two-thirds to three-quarters of patients who have Crohn’s disease will require surgery at some point in their lives. Surgery becomes necessary when medications can no longer control symptoms.
Surgery is used either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess or bleeding in the intestine. At times, a surgery removing part of the intestine can help people with Crohn’s disease; however it does not eliminate the disease.
People who have Crohn’s disease may feel well and be free of symptoms for substantial spans of time while the disease is inactive. Despite the need to take medication for long periods of time, and occasional hospitalizations, most people with Crohn’s disease are able to hold jobs, raise families and function successfully at home and in society.