Crohn’s Disease

Overview

Crohn’s disease is a type of chronic inflammatory bowel disease (IBD). It primarily affects the digestive tract, causing symptoms like diarrhoea, abdominal pain, weight loss, and fatigue. While the exact cause is unknown, the disease is linked to genetics, immune system issues, and environmental factors. The disease cannot be cured, however, treatment plans such as medications, diet changes, and sometimes surgery can help manage symptoms and improve quality of life.

What is Crohn’s Disease?

Crohn's disease is an inflammatory bowel disease (IBD), which causes inflammation of tissues in the digestive tract. The inflammation can further lead to severe diarrhoea, abdominal pain, weight loss, malnutrition and fatigue. Different areas of the digestive tract can be inflamed, which can spread into deeper layers of the bowel.

Types of Crohn’s Disease

The different types of Crohn's disease are highlighted below:

Ileocolitis: It refers to the inflammation in the lower side of the small intestine (ileum), including a portion of the large intestine (colon). Symptoms may include diarrhoea, pain or cramps in the lower region of the abdomen and unexplainable weight loss.

Gastroduodenal Crohn's: This is the inflammation of the stomach and the upper region of the small intestine (duodenum). Signs one may notice include nausea, weight, and appetite loss.
Ileitis: Ileitis refers to the inflammation and irritation in the last section of the small intestine (ileum). One may notice sudden weight loss, pain in the lower abdomen and diarrhoea.

Jejunoileitis: Here, inflammation occurs in the middle part of the small intestine (jejunum), which causes symptoms such as abnormal discomfort, fistulas, cramps after taking meals and diarrhoea.

Colitis: It leads to the swelling of the lining of the large intestine (colon), causing the poop to become painful and more urgent. Complications can lead to weakened colon walls, increased risk of colon cancer and other inflammatory diseases.

Perianal Disease: It involves inflammation around the anus, causing abscesses and fistulas.

Symptoms of Crohn’s Disease

The symptoms of Crohn’s disease vary depending on the part of the gut it occurs in. However, an individual may notice signs and symptoms including pain in the gut or lower right side of the abdomen that transitions into inflammation. Besides mouth ulcers, ulcers may also develop in the gut, for which an individual may find blood in stool.

Fatigue, fever, nausea, vomiting, weight loss, appetite loss and diarrhoea are other common symptoms. One may also experience rectal bleeding and anal fissures. Females may experience discomfort or pain during sex, irregular menstruation and iron deficiency.

Causes of Crohn’s Disease

The causes of Crohn’s disease are not confirmed by researchers, however, it can be said that the disorder relates to an abnormal immune response. While the immune system usually protects the body against any germs and infections by causing inflammation, during an autoimmune response, the immune system mistakenly attacks the body’s healthy cells. It may attack the healthy bacteria found in one’s gut, causing inflammation (Crohn’s disease-related) in the intestines. However, in some cases, this chronic disease may develop due to inherited factors.

Risk Factors of Crohn’s Disease

While one can get the disease at any age, it is very common in late teenagers or individuals in their early 30s. Having a family member with a medical history of inflammatory bowel disease can also raise the risk for Crohn's. Specific gene mutations can increase one’s risk of developing the disorder. Studies also suggest that the risks are high for an individual who has had an appendix surgery. Other factors that flare up the risk include the habit of smoking, the body’s stress response and residing in urban or developed areas.

Diagnosis of Crohn’s Disease

A gastroenterologist will conduct a physical exam initially to check if you have the symptoms of Crohn’s. After finding anything suspicious, they may perform a series of tests to understand if other health conditions are causing similar symptoms. Laboratory tests may include blood tests (to check blood chemistry and blood cell counts) and stool tests (to measure the degree of inflammation in one’s intestines. Imaging procedures may include a CT scan and MRI to create detailed images of the digestive tract and the inside of the body.

A healthcare professional may also perform an endoscopy, in which they will sends a thin tube with a camera (endoscope) and light into the digestive tract to capture clear images of inflamed areas. The doctor may perform either a colonoscopy (examines the inside of the colon and ileum), upper endoscopy (from mouth to the above part of the small intestine) or capsule endoscopy (for checking the digestive tract).

Treatment for Crohn’s Disease

Crohn’s disease treatment does not cure the disorder, however, it helps the affected individual manage the symptoms and complications of the disease as they live with it. A doctor may recommend medicines for managing pain, inflammation and diarrhoea. Medications may include corticosteroids and budesonide (for inflammation), 5-aminosalicylates (for ulcerative colitis), immunosuppressants such as methotrexate azathioprine and JAK inhibitors, and loperamide (for severe diarrhoea).

TNF inhibitors, integrin inhibitors, Il-12/23 inhibitors and Il-23 inhibitors target proteins that cause one’s immune system to have a strong auto-immune response. Antibiotics are also recommended for patients who suffer from severe infections that lead to fistulas or abscesses. One may also be required to get the right nutrition that can improve gut health. In some cases, a medical professional may conduct surgery to remove blockages, intestinal perforations, and fistulas.

Prevention of Crohn’s Disease

Crohn’s disease cannot be prevented, but taking certain measures can help ease symptoms and lower complications and flare-ups. This includes avoiding smoking, caffeine, alcohol, medications (NSAIDs) that trigger flare-ups, and foods that cause inflammation (dairy products, carbonated beverages, spicy food, fatty and sugary foods). One must consume low-fat foods and drink plenty of water. Exercising and engaging in activities such as dancing, watching entertaining videos and talking to a friend can improve your mental health while making life with this chronic disorder manageable.

Myths and Facts Related to Crohn’s Disease

The following points highlight the myths and facts related to Crohn's disease:

Myth 1: Crohn's disease is caused by poor diet
Fact: While diet can trigger flare-ups, this complex condition is influenced by genetics, immune system issues, and environmental factors

Myth 2: Crohn’s disease only affects the digestive system
Fact: Crohn's does affect the gastrointestinal tract; however, it also causes symptoms such as skin conditions, eye inflammation and joint pain.

Myth 3: Crohn’s is the same as irritable bowel syndrome (IBS)
Fact: Crohn's is an inflammatory bowel disease (IBD), while IBS is a different condition that does not involve inflammation or damage to the intestines.