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Crohn's Disease Symptoms Causes Treatment Preventions & More All you need to know

Crohn's disease is an inflammatory condition that affects the gastrointestinal tract. It is one of the inflammatory bowel diseases (IBD), the other being ulcerative colitis.

Where the UC specifically affects the large intestine, Crohn's disease most often affects the distal end of the small intestine. Besides the small intestine, the inflammation associated with Crohn's may affect any part of the digestive tract. Whatever the case is, the inflammation extends into the deeper layers of the bowel.  

Crohn's disease disturbs the normal functioning of the GIT, namely digestion, nutrient absorption, and removal of waste. The signs and symptoms depict this disturbance and present as abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.

Crohn's disease is a life-long chronic disorder with debilitating health effects which may lead to life-threatening complications.

There is no cure for Crohn's; however, it is possible to manage the condition. Remission with the healing of the affected site is possible with the help of medication and other remedies. Most people can live a normal life with Crohn's.

Crohn's Disease Symptoms Causes Treatment

Causes of Crohn’s disease

The precise cause of how Crohn's disease starts is not known.

The condition is suggested to be due to an autoimmune reaction. The exact trigger is unknown, but researchers conclude that misfiring of the immune system against the healthy gut mucosa results in an inflammatory response characteristic of Crohn's.

Hereditary factors are also suggested to contribute to the development of Crohn's. Researchers have observed a familial tendency for Crohn's disease as the condition is more prevalent in family members with a history of Crohn's.

Diet and stress have a definite role to play in Crohn's disease. However, they are not tagged as causative factors. Instead, they are included in predisposing or aggravating factors for the inflammatory response of Crohn's.

Symptoms of Crohn’s disease

Crohn’s disease presents with signs and symptoms related to the digestive system of our body.

The inflammatory condition, affecting about 1.6 million people in the U.S., may involve the gut in a continuous manner or affect segments of the gut.

The signs and symptoms develop gradually over time or may come on suddenly. The presenting complaints in an individual may be mild to severe with periods of remissions in between flare-ups.

The active stage of the disease presents with;

  • Abdominal pain and cramps
  • Diarrhea
  • Fever
  • Fatigue
  • Blood in stool
  • Mouth sores
  • Reduced appetite
  • Weight loss
  • Fistula formation with pain around the anus or its adjacent areas

Since Crohn’s disease is an inflammatory condition, it may affect other parts of the body. Some other related signs and symptoms include;

  • Inflammation involving skin, eyes, and joints
  • Inflammation of the liver tissue and its associated bile duct
  • Kidney stones
  • Iron deficiency and anemia
  • Delayed growth in children
  • Disturbance in sexual development

The warning signs that call for a hospital visit are;

  • Consistent changes in bowel movement
  • Persistent abdominal pain
  • Blood in stool
  • Nausea and vomiting
  • Consistent diarrhea unresponsive to over-the-counter (OTC) medications
  • Unexplained fever that may last more than two days
  • weight loss not explained by other cause

Risk factors for Crohn’s disease

Certain factors increase the chances of Crohn’s in an individual. These include;

  • Age; The condition may affect people at any age, but young people below thirty develop Crohn's disease. 
  • Ethnicity; the disease is linked to people of Eastern European (Ashkenazi) Jewish descent. The incidence is rising in black people living in North America and the U.K.
  • Family history; first degree relatives have more chances of developing the condition. The familial tendency of Crohn’s is shown by the fact that one out of every six patients of Crohn’s has a family member suffering from the condition.
  • Smoking; smokers are at high risk of developing the condition, and it is perhaps the most important risk factor that can help prevent and manage the disease.
  • Nonsteroidal anti-inflammatory medications; medicines like ibuprofen (Advil, Motrin IBIB, others), naproxen sodium (Aleve), diclofenac sodium, and others increase the chances of inflammation in the gut so they can either contribute to Crohn's development or make it worse.

