What is Crohn's Disease?
Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal
(GI) tract. It affects the ileum (small intestine) and the colon (large
intestine) in most cases, but can occur in any section of the GI tract
from the mouth to the anus.
What are common CD symptoms?
Common CD symptoms may include some or all of the following symptoms:
Symptoms may range from mild to severe and be sporadic in nature.
Cramping - abdominal pain
Low or high grade fever
Bloating or gas
Anal pain or drainage
How is CD diagnosed?
The diagnosis of Crohn's disease is suspected in patients with fever,
abdominal pain and tenderness, diarrhea with or without bleeding, and anal
diseases. Laboratory blood tests may show elevated white cell counts and
sedimentation rates, both indicating infection or inflammation. Other blood
tests may show low red cell counts (anemia), low blood proteins, and low
minerals, reflecting loss of these elements due to chronic diarrhea.
Barium x-ray studies can be used to define the distribution, nature,
and severity of the disease. Barium is a chalky material that is visible
by x-ray and appears white on x-ray films. When barium is ingested orally,
pictures can be taken of the stomach and the small intestines. When barium
administered through the rectum, pictures of the colon and the part
of the ileum closest to the colon can be obtained. Barium x-rays can show
ulcerations, swelling, narrowing, and, sometimes, fistulae of the bowel.
Direct visualization of the rectum and the large intestine can be accomplished
with flexible viewing tubes (colonoscopes). Colonoscopy is more accurate
than barium x-rays in detecting small ulcers or small areas of inflammation
in the bowel. Colonoscopy also allows for small tissue samples
(biopsies) to be taken and sent for examination under the microscope
to confirm the diagnosis of Crohn's disease. Colonoscopy is more accurate
than barium x-rays in assessing the activity and the degree of inflammation.
Computerized axial tomography (CAT or CT) scanning is a computerized
x-ray technique that allows imaging of the entire abdomen and pelvis. It
can be especially helpful in detecting abscesses.
The use of serology to test for antibodies to yeast and bacteria helps
us confirm the diagnosis and often helps us decide the best treatment strategy.
We have shown that the use of these tests improves the diagnostic accuracy
between Crohn's and ulcerative colitis where overlapping features of both
diseases may be present.
What causes CD?
The exact cause of CD has yet to be proven. Current theories
and research focus on immunologic and bacterial causation. Some researchers
believe that the immune system, acting by itself, attacks the GI tract.
Some researchers believe that a strictly environmental agent is involved
and some believe that an environmental agent causes triggering of
the immune response.
Where does CD occur?
CD can occur anywhere along the GI tract, from the mouth to the anus,
but is most common in the colon and distal ileum.
How is CD treated?
Drug therapy is the front line for treating CD, drug treatments can
include one or more of the following:
Corticosteroids: Prednisone, medrol, methylprednisolone, hydrocortisone
have been used since the 1950's for acute flare ups. Patients should take
a calcium supplement to prevent osteoporosis.
Herbal or supplement
Antidiarrheal: Imodium and Lomotil can help to reduce some symptoms,
great care should be used to avoid blockage.
5-ASA: Asacol, Pentasa, Dipentum and Rowasa enema, deliver the 5-aminosalicylate
molecule which has anti-inflammatory properties to the intestine wall.
5-ASA is a topical anti-inflammatory. 5-ASA are usually well tolerated.
Immunomodulators: Imuran, 6-MP, and Purinethol work by blocking the
immune system from causing inflammation, but may take up to six months
before being effective. Methotrexate may work quicker, but pregnancy needs
to be avoided if either partner has taken methotrexate in the past three
Antibiotics: Ciprofloxacin (Cipro), metronidazole (Flagyl), are used
primarily to fight intestinal infections that can lead to a flare, they
are also helpful in healing fistulas. RMAT (Rifabutin and macrolide antibiotic
therapy) treatment consist of clarithromycin (Biaxin) and rifabutin (Mycobutin)
plus a probiotic (good bacteria). In limited studies the remission rate
for RMAT is around 70%. Any antibiotic treatment should be coupled with
a good probiotic.
Herbal or supplement: Probiotics, Omega 3, and certain herbs have shown
promise in the treatment of CD or the relief of the symptoms. Please remember
that herbs and supplements act with in your body as drugs. It is important
to inform your doctor before attempting any herbal or supplement treatment.
Monoclonal antibody: Infliximab (Remicade) an anti-tumor necrosis factor.
This antibody blocks the production of tumor necrosis factor-alpha (TNF-alpha).
Studies show that TNF-alpha plays a role in inflammation. The long term
side effects have not been determined.
Surgery: Normally reserved for strictures or blockages. The chances
of a recurrence of the disease after surgery is very high.
A renewed interest in Crohn's research is bringing forth the great
promise of new and novel treatments. RMAT is on the forefront of these
new treatments. You can read about RMAT here.
The information contained in this site is intended
for information purposes only and is not intended as a means of diagnosing
or treating disease. Please consult your doctor before starting any treatment.