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Know the inside-out of Crohn’s Disease

What do you understand by the term ‘Crohn’s Disease?’

Crohn’s Disease is one of the two entities that come under the common name of ‘Inflammatory Bowel Disease’, abbreviated as IBD,the other one being Ulcerative colitis. Crohn’s Disease is a severe inflammation of your bowels where segments of your intestines are either completely swollen or have deep sores namely ulcers. The inflammation usually starts off, from the last portion of your small intestine, and the first part of your large intestine, name dileocecal area. But the inflammation can affect any part of your digestive tract, starting from your mouth, ending with your anus.

Causes of Crohn’s Disease

No specific cause has been clearly implicated, a few possible causative factors are:

• Abnormal response by the body’s immune system towards the intestinal bacteria

• Hereditary- Jewish families belonging to Eastern Europe are more susceptible to getting the inflammatory disease.

• Smoking

• Infections caused by certain types of bacteria or viruses

Symptoms of Crohn’s Disease

The common symptoms may include:

• Intermittent or persisting pain, near the lower quadrant of your abdomen

• Diarrhea accompanied with blood (People diagnosed with the Crohn’s Disease may pass stools or diarrhea for 10-20 times in a day)

• Passage of mucus in stools

• Loss of appetite and loss of weight

• Mouth sores/ulcers – called apthous ulcers

• Abdominal distension due to Intestinal obstruction – which means severe narrowing of the caliber of the intestines.

• Anal tears or fissures

• Anal fistulas.

Complications of Crohn’s disease

Intestinal Complications

Obstruction and perforation of small or large intestine, abscess formation (pus collection) bleeding from the intestines and fistula (internal communication between intestines. Any of these complications may require emergency surgery. Crohn’s patients have increased risk of intestinal cancer as well.

Other complications

Skin nodules (erythema nodosum), Skin ulcers (pyoderma gangrenosum)painful eye (iritis, uveitis), joint swelling (arthritis) back ache(ankylosing spondylitis) and liver involvement (primary sclerosingcholangitis)

Diagnosis of Crohn’s Disease

A thorough history regarding your illness and physical examination along with few tests will help your doctor suspect Crohn’s disease.He would be able to assess the degree of inflammation within your intestines with the help of few lab tests. The tests can detect inflammation, infection, internal bleeding or help him identify the nutritional consequences of the disease in your body. These include

• Hemoglobin

• WBC count

• ESR

• CRP

• Iron profile

• Proteins

• C ANCA and P ANCA

Colonoscopy

Colonoscopy is a technique, where a lighter long flexible tube is passed through your anus to visualize the lower part of your digestive tract - the large intestine and terminal portion of the small intestine. Ulcers, narrowing and mucosal inflammation in your bowels can be seen and your physician can take biopsies from suspicious areas.

CT scan and CT Enterography

CT scans provide detailed images of your abdomen and the pelvis region. The entire small and large bowel and structures around are very well seen in detail. CT Enterography is a special technique thatis more commonly used in suspected Crohn’s disease and has replaced the traditional Barium X rays. Abscesses (pockets of infection),areas of bowel narrowing (stricture) and connections between bowel loops (fistulae) are very well delineated by these techniques.

Treatment options for Crohn’s Disease

In order to treat, Crohn’s disease, you will first be supplied with drugs or medicines to suppress inflammation and reduce symptoms of nausea or diarrhea.

Medication

These include

Amino salicylates

The drugs include Mesa amine, Olsalazine, Balsalazide and sulfasalazine. All these drugs work at the lining of the gastro-intestinal tract and help reduce inflammation

Corticosteroids

These steroids suppress the body’s immune system and are preferably used to treat moderate or a severe form of the disease or for short term improvement of the disease.

Immunosuppressants

These drugs act on the immune system to reduce the production of substances that cause inflammation. Different types of immuno suppressants include Azathioprine, Methotrexate, Infliximab,Adalimumab and Certolizumab pegol

Antibiotics

Antibiotics that are typically used to suppress bacterial infections heal fistulas include metronidazole and ciprofloxacin.

Surgical options

A few patients do not respond very well to medical treatment and its said that at least half of patients will need surgery at some point of their disease. Surgery doesn’t cure Crohn’s disease. Its primarily intended to deal with complications like intestinal obstruction, perforation, bleeding, abscess and fistulas.

Surgery basically involves removing that segment involved and joining back the relatively healthy segments. One common surgery is stricturoplasty, where narrowed segment of bowel is widened up to a normal caliber.