Crohn’s Disease: Causes, Symptoms, Diagnosis, and Treatments

Overview

Crohn’s disease usually affects the ileum (the last portion of the small intestine) but in some cases it can occur anywhere along the GI tract from mouth to anus.

Inflammation in Crohn’s disease occurs in segments, with some colon areas being skipped (it is not continuous like colitis); the entire bowel wall from the inner to the outer lining gets inflamed.

As Crohn’s disease progresses it may cause thickening of the intestinal wall leading to narrowing of the intestinal passageway, which in time can result in intestinal obstruction preventing normal flow of stool.

Surgery must be done if the intestines become blocked.

Patients with Crohn’s disease usually suffer multiple bowel surgeries because when the diseased segment of the intestine is removed, in time (it takes anywhere from few months to 5 years) other previously healthy portions of the intestines become diseased and inflamed.

So one surgery triggers another until 50% or more of the intestine is removed causing Short Bowel Syndrome (when the patient runs to the bathroom 5-10 times daily and complains of chronic diarrhea, cramps, bloating, malnutrition and malabsorption.)

Crohn’s disease may also cause anal fissures (tear in the anal canal), abscesses (a pocket filled with urine,  feces or pus), fistulas (an abnormal passageway connecting two body cavities like the vagina and the rectum).

Besides intestinal symptoms, Crohn’s disease may affect  other organs and cause arthritis, osteoporosis, eye pain and inflammation, skin lesions, hemolytic anemia and depression.

Anemia can become chronic in Crohn’s disease due to blood loss, vitamin B12 deficiency (B12 is absorbed in the ileum), medication use (such as sulfasalazine and azathioprine).

And last but not least, Chrohn’s disease increases patient’s risk for small or large bowel cancer.

Cause

The following risk factors may trigger Crohn’s disease:

• Viral / Bacterial infections
• Antibiotics
• Cigarette smoking
• Birth control pills
• Food allergies/sensitivities
• High intake of meat and simple sugars

Symptoms

• Abdominal pain (often in the right lower side)
• Diarrhea with blood and mucus
• Weight loss, poor appetite, fat malabsorption
• Fever, fatigue, nausea/vomiting

Diagnosis

A gastroenterologist should complete a complete physical examination together with a detailed medical history along with the following tests:

Blood Work

• CBC (complete blood count) for anemia and leucocytosis (C-reactive protein and ESR (erythrocyte sedimentation rate) indicate inflammation process)
• Vitamin B12 and folate levels
• Serological marker ASCA (anti-Saccharomyces cerevisiae antibodies) found in 60-70% of patients with Crohn’s.

Colonoscopy

A colonoscopy can be used to see the terminal ileum.  During colonoscopy, physician takes few biopsies (small tissue samples) for confirming Crohn’s disease diagnosis and pathology analysis.

Radiologic tests

Radiologic tests such as CT and MRI are used to locate small bowel obstruction, fistulae and abscesses.

Wireless Camera Capsule

A new technique using a wireless capsule has been used to identify Crohn’s disease in the small bowel.  Patient swallows a capsule with a built-in camera. While camera goes through the entire GI tract, it takes pictures. At the end, the patient discharges the capsule from the anus together with feces.

Medical Treatment

Drugs and surgery are two ways modern medicine treats Crohn’s Disease.

Antibiotics

Antibiotics are used to treat fistulas and perineal (pelvic area) Crohn’s disease.

Example: Flagyl (Metronidazole) and Cipro (Ciprofloxacin).

Side Effects: Nerve damage, vomiting, nausea, cramps and a metallic taste in the mouth.

Corticosteroids

Corticosteroids are used to reduce inflammation in moderate to severe Crohn’s  disease.

Example: Prednisone and Budesonide.

Side Effects: Osteoporosis, high blood pressure, increased risk of infection, depression and mood swings.

Immunosuppressive Drugs

Immunosuppressive drugs block inflammation by suppressing the body’s immune system. Immunosuppressants are used when Crohn’s disease stops responding to steroids.

Example: Methotreaxate, Imuran (Azathioprine), 6-MP (6-Mercaptopurine), Remicade (Infliximab), Humira (Adalimumab).

Side Effects: Pancreatitis, hepatitis, weakened immunity, bone marrow toxicity, upper respiratory infections, lymphoma, liver cirrhosis.

Galina’s Opinion

Crohn’s is an autoimmune disease.  When our immune system becomes suppressed and out of balance, we get sick with autoimmune diseases.

I cannot find any logic in suppressing our already compromised immune system further with immunosuppressive drugs, when it should be strengthened and rebalanced via diet, physical exercise, natural herbs and supplements.