General Illness Information
Medical Term: Regional Ileitis, Granulomatous ileitis
Crohn’s disease is a chronic inflammation of the intestinal wall, usually affecting the full thickness of the intestinal wall. The disease typically affects the most distal part of the small intestine (ileum) and the large intestine. One-third of the cases involve only the small bowel, most commonly the terminal ileum. About half of the cases involve the small bowel and the colon. In 15 to 20% of the cases only the colon is affected.
It occurs equally in both sexes, and tends to run in families that also have a history of ulcerative colitis. Usually occurs between the ages of 14 and 24.
It occurs more commonly among the Caucasians than African-Americans and Asians. Also higher incidence among the Jews. Prevalence is 20-100/100,000
Unknown- However, research is focusing on three main possible causes, namely, dysfunction of the autoimmune, system, infection , diet and smoking cessation.
Prevention: Cannot be prevented at present.
Signs & Symptoms
- Because of variable nature and location, there may be a variety of signs and symptoms;
- Insidious onset;
- Intermittent bouts of low grade fever, diarrhea and right lower abdominal pain;
- Appetite and weight loss;
- Abdominal tenderness and mass, usually in the right lower quadrant;
- Perianal disease with fissures, fistulas and abscesses (usually occurs in one third of the patients with Crohn’s disease);
- General malaise
Attacks begin in patients in early 20’s, and become chronic, with relapses and remissions.
Crohn’s disease is often associated with certain disorders affecting other parts of the body such as arthritis, episcleritis (inflammation of whites of the eyes), ulceration in the mouth, painful skin nodules on arms and legs (erythema, nodosum), blue-red skin sores filled with pus (pyoderma gangrenosum) and inflammation of bile ducts (primary sclerosing cholangitis).
Sometimes associated with kidney stones (calcium and oxalate stones).
- Family history of Crohn’s disease;
- Smoking may be a risk;
- Medical history of food allergies
Diagnosis & Treatment
The initial diagnosis of Crohn’s is based on the patient’s history of crampy abdominal pain and diarrhea, especially if the person also has inflammation of joints, eyes and skin.
There are no laboratory test available to confirm the diagnosis, however, the blood tests may show anemia, a low white blood cell count and low albumin levels.
Investigations such as an upper gastro-intestinal series with small bowel follow through and a barium enema may help in making the diagnosis. If the diagnosis is still in doubt, a colonoscopy (examination of the large bowel using a flexible viewing tube) and a biopsy will help confirm the diagnosis.
Crohn’s disease is a chronic life-long illness characterized by relapses and remissions and for which there is no cure. Treatment is aimed at relieving the symptoms.
Use heat to relieve pain. Apply a heating pad or warm compresses to the abdomen.
Warm water baths may help reduce discomfort.
Check your stool daily for signs of bleeding. Take any suspicious specimens to the doctors office for analysis.
Surgery (ileostomy) to resect the inflamed area (sometimes) although non-surgical treatment is preferred.
- Pain relievers;
- Antidiarrheal medication. Chronic diarrhea may respond dramatically to anti-diarrheal agents. Loperamide (2-4mg), diphenoxylate with atropine (one tablet), and tincture of opium (8-15 drops) may be given as needed up to four times daily;
- Antispasmodics – Propantheline (15mg) , dicyclomine (10-20mg), or L-hyoscyamine (0.125mg) given before meals may reduce abdominal cramps. However patients should discontinue these at the first sign of intestinal obstruction;
- Anti-inflammatory drugs and immuno-suppressant medication. Sulfasalazine and related drugs can suppress inflammation in the large bowel but it is not very effective for inflammation in the small intestine. The newer compounds called mesalamine have fewer side effects and are effective in treatment of inflammation in the terminal ileum. These drugs, however, are less effective in sudden, severe flare ups;
- Corticosteroids are useful in treating severe disease. Numerous side-effects make long-term use problematic. Generally, high doses are prescribed to relieve symptoms in a severe flare up and the dose is then tapered and then discontinued if possible. Some patients cannot be completely withdrawn from the steroids without experiencing a symptomatic flare up. These patients have to be maintained on a low dose of steroids;
- Long-term use of steroids may be associated with serious complications such as osteoporosis, avascular necrosis of the hips, cataracts, growth retardation in children, diabetes and high blood pressure;
- Immunosuppressive agents such as azathioprine and 6-mercaptopurine are used for intractable disease, and for reducing the steroid dose required to control the disease;
- Antibiotics to fight infections. Broad-spectrum antibiotics (antibiotics that are effective against many types of bacteria) are often prescribed. Metronidazole – appears to be effective in relieving symptoms of Crohn’s disease, especially if it affects the large intestine or if there are abscesses and fistulas around the anus;
- Others – cyclosporine is used for intractable fistulas;
- Experimental medications under investigations are methotrexate, chloroquine, fish oil, nicotine.
During acute attacks, rest is advised. Get up only to go to the bathroom, to bathe or to eat.
During periods between attacks, resume activities to the extent possible.
Usually no restrictions. However, patients should eat a well-balanced diet.
Because of lactose intolerance, a trial off dairy products is warranted.
If you have possible food allergies, omit milk, wheat, eggs, nuts and other suspected foods. Omit each one, especially milk, for a short period, then try it again in a few weeks.
Reducing the amount of fat in the diet may help.
If diarrhea is a problem, increase amount of fiber.
Defined formula diets- in which each nutritional component is precisely measured, may help in inducing a remission, but the relapse rate after resuming a normal diet is high.
Total parenteral nutrition (TPN) – Occasionally concentrated nutrients are given intravenously to patients with active disease and severe malnutrition. It is also given to patients pre-operatively to improve their nutritional status.
- Bleeding and anemia;
- Intestinal obstruction;
- Fistula between bowel and bladder;
- Perirectal abscess;
- Perforation of the inflamed bowel;
- Increased susceptibility to cancer of the ileum;
- Joint pain and inflammation; eye inflammation;
- Kidney disorders;
- Vitamin B 12
With proper medical and surgical treatment, the majority of patients are able to cope with the chronic disease and its complications, and lead productive lives. Few patients die as a direct consequence of the disease.