Complications

Crohn's disease should be addressed promptly. Overlooking the signs and symptoms can contribute to complications which may include;

  • Ulcer formation

Since the disease causes inflammation and can involve any site in the GIT, the chances of ulcer formation are more. The inflammation extends into deeper layers and may form ulcers and sores in the mouth, stomach, anus, and genital area. Ulcer formation is a complication of long-standing Crohn's that is improperly treated.

  • Bowel obstruction

The inflammatory lesions of Crohn's involve the entire thickness of the intestine, which may heal. The healing takes place with scar formation. As time passes, repeated injury and scar formation can restrict and narrow the lumen of the bowel. Crohn's disease is one of the major factors that result in intestinal obstruction.

  • Fistulas.

Crohn's disease is linked to fistula formation in the intestine. Fistulas are abnormal connections formed between different body parts.

The ulcers can extend through the intestinal wall, and the healing process involves the adjacent skin or nearby organ, allowing fistula formation. This causes the passing of the intestinal content to the skin.

If fistulas are formed between adjacent loos of bowel, bladder, or vagina, the digested food passes into the respective organs. This creates havoc in the health status of organs involved in fistulas and disturbs the intestine's normal function, that is, nutrient absorption.

Perianal fistulas (near or around the anal area) are most commonly associated with Crohn's disease.

In cases of closed fistulas, the accumulated intestinal content may become infected with a superadded bacterial infection. This may result in life-threatening abscess formation and requires immediate medical or surgical intervention.

  • Anal fissure

Persistent diarrhea of Crohn’s disease often results in small tears involving the skin lining the anus. These tears may become infected and even complicate to become fistulas. An anal fissure is a painful condition that disturbs everyday life activities and requires prompt treatment.

  • Malnutrition

Crohn's disease is associated with nutritional deficiencies of many kinds. The condition cuts back on your appetite, and food intake, any food you consume is not properly digested nor adequately absorbed. The constant state of diarrhea also results in the loss of important nutrients and minerals.

This leaves nutritional deficits; for example, vitamin B12, absorbed in the small intestine, is often deficient in patients with Crohn's. These patients commonly develop low iron stores and iron deficiency anemia in the long run.

  • Colon cancer

Crohn's disease is associated with an increased risk of colon cancer, especially in men.

  • Side effects of Crohn’s medication

Some of the drugs used for managing Crohn's disease work by blocking the immune response. This increases the risk of developing cancers and multiple infections in high-risk patients.

For example, long-term use of corticosteroids for managing Crohn's results in an increased risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes, and high blood pressure, and so on.

  • Blood clots

Crohn's disease is linked to an increased risk of clot formation in blood vessels.  

  • Other health problems

Crohn's disease may progress to long-term complications like iron deficiency anemia, skin disorders, osteoporosis, arthritis, and gallbladder or liver disease.

Diagnosis

The diagnosis of Crohn's disease is complicated as no single test is specific to the condition. The lab tests are usually done to rule out any other state with the same signs and symptoms. Some of the tests required are;

  • Blood tests to diagnose anemia or rule out infection
  • Stool examination to exclude parasitic infection 
  • Colonoscopy to examine the colon and take a tissue sample if required
  • CT-scan to have a detailed look at the colon
  • MRI scans to investigate fistula presence

Treatment of Crohn’s disease

Treating Crohn's is aimed at symptomatic relief of symptoms and preventing long-term complications. This is achieved with the help of a multiple remedy approach including;

  1. Anti-inflammatory drugs
  • Drugs like corticosteroids (prednisone and budesonide) may not work for everyone, but they are very helpful in alleviating inflammation in cases where it suits the patient.

They are often opted as a short-term treatment option to control and manage a flare-up. They may be used alone or in combination with immune suppressant drugs. 

  • Oral 5-aminosalicylates as sulfasalazine may be another anti-inflammatory remedy for Crohn’s disease in some cases.
  • Immune system suppressors

Since the immune system is suggested to play a role in triggering an inflammatory response, immune suppressant therapy is also beneficial in managing Crohn's. A close lookout for side effects is necessary when these medicines are sued for Crohn's disease.

