26 Jan What is Crohn’s Disease?
Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. Named after Dr. Burrill B. Crohn, who first described the disease in 1932 along with colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, Crohn’s disease belongs to a group of conditions known as Inflammatory Bowel Diseases (IBD). Crohn’s disease is not the same thing as ulcerative colitis, another type of IBD. The symptoms of these two illnesses are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different. Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis is limited to the colon, also called the large intestine. Crohn’s disease can also affect the entire thickness of the bowel wall, while ulcerative colitis only involves the innermost lining of the colon. Finally, in Crohn’s disease, the inflammation of the intestine is not always in one spot. In other words, some areas can be normal in between patches of diseased intestine. In ulcerative colitis this does not occur.
Recognizing the Signs and Symptoms
Crohn’s disease can affect any part of the GI tract as mentioned above. While symptoms vary from patient to patient and some may be more common than others, the most common symptoms of Crohn’s disease include:
Symptoms related to inflammation of the GI tract:
Urgent need to move bowels
Abdominal cramps and pain
Sensation of incomplete evacuation
Constipation (can lead to bowel obstruction)
General symptoms that may also be associated with IBD:
Loss of appetite
Loss of normal menstrual cycle
Even if you think you are showing signs of Crohn’s Disease symptoms, only proper testing performed by your doctor can render a diagnosis. People suffering from Crohn’s often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, Crohn’s may delay growth and development. Crohn’s is a chronic disease, so this means patients will likely experience periods when the disease flares up and causes symptoms, followed by periods of remission when patients may not notice symptoms at all. In more severe cases, Crohn’s can lead to tears (fissures) in the lining of the anus, which may cause pain and bleeding, especially during bowel movements. Inflammation may also cause a fistula to develop. A fistula is a tunnel that leads from one loop of intestine to another, or that connects the intestine to the bladder, vagina, or skin. This is a serious condition that requires immediate medical attention. The symptoms you experience may depend on which part of the GI tract is affected.
What are the Causes of Crohn’s Disease? Who is Affected?
Crohn’s disease may affect as many as 700,000 Americans. Men and Women are equally likely to be affected, and while the disease can occur at any age, Crohn’s is more prevalent among adolescents and young adults between the ages of 15 and 35 however I have seen cases with young children so if you have a suspicion with your child get them checked out. The causes of Crohn’s Disease are not well understood. Diet and stress may aggravate Crohn’s Disease, but they do not cause the disease on their own. Recent research suggests hereditary, genetics, and/or environmental factors contribute to the development of Crohn’s Disease. The GI tract normally contains harmless bacteria, many of which aid in digestion. The immune system usually attacks and kills foreign invaders, such as bacteria, viruses, fungi, and other microorganisms. Under normal circumstances, the harmless bacteria in the intestines are protected from such an attack. In people with IBD, these bacteria are mistaken for harmful invaders and the immune system mounts a response. Cells travel out of the blood to the intestines and produce inflammation (a normal immune system response). However, the inflammation does not subside, leading to chronic inflammation, ulceration, thickening of the intestinal wall, and eventually causing patient symptoms.
Just like Celiac, Crohn’s tends to run in families, so if you or a close relative have the disease, your family members have a significantly increased chance of developing Crohn’s. Studies have shown that 5% to 20% of affected individuals have a first – degree relative (parents, child, or sibling) with one of the diseases. The risk is greater with Crohn’s disease than ulcerative colitis. The risk is also substantially higher when both parents have IBD. The disease is most common among people of eastern European backgrounds, including Jews of European descent. In recent years, an increasing number of cases have been reported among African American populations. The environment in which you live also appears to play a role. Crohn’s is more common in developed countries rather than undeveloped countries, in urban rather than rural areas, and in northern rather than southern climates.
A Summary of Risk factors for Crohn’s disease may include:
• Age. Crohn’s disease can occur at any age, but you’re likely to develop the condition when you’re young. Most people who develop Crohn’s disease are diagnosed before they’re 30 years old.
• Ethnicity. Although Crohn’s disease can affect any ethnic group, whites and people of Eastern European (Ashkenazi) Jewish descent have the highest risk.
• Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn’s disease has a family member with the disease.
• Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. Smoking also leads to more severe disease and a greater risk of having surgery. If you smoke, it’s important to stop.
• Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox), diclofenac sodium (Voltaren, Solaraze) and others. While they do not cause Crohn’s disease, they can lead to inflammation of the bowel that makes Crohn’s disease worse.
• Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop Crohn’s disease. This suggests that environmental factors, including a diet high in fat or refined foods, play a role in Crohn’s disease. People living in northern climates also seem to be at greater risk.
What to expect from your doctor?
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or off and on?
• How severe are your symptoms?
• Do your symptoms affect your ability to work or do other activities?
• Does anything seem to improve your symptoms?
• Is there anything that you’ve noticed that makes your symptoms worse?
• Do you smoke?
• Do you take nonsteroidal anti-inflammatory drugs (NSAIDs) — for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox), or diclofenac sodium (Voltaren, Solaraze)?
Your doctor will likely use a combination of endoscopy with biopsies and radiological testing to help confirm a diagnosis of Crohn’s disease. You may have one or more of the following tests and procedures:
• Tests for anemia or infection. Your doctor may suggest blood tests to check for anemia — a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Expert guidelines do not currently recommend antibody or genetic testing for Crohn’s disease.
• Fecal occult blood test. You may need to provide a stool sample so that your doctor can test for hidden blood in your stool.
• Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Clusters of inflammatory cells called granulomas, if present, help confirm the diagnosis of Crohn’s.
• Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last section of your colon.
• Computerized tomography (CT). You may have a CT scan — a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
• Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography).
• Capsule endoscopy. For this test, you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn’s disease. The camera exits your body painlessly in your stool. You may still need endoscopy with biopsy to confirm the diagnosis of Crohn’s disease.
• Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don’t reach. This technique is useful when capsule endoscopy shows abnormalities, but the diagnosis is still in question.
• Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. After you drink a liquid containing barium, doctors take X-ray, CT or MRI images of your small intestine.
Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery. There is currently no cure for the disease, and there is no one treatment that works for everyone. Doctors use one of two approaches to treatment — either “step-up,” which starts with milder drugs first, or “top-down,” which gives people stronger drugs earlier in the treatment process.
The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission. Corticosteroids such as prednisone are a class of drugs often prescribed to reduce inflammation. A doctor is likely to prescribe an initial large dose of prednisone when the disease is very active. The dose is then tapered off. A problem with corticosteroids is the large number of possible side effects — some of them serious — such as a higher susceptibility to infection and stomach ulcers.
There are alternative options such as herbs and acupuncture, so make sure you get several opinions from reputable doctors before you start any invasive therapies including drugs.
There are times where medications are beneficial, however they are not a permanent solution. Addressing inflammation is key! Find the triggers, heal the GI tract and reduce stress are key! Changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
You are what you eat so it’s fair to say, what you eat or don’t eat influences inflammatory bowel disease and plays a key role in your overall wellness. A poor diet will trigger inflammation which is what causes 80% of disease so yes, an appropriate diet is key! With that being said, certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up. Each person is unique so it’s important to find what diet works best and address food intolerance. Cooked food is easier on the GI tract as opposed to raw. When you cook vegetables for example you are releasing enzymes so the food becomes partially digested for you. If you eat raw vegetables your body has a lot more work to do in breaking it down for absorption. It can be helpful to keep a food diary to keep track of what you’re eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try eliminating them. When you bring new foods into your diet it’s recommended to rotate them every 3-4 days. I tell my patients to try a new food weekly and monitor how they feel. A great tool we use that eliminates the guess work is an IgG panel for food intolerance. Food intolerance can be an underlying cause in many GI disorders as well as weight issues and other systemic problems. Here are some suggestions that may help:
Foods to avoid
• Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas, improve by limiting or eliminating dairy (casein) products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well. Remove any products made with carageenan from your diet. (Read labels on soy products carefully). Avoid products sweetened with sorbitol, xylitol, or other sugar alcohols
• Try low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Try avoiding butter, margarine, cream sauces and fried foods.
• Limit fiber, if it’s a problem food. If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.
In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. You may be told to limit fiber or go on a low residue diet if you have a narrowing of your bowel (stricture).
• Avoid other problem foods. Spicy foods, alcohol, and caffeine may make your signs and symptoms worse.
• Avoid coffee, including decaffeinated varieties (which may still contain some caffeine), all other sources of caffeine and all stimulant drugs.
Other dietary measures
• Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
• Take slippery elm in the form of gruel: Combine one teaspoon of the powder with one teaspoon of sugar and two cups of boiling water. Stir well. Flavor with cinnamon and drink one or two cups twice a day.
• If cramping is a problem, take enteric-coated capsules of peppermint oil between meals to relieve the spasmodic component of inflammatory bowel disease
• Eat cooked foods like vegetable soups
• Drink quality bone broth which helps heal the GI tract lining and inflammation
• Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
• Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
• Talk to a nutritionist. If you begin to lose weight or your diet has become very limited, talk to a qualified nutritionist who specializes in GI disorder.
Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms worse and may trigger flare-ups. This goes for any medical condition as stress is a trigger.
When you’re stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself. Although it’s not always possible to avoid stress, you can learn ways to help manage it.
Some of these include:
• Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.
• Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). Even though there may be few well-designed studies of their safety and effectiveness (sure beats the side effects of medications) it’s a good place to start before looking at medications. First and foremost, change the diet.
Some commonly used therapies include:
• Herbal and nutritional supplements. The majority of alternative therapies aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it which is why it’s so important to work with a practitioner who can guide you through a protocol using alternative therapies. Keep in mind even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
• Probiotics. Beneficial bacteria is important in building the immune system to fight pathogens that can trigger a flare up.
• To help address inflammation, follow an anti-inflammatory diet and increase your intake of dietary omega-3 fatty acids by taking supplemental fish oil, start with one gram a day and increase slowly to two to four grams a day. If there is any increase in diarrhea, and cut back the supplement dose if necessary.
• Acupuncture. Some people may find acupuncture or hypnosis helpful for the management of Crohn’s, but neither therapy has been well studied for this use.
• Prebiotics. Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. Studies have not shown positive results of prebiotics for people with Crohn’s disease.
Coping and support
Crohn’s disease doesn’t just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. All of these factors can alter your life and may lead to depression.
Here are some things you can do:
• Be informed. One of the best ways to be more in control is to find out as much as possible about Crohn’s disease. Look for information from the Crohn’s & Colitis Foundation of America.
• Join a support group. Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with Crohn’s disease.
• Talk to a therapist. Some people find it helpful to consult a mental health professional who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause.
Although living with Crohn’s disease can be discouraging, research is ongoing and the outlook is improving.
Sources: Mayo Clinic and CCFA (Crohn’s, Colitis Foundation of America), Dr. Weis.