Crohn's disease is a form of inflammatory bowel disease (IBD) that mainly affects the large and small intestines, but can appear anywhere between the mouth and anus. The most common place it occurs is in the ileum, the last part of the small intestine. Like ulcerative colitis, the other common type of IBD, it causes sores in the lining of the intestines and may lead to life-threatening complications. The main symptoms are severe diarrhea, abdominal cramping and general tiredness. Crohn's disease is an autoimmune disease, which occurs when your body's immune system attacks your own tissues. There are several treatment options available, but this condition often requires lifelong management including medications, dietary measures and, in some cases, surgery. Crohn's disease may also be referred to as regional enteritis, ileitis, terminal ileitis, granulomatous enteritis and colitis.
A group of conditions characterized by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
The inflammation associated with Crohn's disease involves the full thickness of the gut wall. The actual cause of this inflammation is unknown, but a combination of factors are thought to be involved. The current thinking is that an inappropriate response of the immune system is probably central to the cause. Our bodies usually have trillions of 'good' bacteria living in our intestines, helping to break down and absorb nutrients. Parts of these bacteria pass through the lining and become a target for the immune system. Immune cells within the wall of the bowel are activated, releasing immune mediators such as tumor necrosis factor (TNF). This process is thought to be an integral part of how Crohn's disease occurs.
In Crohn's disease, the released immune mediators cause inflammation of the gut wall.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
The following are thought to be risk factors in developing Crohn's disease:
Smokers are twice as likely to develop Crohn's disease as non-smokers. Smoking also makes the condition harder to manage, leading to more severe symptoms.
Crohn's disease is more common in certain ethnic groups, such as Caucasians and people of Jewish descent. You are also more likely to develop Crohn's disease if you have a close relative who has the condition.
Crohn's disease is much less common in undeveloped nations, pointing to an environmental link.
The symptoms of Crohn's disease can vary, depending on the extent, location and severity of the condition. A common area involved in Crohn's disease is the last part of the small intestine, called the terminal ileum. Involvement of the large bowel is also common, particularly in combination with terminal ileitis. Less prevalent patterns of involvement are isolated disease around the anus and the stomach and first part of the small intestine. All cases are different, but common symptoms are as follows:
The gastrointestinal system.
Depending on the severity of the condition, there is a wide range of other symptoms that may occur with Crohn's disease, such as:
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
The formation of an ulcer, which is an open sore in the skin or mucous membranes, such as those of the stomach lining, intestine or mouth.
Crohn's disease can easily be confused with other conditions that have similar symptoms, such as ulcerative colitis. Along with taking a full medical history, your doctor may want to conduct a range of medical tests in order to reach a correct diagnosis.
A full medical history will help your doctor discover whether your symptoms are consistent with inflammatory bowel disease. Your doctor will ask questions about the type and pattern of pain, the appearance and frequency of bowel motions and other related symptoms. A family history of bowel disease such as Crohn's may be discussed.
A physical examination will detect any tenderness in the abdomen, signs of changes in the anal region (fissures or abscesses) and any signs of inflammation.
These will check for infections, inflammation and internal bleeding. Levels of iron, proteins and certain minerals may also be checked.
Stool tests can help decide which type of bowel condition is present and also check for signs of parasites, blood, mucus, or infection.
This test involves inserting a thin, flexible, lit tube with a camera (endoscope) into parts of the intestines through the mouth (gastroscopy) or via the rectum (colonoscopy). You will be given a mild sedative to help you relax during the procedure and often will be asked to do a bowel preparation prior to the test. The endoscope can take video, photos and tissue samples to provide a highly detailed view of the bowels and locate areas of inflammation.
Colonoscopy procedure.
A biopsy of the wall of the gut is usually taken during an endoscopy. This sample can then be examined to look at the specific patterns of inflammation. For example, seeing inflammation that involves the full thickness of the bowel wall distinguishes Crohn's disease from other diseases such as ulcerative colitis.
These tests can be helpful in the diagnosis of Crohn's disease and its complications. They are also often used to monitor your condition and how you are responding to treatment.
Barium testing involves drinking a chalky liquid called barium (a barium swallow) or having the liquid inserted in the rectum (barium enema). This allows structures such as the esophagus, stomach, rectum and sigmoid colon to be clearly seen on X-ray. Strictures, inflammation, fistulas and other disorders may then be seen.