These include;

  • Azathioprine and mercaptopurine
  • Methotrexate
  • Biologics

Biologics target the proteins made by the immune system and help cut back an autoimmune response. These include drugs like

  • Natalizumab, vedolizumab Vedolizumab
  • Infliximab, adalimumab, and certolizumab pegol
  • Ustekinumab
  • Antibiotics

Antibiotics, such as ciprofloxacin (Cipro) and metronidazole (Flagyl), may have a role in cutting back the number of harmful intestinal bacteria. These also help to prevent abscess formation in fistulas and decrease inflammation.

  • Other OTC medications

Some types of OTC cater to relieve signs and symptoms of Crohn's during a flare-up. OTC medicines should be taken after consulting with your doctor. These include;

  • Anti-diarrheal remedies as a fiber supplement (psyllium powder or methylcellulose) or medication like loperamide (Imodium A-D) may be effective depending upon the severity of the symptoms.
  • Pain relievers like acetaminophen (Tylenol) may be taken. Ibuprofen (Advil, Motrin IBIB, others) or naproxen sodium (Aleve) are contraindicated in Crohn’s disease as they make the symptoms worse.
  • Supplements like vitamins and minerals like B12 and iron.
  • Nutritional therapy for Crohn’s

In severe cases with prolonged flare-ups, doctors prescribe enteral (diet given by mouth or a feeding tube) or parenteral (nutrient supply via intravenous route) feeding.  This enables the gut to rest and heal.

Short-term nutrition therapy may be combined with medications. Such options are usually adopted to improve the health status before surgery or when other treatments fail to bring desired results.

A low residue or low-fiber diet is also beneficial where there is s potential risk of intestinal blockage. The size and number of stools are reduced, which eases the burden on the intestine and promotes healing and recovery.

  • Surgery

Surgery is required in long-standing cases, which are complicated by repeated fistula and scar formation. It may be an option in circumstances that are unresponsive to medications and can become complex.

Surgery does not cure Crohn’s disease. Rather it may help in easing the situation for a patient. It is suggested to follow up with your medication plan after surgery to get the best out of surgery.

The damaged portion of the intestine is removed, and the healthy ones are joined together. Closure for fistulas and drainage of an abscess requires surgical intervention.

Lifestyle and home remedies for Crohn’s disease

Dietary modifications certainly help in managing symptoms and increasing the duration of remission with Crohn’s disease. Here is what you can do;

  • Avoiding certain foods that aggravate the symptoms of Crohn's is absolutely essential for such patients. However, there is no evidence about special food items that may bring relief.
  • Patients of Crohn’s are asked to keep a record of all the foods they consume. This helps in mapping out a dietary strategy where aggravating foods are opted out. Some common suggestions regarding diet include;
  • Limit intake of dairy products.
  • Eat small meals in batches of six per 24-hours instead of three large meals.
  • Keep hydrated by drinking plain water and herbal teas. Avoid alcoholic beverages, caffeinated and fizzy drinks.
  • Supplement your diet with vitamins and minerals.
  • Sudden weight loss should be consulted with a dietitian.

Some other lifestyle measures to improve the symptoms of Crohn’s disease are;

  • Smoking is a contributor as well as an aggravating factor for Crohn's. It increases the relapses, which means more medication and increased chances of surgeries owing to complications. So quitting smoking is important.
  • Stress is also observed to be an aggravating factor for Crohn’s. Adopt ways to manage everyday stress. These include moderate exercise, meditation, yoga, adopting a hobby, mindful breathing, etc.
  • Biofeedback is a stress-reducing technique that relieves muscle tension, slows the heart rate, and so on. Ask your doctor if it helps your particular case.
  • Alternative medicine has little or no role in managing Crohn’s symptoms. However, if anything helps you, go for it after consulting with your physician.
  • Coping and support are important in the case of Crohn's. Any disease can take a physical as well as emotional toll on your health. Join a support group and remain informed about your condition.
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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