Crohn’s disease causes long-standing inflammation of the digestive system, which can lead to severe symptoms and lasting damage if not caught and treated. Start a search to learn more about this disease, including how it’s diagnosed and treated.
Crohn’s causes a variety of uncomfortable and challenging symptoms, the two most common being abdominal pain and diarrhea. If you regularly experience either or both of these, talk to you doctor about screening for digestive system diseases.
Screening and Prevention
Currently, there are no professional guidelines that recommend screening for Crohn’s disease. This does not mean that there is no interest in developing screening tools for the disease, as the diagnosis of Crohn’s disease is often delayed.
With the recent development of the Red Flags index — a clinical tool that has great potential for predicting the presence of Crohn’s disease based on early signs and symptoms — this may change. Furthermore, Crohn’s disease cannot be prevented.
Diagnosis
As Crohn’s disease shares similar signs and symptoms with other digestive system diseases, your doctor will need to eliminate other possible causes for your symptoms. There isn’t a single test or examination to diagnose Crohn’s disease. Your doctor will begin the process by taking a thorough medical history and performing a thoughtful physical examination.
As part of the medical history, your doctor may ask you about your current medications and about the presence of the following:
- Abdominal pain and/or cramping
- Family history of IBD
- Recurrent fevers
- Recent weight loss and/or fatigue
- Diarrhea and/or bloody stools
As part of the physical examination, your doctor will take your vital signs, such as weight, temperature, blood pressure, and pulse. Other pertinent parts of the physical examination should include attentive abdominal and rectal exams.
Your doctor may order lab tests such as a complete blood count to check for anemia and the possible presence of an infection. Other blood tests may include a check of electrolytes, kidney and liver function, C-reactive protein or erythrocyte sedimentation rate, and iron and vitamin B12 levels. Additionally, a stool sample may be collected to check for the presence of microscopic blood or white blood cells as well as culture to rule out bacterial or parasitic infections.
Procedures that may be useful in your doctor’s investigation for Crohn’s disease include:
- Colonoscopy, which is one of the most important diagnostic tools, as it visualizes the entire colon and provides the opportunity for tissue sampling
- Abdominal computed tomography or magnetic resonance imaging
- Flexible sigmoidoscopy
- Video capsule endoscopy, which involves swallowing a capsule with a miniaturized video camera
- Balloon assisted enteroscopy, which is most useful if video capsule endoscopy reveals possible disease, but the diagnosis of Crohn’s disease is still in question
Treatments
Currently, there is no cure for Crohn’s disease. As a result, the goal of treatment is the reduction of associated inflammation. This can lead to relief of symptoms, long-term remission, and limitation of complications — all of which can improve the long-term prognosis of the disease.
Drugs
There are several classes of drugs that can be used in the management of Crohn’s disease.
Anti-Inflammatory Drugs
As Crohn’s disease is a chronic inflammatory condition, the first class of drugs used to treat the disease is anti-inflammatory drugs.
Steroids, such as prednisone and budesonide, are mainstays in the treatment of Crohn’s disease. They should be used in short courses of three to four months due to their potential for serious side effects, which includes weight gain, cataracts, diabetes, high blood pressure, and osteoporosis.
Also in this class are the two main oral 5-aminosalicylate (5-ASA) drugs — sulfasalazine (Azulfidine) and mesalamine (Asacol). Nowadays, they are considered to be of limited value in the treatment of Crohn’s disease.
Immunosuppressant Drugs
Another class of drugs used to manage Crohn’s disease is immunosuppressant drugs. They fight inflammation by targeting the immune system, whose cells produce pro-inflammatory substances. This class of drugs is often used in combination with 5-ASA drugs.
Common immunosuppressants used to treat Crohn’s disease include:
- Azathioprine (Imuran)
- Cyclosporine (Neoral)
- 6-mercaptopurine
- Tacrolimus (Prograf)
- Methotrexate (Rheumatrex)
The most common side effects of immunosuppressant drugs are increased susceptibility to infection, diarrhea, nausea, and vomiting.
Biologics
Biologics are a relatively new class of drugs used to treat Crohn’s disease. They are typically reserved for Crohn’s patients non-responsive to steroids, 5-ASA drugs, and immunosuppressants.
