Crohn’s disease

 Definition of Crohn’s disease

 

Crohn’s disease (CD) is a type of inflammatory bowel disease commonly affecting the end of the small intestine but can affect the entire digestive tract in patches.

 

 

The exact cause of this disease is unknown but following factors might play a role in the development of CD:

1. Heredity

2. Immunity

3. Smoking

4. Environmental factors: Poor domestic hygiene

5. History of removal of appendix (appendicectomy) in childhood

 

 

Early symptoms include:

1. Diarrhea: Since the intestinal lining is inflamed and ulcerated, its ability to adequately process food and waste or absorb water is lost, resulting in diarrhea.

2. Pain in abdomen

3. Low-grade fever

4. Nausea

5. Vomiting

6. Lethargy

7. Loss of appetite

Late symptoms include:

1. Unexplained weight loss

2. Feeling unwell (malaise)

3. Blood in stool: Inflammation leads to the formation of small sores (ulcers) in the colon and rectum. These ulcers may join and become large ulcers that bleed, resulting in bloody stools.

 

 

1. Diagnosis: Complete blood count, liver function test, erythrocyte sedimentation rate (ESR), and stool culture to rule out an infectious cause of diarrhea. A special test called the p-ASCA (p-anti-Saccharomyces cerevisiae antibodies) test is done to confirm CD and differentiate it from ulcerative colitis.

2. Imaging: Barium follow-through is done to visualize the lesions; colonoscopy can be done if colon involvement is suspected. High-resolution ultrasound and spiral CT scan may also be done.

 

 

The main goals of medical treatment are to first achieve remission (the absence of symptoms) and then to maintain remission (prevent flare-ups of symptoms). There is no standard treatment for all patients; a plan is tailor-made for every individual case.

Following medicines are used during the treatment:

1. Aminosalicylates: These drugs decrease inflammation in the wall of the intestine and are effective in treating mild-to-moderate episodes of CD and preventing relapses and maintaining remission, e.g., mesalamine, balsalazide, etc.

2. Corticosteroids: These medicines are used to control short-term flare-ups, e.g., prednisone, methylprednisolone, budesonide, etc.

3. Immunomodulators: These medicines are commonly used to maintain remission in people unresponsive to other medicines.

4. Antibiotics: Like ciprofloxacin and metronidazole have limited benefit. They are used in CD affecting the colon or area around the anus.

5. Biologic therapies: These novel agents are indicated for people with moderate to severe active disease who have not responded well to conventional therapy, e.g., golimumab, infliximab, etc.

 

 

Complications of CD include:

1. Malabsorption and malnutrition

2. Weight loss and anemia

3. Fistula, i.e., a connecting path between the intestine and another organ, or to the skin surface

4. Stricture in intestine leading to an intestinal blockage

5. Abscess in the abdomen, pelvis, or around the anal area

6. Perforated bowel

Complications outside the GI tract like redness, itching and pain in eyes, mouth sore, pain and swelling of joints, osteoporosis, etc. may occur in later stages of the condition. See a doctor immediately if you start showing any of the symptoms of this disease, earlier the better.

 

 

Patients with CD can lead full and productive lives. When the disease is active it has a significant impact on patient’s quality of life due to flare-ups and complications.

The exact cause of the disease is not known hence it is difficult to prevent it, but certain lifestyle changes like reducing stress, not smoking, limiting insoluble fiber during active phase, limiting dairy and fat intake, eating small meals, taking nutritional supplements can help in managing the disease better.