|
|
Crohn's Disease
What is Crohn’s disease?
Crohn’s disease, which affects both men and women, is a type of inflammatory bowel disease of the gastrointestinal tract. It is characterized by having “skip lesion,” meaning the areas affected are not necessarily in continuity. The inflammation is usually considered “full thickness” and involves all layers of the intestinal wall. Crohn’s disease more commonly affects the small intestines, colon, rectum and anus. There are also non-gastrointestinal symptoms of Crohn’s disease, which can affect the skin, eyes and joints.
What are the risk factors?
Family History – Crohn’s disease is more common in people who have relatives with inflammatory bowel disease. However, not all people diagnosed with Crohn’s disease have relatives with the disease.
Race and Ethnicity – Although Crohn’s disease is more common in Caucasians, particularly those of Jewish descent, it can be diagnosed in patients of any ethnic background.
What causes it?
Though there are no known causes for Crohn’s disease, there seem to be several risk factors, including inherited genes, an overactive immune system, a reaction to infection and exposure to environmental factors.
What are the symptoms?
The most common symptoms of Crohn’s disease are abdominal pain, fever, diarrhea (sometimes with bleeding), chronic tiredness/fatigue, weight loss and malnutrition. Kidney and gallstones, and the symptoms related to these problems, are more common with this condition. Intestinal fistulas to other organs or the skin can also occur, leading to symptoms such as urinary tract infections and pus draining from the skin. People with anal disease may have symptoms of anal pain or drainage. Other non-gastrointestinal symptoms may include visual changes, arthritis, jaundice and skin rashes/lesions.
Since Crohn’s disease is a chronic disease, patients may experience these symptoms during certain periods of time and then experience periods of time in which symptoms decrease or even disappear. Therefore, individuals should seek medical evaluation if they experience any of the above symptoms.
How is Crohn’s disease diagnosed?
Crohn’s disease is not always easy to diagnose. When a person has the typical symptoms – particularly if a family history exists – an evaluation with a physician may be recommended. A thorough Crohn’s evaluation often involves blood tests, radiographic imaging studies and endoscopic evaluation (usually colonoscopy). However, it is important to remember that even with the findings from these tests, a diagnosis of Crohn’s disease may be elusive, and sometimes can take years to confirm.
What treatments are available?
There is no known cure for Crohn’s disease, but there are many therapies available to manage the condition. First, it is important for patients with Crohn’s disease to stop smoking. Smoking (in particular nicotine) is well known to aggravate this condition.
Medication Management
Medications are the mainstay for treating Crohn’s disease. Medical therapies include: aspirin-related 5-ASA agents (such as mesalamine), antibiotics (such as metronidazole), steroids (such as prednisone), immunomodulators (such as azathioprine), and monoclonal antibodies (such as inflizimab). Some of these treatments are taken orally, some are given intravenously and some via the rectum. Probiotics are also gaining popularity in the treatment of Crohn’s disease.
Surgical Intervention
Surgical intervention is sometimes required for treatment of Crohn’s disease and may involve removal of a segment(s) of intestine. Surgery can be performed in either an emergency setting (such as due to a bowel obstruction) or less urgently (“failure” of medication management).
Surgery may also be required for anal Crohn’s or to treat abscess, fistula or fissure.
The goals of surgery are to improve an individual’s lifestyle, while also preserving intestinal length and continuity. It should be noted that many patients with Crohn’s disease require more than one operation over the course of their lifetime. Thankfully, many of the procedures performed today can be done using minimally invasive technology.
|
|
|