Crohn’s Disease is an inflammation of the intestines that is chronic or ongoing. Crohn’s disease can affect the entire digestive system, causing ulcerations, breaks in the lining, in both the large and small intestines. First described by a physician in 1932 (and hence, named after him) this disease is also called granulomatous enteritis or colitis or regional enteristis, ileitis or terminal ileitis.
Ulcerative colitis is an associated condition. When a patient suffers from both Crohn’s disease and ulcerative colitis the diagnosis is inflammatory bowel disease (IBD). Crohn’s disease is incurable, fluctuating between remission and relapses. In the United States 500,000 to 2 million people are afflicted with Crohn’s disease, affecting both men and women equally. There is a familial association with Crohn’s disease, being more common among relatives with ulcerative colitis.
Crohn’s disease can affect the entire digestive tract. Therefore, symptoms depend on the area affected and the degree of inflammation. The most common symptoms are abdominal pain, weight loss and diarrhea. Symptoms that are not as common are fever, night sweats, rectal pain and bleeding, and poor appetite.
A third of all patients have specific symptoms that affect the anal area. These symptoms are swelling of tissue surrounding the anal sphincter, ulcers and fissures within the sphincter (pain and bleeding occurs with defication), anal fistulae and peri-rectal abscesses. Anal fistulae are abnormal tunnels that form between the rectum and anus. Mucus and pus can drain from the openings of the fistulae. Peri-rectal abscesses are collections (sacs) of pus which form around the anal and rectal area. These abscesses can cause tenderness, fever and pain.
The different subtypes of Crohn’s disease are Crohn’s colitis, Crohn’s enteritis, Crohn’s terminal ileitis, Crohn’s entero-colitis and Crohn’s ileo-colitis. Each subtype has a specific set of symptoms.
Crohn’s enteritis is refers to inflammation in the small intestine. Symptoms are abdominal pain, diarrhea and small intestine obstruction. Crohn’s colitis defines this disease when it is located in the colon. Abdominal pain, bloody diarrhea, anal fistulae, and peri-rectal abscesses are the typical symptoms. Crohn’s ileitis is Crohn’s disease of the second part of the small intestine. Its symptoms are the same a Crohn’s enteritis. The enteritis is the first part of the small intestine. Crohn’s terminal ileitis refers to Crohn’s disease that is present at the very end of the small intestine called the terminal ileum. The symptoms for this subtype are the same as Crohn’s ileitis. Crohn’s entero-colitis and ileo-colitis describe the same condition: chronic inflammation of the small intestine and the colon. The symptoms for this subtype of Crohn’s disease are bloody diarrhea, abdominal pain and possible small intestine obstruction.
The most commonly diagnosed forms of Crohn’s disease are Crohn’s terminal ileitis and ileo-colitis.
The cause of Crohn’s disease has not been identified. Diet can impact symptoms, but it is not considered to be the cause of Crohn’s disease. One theory is that this disease is caused by a bacterial infection, but no research has proven this. A gene has recently been identified in families that have Crohn’s disease, called NOD2. Individuals who have mutations in the NOD2 have a greater risk of becoming affected by Crohn’s disease. This gene is responsible for regulating how the body reacts to the bacterial invasion and infection.
Individuals presenting with the symptoms of fever, diarrhea with or without blood, anal diseases and abdominal pain and tenderness are evaluated for Crohn’s disease. Blood tests are used to check for high or elevated white blood cells, sedimentation rates, low red blood cell counts, low blood proteins and body minerals.
A Barium x-ray will enable physicians to determine the location of diseased areas and the severity of the disease. A Barium solution is swallowed to fill the intestines with a visible tracer. X-rays are then taken of the stomach and small intestines. This procedure is called an upper GI. A lower GI is x-rays performed after the patient has been administered with a Barium enema. Barium x-rays can show narrowing of the intestines, ulcerations, and bowel fistulaes.
To view the rectum and large intestine directly a colonoscopy can be performed. This procedure is more accurate than barium x-rays because it can pick up small ulcers and smaller inflammation patches. Colonoscopy also makes biopsies possible for pathological evaluation and definite diagnosis of Crohn’s disease.
A computerized Axial Tomography, known as CAT or CT scan can provide a computerized scan of the abdomen and pelvis. This procedure is useful for picking up abscesses.
Video capsule endoscopy is a newer test that is used for diagnosing Crohn’s disease. A capsule or pill containing a video camera is swallowed by the patient. As the capsule travels through the small intestine, it captures pictures which are sent to a receiver that is worn on a belt by the patient. These pictures can then be reviewed on a computer. This test is valuable in that it can diagnose early stages of Crohn’s disease. This disease cannot be performed on a patient with a small intestine obstruction.
Treatment depends on the severity of the disease. There is no cure for Crohn’s disease. This disease usually follows a cycle of relapse and remission. Remission may be achieved with medication and surgery or can happen without cause. The goal of treatment is remission, maintain remission, and alleviate side affects for a better quality of life. Medications used for Crohn’s disease are anti-inflammatory agents such as corticosteroids and topical antibiotics and immuno-modulators.
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