The most commonly used drugs in this class work by blocking tumor necrosis factor (TNF), an inflammation-promoting protein. The classic anti-TNF drugs include infliximab (Remicade) and adalimumab (Humira).
Alternatives to anti-TNF drugs are drugs that target integrin, another inflammation-promoting protein, of which natalizumab (Tysabri) and vedolizumab (Entyvio) are examples.
Antibiotics
Antibiotics are another class of drug used to treat Crohn’s disease, specifically the infectious complications of the disease such as fistulas, abscesses, and perianal disease.
Commonly prescribed antibiotics for Crohn’s disease include metronidazole (Flagyl) and ciprofloxacin (Cipro).
Other Medication
Other medications used in the treatment of Crohn’s disease, depending on the symptom or complication, may include:
- Anti-diarrheals (Imodium A-D)
- diphenoxylate with atropine (Lomotil)
- Iron supplements
- Vitamin B12 injections
- Calcium and vitamin D supplements
Surgery
Surgery is sometimes the last resort or needed emergently for the complications associated with Crohn’s disease. It is estimated that 66 to 75 percent of patients with Crohn’s disease will need one or more surgeries during their lifetime.
The following surgeries may be used to treat Crohn’s disease:
- Colectomy to remove damaged portion/s of the colon
- Proctocolectomy to remove the colon and rectum, which usually requires the creation of an ostomy
- Strictureplasty to repair strictures resulting from chronic inflammation
Complications
If you have been diagnosed with Crohn’s disease, you are at risk for a multitude of complications. In general, complications of Crohn’s disease can be categorized as:
- Local: Affecting only the intestines
- Systemic: Manifests outside of the intestines
Local Complications
Local complications of the disease may include:
- Abscesses: Pockets of pus secondary to a bacterial infection that may be characterized by swelling, tenderness, pain, and fever.
- Strictures: Portions of the bowel that has become thickened and narrowed due to chronic inflammation. It can lead to bowel obstruction.
- Perforations: Holes in the wall of the small intestine or colon. They are considered a surgical emergency.
- Malabsorption: Can lead to anemia from iron and/or vitamin B12 deficiency.
- Anal Fissures: Painful tears in the anus that can become infected and lead to perianal fistulas.
Fistulas are abnormal connections between the intestines and other organs. They are local complications that deserve special mention due to their variation, which are determined by their location. The different types of fistulas include:
- Entero-Vesical Fistula: The intestines communicate with the bladder. It is characterized by the passage of gas, blood, or even stool when Crohn’s patients urinate.
- Entero-Vaginal Fistula: The intestines communicate with the vagina. It is characterized by the passage of gas or stool through the vagina.
- Entero-Cutaneous Fistula: The intestines communicate with the skin, causing the drainage of stool through the skin.
- Entero-Enteric Fistula: One portion of the intestines communicates with another portion of the intestines, which can have no symptoms or present with diarrhea and/or abdominal pain.
- Perianal Fistula: This is the most common type of fistula. It represents an abnormal communication between the skin and anus.
The last local complication of Crohn’s disease is colon cancer, also referred to as colorectal cancer (CRC). Having Crohn’s increases your risk of developing CRC. As a result, you should initiate CRC screening — preferably with a colonoscopy — eight to 10 years after a diagnosis of Crohn’s disease. In contrast, individuals at average risk for CRC should initiate CRC screening with colonoscopy at age 50.
Systemic Complications
Systemic complications of Crohn’s disease can affect various areas/body systems outside the walls of the intestines. They may include:
- Arthritis
- Erythema nodosum
- Pyoderma gangrenosum
- Skin tags
- Osteoporosis
- Episcleritis
- Scleritis
- Uveitis
- Kidney stones
- Fatty liver disease
- Gallstones
- Hepatitis
- Pancreatitis
Additionally, systemic complications that may occur specifically in children with Crohn’s disease include growth failure and delayed puberty.
Learn More Today
As a result of its possible complications, Crohn’s disease can be a challenging disease to manage. This makes early diagnosis and treatment critical, as it can potentially delay or prevent the development of complications.
Search online to learn more about Crohn’s and how it’s screened for and treated. Don’t hesitate to talk to your doctor if you have concerns about your own health.