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Crohn’s disease:

Crohn’s disease is an inflammatory bowel disorder (IBD), there is inflammation and pain in the gastrointestinal pathway. Most Crohn-related diseases affect the intestines but they can attack anywhere from the mouth to anus.


Mostly following symptoms are observed in Crohn’s disease:

  • Severe stomach pain

  • Difficulty in controlling bowel movements

  • Severe diarrhea

  • Weakness

  • Tiredness

  • Other major symptoms are:

  • Pain in rectum

  • Anemia

  • Stunt growth

  • Fistulas formation

  • Rapid weight loss

Diagnosis

Crohn’s disease is mostly diagnosed in the last portion of the small intestine (ileum) and large intestine (colon). Some healthy groups of tissues can be found between the sick areas. If there is a continuous inflammation it can cause thickening of intestinal walls, and it may also lead to a blockage termed as a stricture.


There is no proper cure for Crohn’s disease but there are different types of medication that will help you to relieve the main symptoms and allow you to live a proper life. In some cases, surgery can be a good option but usually, it is not curative.

Major differences between Crohn’s disease and ulcerative colitis

Even though both are inflammatory bowel disorders but medically they are not the same. The main differences are described below:

In the case of ulcerative colitis, only the large intestine gets inflated and the ulcer travels along with the epithelium of the colon and rectum.


Symptoms are different for each organism and may involve:

  • Diarrhea

  • Blood with pus

  • Stomach cramping

  • Pain in rectum

  • Rectal Bleeding

  • Difficult in passing out feces

  • Weight loss

  • Tiredness

  • Temperature


Difference between Crohn’s disease and IBS

Some people misunderstand Crohn's disease with irritable bowel syndrome, a kind of functional bowel disorder. IBS also attacks the colon but it is not associated with inflammatory bowel disease.

IBS has the following symptoms:

  • Cramping

  • Stomach pain

  • Bloating

  • Gas

  • Diarrhea

  • Constipation

  • Severe diarrhea

  • Constipation

  • IBS does not affect the lining of the large intestine

The treatment plans for IBD and IBS are also different.

Causes of Crohn’s disease

Although the actual reason for Crohn’s disease is still unknown according to extensive research this condition is related to our genetics, immune system, and surroundings. In normal conditions, the immune system guards the body against the pathogens such as bacteria, viruses, and other microorganisms. But in patients with IBD and Crohn’s disease, the immune system can’t distinguish between the normal cells and the invaders. As a result immune system starts responding excessively and it leads to a condition termed as an autoimmune disorder that is a reason for Crohn’s disease.

According to a rough estimate, 750,000 people are living with Crohn’s disease. The disease can occur at any age especially in adults between 15 to 35 years. People with a family history of Crohn's disease, Jewish background, NSAIDs take, and smoking has higher chances to develop Crohn’s disease.

Types

There five main types of Crohn’s disease:

Ilecolitis affects the lowest portion of the small and large intestine

The ileum is affected by Ileitis

Gastroduodenal Crohn’s disease is the reason for inflammation in the stomach and first, most portions of the small intestine have termed the duodenum.

The large intestine can be affected by Crohn’s (granulomatous) colitis.

Symptoms of Crohn’s disease

The symptoms of Crohn’s disease rely on the part or portion of GIT that is affected. Symptoms can appear and go from time to time.

The major symptoms include:

  • Diarrhea

  • Cramps in Stomach

  • Lack of appetite

  • Rapid weight loss

  • Temperature

  • Tiredness

  • Blood in stools

  • Soreness in mouth

  • Pain and Soreness in the anus

  • Some other complications related to Crohn’s disease are:

  • Tearing in the intestinal wall or anus (fissures)

  • Ulcers

  • Fistulas

  • Pus or mucus from anal area or anus

  • Inflammation in the bile duct or liver

  • Pain in Joints and arthritis

  • Skin rashes

  • Inflammation in eyes

  • Stunted or delayed growth in children

  • Higher chances to develop colorectal cancer

Diagnostic criteria

Your healthcare expert can make a correct diagnosis on the following basis:

  • Description of your symptoms

  • Results of the various tests

  • Any infection

There is not any specific test that is used for the diagnosis of Crohn’s disease.

Other conditions that may be diagnosed during the diagnosis of Crohn’s disease are:

  • IBS

  • Lactose intolerance

  • Ulcerative colitis

  • Infection in colitis

  • Perforating cancer

  • Diverticulitis

Your doctor might notice abdominal bulk or soreness, skin rashes, inflamed joints, and ulcers in the mouth. The doctor might use a stethoscope to listen to the sounds in your abdomen. He might hear abdominal sounds such as gurgling or splashing.

Tests that may help in the diagnosis of Crohn’s disease:

  • Blood tests such as CBC are performed for marking any change in the white and red blood cells level, it also tells about any inflammation, for example, C-reactive proteins (CRP).

  • Serum vitamin B12 test, iron test, and vitamin D test

  • Feces testing: The doctor might write a calprotectin test for distinguishing between Crohn’s disease and IBS.

Common procedures for diagnosis of Crohn’s disease:

Colonoscopy /flexible sigmoidoscopy: Your healthcare provider inserts a camera into your colon with the help of a thin tube. A biopsy is collected as a sample for testing inflammation.

Capsule endoscopy: You will be asked to swallow a capsule that has a camera inside it. It will capture the pictures of your intestines which can be seen on the computer screen. The doctors can easily look for any symptom of Crohn’s disease. That small capsule is passed out via the stool without any effort or pain. An endoscope may be still necessary for the confirmation.