Magnetic resonance imaging (MRI) uses radio waves and magnets to create highly-detailed images of your internal organs. MRI may detect abnormalities and complications of Crohn's disease including abscesses or fistulas in the intestines, as well as changes in the bowel wall related to Crohn's disease.
A computerized tomography (CT) scan is a type of highly-specialized X-ray. A dye is ingested, injected or inserted into the rectum. Abnormalities of the intestines related to Crohn's and its complications can show up in a CT scan.
Ultrasound uses sound waves to create a picture of your internal organs. This will detect abnormalities such as abscesses, which can be complications of Crohn's disease.
A swollen area of tissue containing a build-up of pus.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
A group of conditions characterized by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.
As there is no known cure for Crohn's disease, the main focus of treatment is to reduce the inflammation that causes your symptoms and lessen the risk of complications. In the long term, this can reduce flare-ups and greatly improve your quality of life. In the best possible case, this could lead to you becoming symptom-free for long periods of time (remission).
Being diagnosed with Crohn's disease may make you feel helpless, but making simple changes to your lifestyle and diet may help you to manage your symptoms.
While there is no diet that has been shown to treat Crohn's disease, some people with Crohn's disease may find certain foods and drinks can make their symptoms worse during a flare-up. It is a good idea to keep a food diary to remind you which foods to avoid, as everyone is different, but some suggestions include:
Smoking increases your chances of developing Crohn's disease and tends to make all aspects of the condition worse. If you are a smoker and have Crohn's disease, you are more likely to have more flare-ups and also more likely to need surgery. By quitting smoking, symptoms of the disease can be alleviated.
Although stress does not actually cause Crohn's disease, it can make your symptoms worse and trigger flare-ups. At times of stress, your stomach empties more slowly, which increases acid production. The movement of food through your intestines may speed up or slow down, often causing cramping or pain. Stress is unavoidable in life, but finding ways to manage it can help. Even small amounts of exercise can reduce stress, ease depression and normalize bowel function. Learning how to relax by doing deep-breathing techniques can greatly reduce your stress levels.
Medication cannot cure Crohn's disease, but it can help ease many of its symptoms. In the best cases, these drugs can lead to a mostly symptom-free life and long-term relief in-between flare-ups. However, some medications can have side effects, so your doctor can advise you on the best choices for your particular case. Medications include:
If lifestyle and diet changes, medications and any other treatments do not give you any relief from symptoms, your doctor may consider surgery. A common surgery for Crohn's disease is bowel resection. Diseased sections of the bowel are removed and the healthy parts sewn together (anastomosis). Surgery can also drain abscesses, close fistulas and widen segments of the bowel that are too narrow (strictureplasty). Unfortunately, the benefits of surgery are often temporary, with symptoms eventually returning. Therefore, surgery is largely reserved for managing the complications of Crohn's disease.
A swollen area of tissue containing a build-up of pus.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
The lining of the small intestine is covered in tiny finger-like projections, called villi. These villi absorb nutrients, which then enter your bloodstream. Inflammation or surgery in the small intestine can reduce the amount of nutrients being absorbed, causing malnutrition, fatigue, delayed growth in children and anemia. Medications can also reduce the body's ability to absorb some nutrients. You may need to get vitamin B12 injections on a regular basis.
These are openings between the intestines and other structures in the body such as the bladder, vagina and skin. A fistula may be detected as the cause for recurrent urinary tract infections, or an offensive vaginal discharge. They may heal themselves, but sometimes need surgery.
This is a life-threatening condition in which the colon widens rapidly, accompanied by fever, shock, infection, rapid heart rate and tenderness of the abdomen. Surgery may be needed to remove part of the colon if the condition is severe.
Inflammation can cause strictures, narrowing of the space in the intestines, which cause pain, discomfort and bloating. Surgery may be required. Bowel obstruction may result from strictures, usually presenting as severe abdominal pain with the inability to pass either gas or stools.
A fistula is an abnormal passage between an organ and the body surface or another organ that is caused by surgery, congenital defect, or injury.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
Crohn's disease is a lifelong condition with symptom-free periods that can vary in length, followed by flare-ups. While recurrence is common, some people can be symptom-free for decades, while others may experience symptoms every few months. Although there is no cure for Crohn's disease, there is a range of medication available, enabling most people to live a normal life. Surgery can sometimes help relieve serious symptoms that are not responding to medications, although it is often not permanently successful.
Crohn's disease is a chronic condition with no known prevention or cure, but the severity of signs and symptoms may be reduced in some cases by carefully monitoring your diet, quitting smoking, exercising regularly and reducing your stress levels.