Balloon-assisted enteroscopy: In this procedure, a small tube is used that reaches farther into the bowel where the endoscope doesn’t. This technique is used when there are abnormalities shown in the report of a capsule endoscopy but the diagnosis is still not clear.

Computerized tomography: It is termed a CT scan. It is a special type of x-ray that allows a thorough visualization of the bowel and nearby tissues.

Magnetic resonance imaging: It is generally called MRI. It is a special type of imaging technique that involves a magnetic field and radio waves to produce detailed and clear images of the organs and the tissues.

Treatment for Crohn’s disease:

Not all patients need medication (ongoing). Patients with mild symptoms and lower risks can overcome it by using antidiarrheal drugs, dietary changes, and careful observations.

There five major classifications of the medication for the treatment of Crohn’s disease. The severity of the disease decides the treatment. It also depends on the level of the risks, location in the bowel, and your medication history.

Drug therapy used for the treatment of Crohn’s disease:

Oral Corticosteroids: These drugs are used for patients with mild Crohn’s disease in

  • Ileum

  • Proximal colon

Oral or intravenous forms are used for the treatment of mild or severe and high-risk Crohn’s disease.

These drugs help in lowering the inflammation and helps to control short-term flare-ups, they are not effective for a long-lasting healing effect. You should use them sparingly and should introduce a steroid-sparing agent as soon as possible.

They are not advised for long term use since they have side effects which may include:

  • Infection

  • Osteoporosis

  • Bone loss

  • Insomnia

  • Increased appetite

  • Weight gain

  • High blood pressure

  • Blood glucose changes

  • Acne

  • Glaucoma

  • Skin fragility

  • Insomnia

  • Mood swings


The 5-aminosalicylates is an anti-inflammatory agent that aids in controlling mild to moderate Crohn’s disease. Some drugs can be taken orally and some are introduced through rectum or enema.

Oral mesalamine is not allowed to treat patients having active Crohn’s disease because of the healing of the intestines. These drugs are prescribed widely despite their side effects and lack of efficiency.

Thiopurines are used for treating inflammation by activating the immune system. They aid in lessening the need for corticosteroids. These drugs are used for the treatment of IBD. They have slow onset action.

Biological Therapy: Biological therapy is used for the treatment of mild to severe Crohn’s disease may also be used when Crohn’s disease doesn’t respond to any other medication. These drugs are used for blocking several chemicals in the immune system that produce inflammation.

Biological therapy has the following uses:

  • It is used for the remission of Crohn’s disease

  • For mucosal healing

  • They can be used with immunomodulators to help the formation of anti-drug antibody which reduces the efficiency of the drugs.

  • Infliximab along with thiopurine is the best combination for effective treatment.

A tumor necrosis factor-alpha (TNF) blocker is an example of a biological monoclonal antibody.

Other treatments are:

  • Anti-integrin therapy

  • Anti-IL12/23 therapy

Broad-spectrum antibiotics are also used for the healing of fistulas or abscesses due to Crohn’s disease. In past, these were used for treating Crohn’s disease but now they are no longer in use.

Surgery for the treatment of Crohn’s disease

In some patients, medication can be effective or may not work to reduce or control the symptoms. That’s why surgery is needed. Though the surgeries are not curative such as in ulcerative colitis surgery, with the exception where only the rectum, colon, or anus is affected. 50% of patients are diagnosed with Crohn’s disease again after the surgery.

The most common surgeries are:

Resection and Anastomosis: During this surgery part of the intestine is removed (resection) and two healthy terminals and reconnected after the removal of the diseased part (anastomosis), for example, partial colectomy. Bowel movements are usually not affected by the anastomosis and they can pass through the anus.

Ostomy: Ostomy is a procedure in which a hole is created in the abdomen that is called a stoma. The bowel content leaves the body through the stoma and drains into the pouch that is worn outside. An ostomy may be permanent or temporary. Most people live a normal life after the ostomy.

Strictureplasty: If there is a continuous inflammation it can cause tissues death leading to the blockage of the intestines that is called a stricture. This method is used to open that stricture and it can be performed during the resection or any other surgery. Nausea and vomiting and constipation are some known symptoms of the stricture.

Dietary and Lifestyle Changes

You should maintain a healthy quantity of calories, vitamins, proteins, and other nutrients in your diet during Crohn’s disease. Food problems are different for each person. You can seek help from a nutritionist in this regard.

Some foods flare up some symptoms such as bloating, diarrhea, etc. You may stop eating these foods.

Some food items you should avoid are:

  • Raw fruits and veggies

  • Nuts

  • Whole grains

  • Insoluble fibers

  • Lactose milk

  • Sugar alcohols

  • Chewing gums

  • Ice cream

  • Some juices

  • Foods with a lot of carbohydrates or sugars

  • Foods with high fats

  • Alcohol

  • Caffeine

  • Spicy foods


Regular exercise is very important for patients with Crohn’s disease. You can ask your doctor about the pace of your exercise.


Smoking is injurious to health especially for people with Crohn’s disease. If you are a smoker you need to quit it immediately.

Colon cancer is a risk for Crohn’s disease patients. You should keep a strict follow-up and screening at regular intervals.


NSAIDs use during Crohn’s disease

You must avoid NSAIDs like ibuprofen or naproxen because they may worsen your condition. These medicines are used for treating headaches and pain.

Examples of NSAIDs are:

  • Ibuprofen (Advil , Motrin)

  • Naproxen (Aleve)

  • Diclofenac (voltren, cambia, cataflam)

See your doctor if:

  • You observe any symptoms of Crohn’s disease.

  • Your symptoms of Crohn’s disease are becoming worse day by day.

  • You observe any new symptoms