Crohn’s disease is a type of inflammatory bowel disease (IBD) characterized by abdominal pain, fever, pain during passing stool and persistent water diarrhea due to inflammation of the intestines. Crohn’s disease mostly occurs in the last part of small intestine or the first part of the large intestine but it can affect any part of the digestive tract form the mouth to the anus. There is no cure for this disease so symptomatic management is required to reduce the signs and symptoms. Ulcerative colitis is another type of inflammatory bowel disease.
What causes the Crohn’s disease?
Although the exact cause is still unknown but some research shown that immune system (in this condition immune system abnormally response to bacteria and virus) and hereditary factors can play the role to develop Crohn’s disease.
What are the risk factors of Crohn’s disease?
- Family history
- Cigarette smoking (where cigarette smoking is protective effect against the development of ulcerative colitis)
- White race
- Age less than 30 years
What are the signs and symptoms of Crohn’s disease?
- Water diarrhea (some people have 10-20 times per day)
- Cramping abdominal pain
- Blood in stool or mucus on stool or both
- Tenesmus (Pain during pass stool)
- Weight loss
- Eye inflammation
- Gums inflammation
- Mouth ulcers
- On physical examination may find an abdominal mass, skin rash ,mouth and gums ulcers.
How is Crohn’s disease diagnosed?
Diagnosis relies on laboratory tests and radiological imaging which include:
A) Laboratory tests are:
- Blood test: To detect anemia, infection and
- Fecal occult blood test: Detect blood in stool
- Positive ASCA and negative p-ANCA antigen suggest of crohn’s disease
- C-reactive protein
- Liver function tests
Radiological imagings include:
- Barium enema
- Endoscopy (cobblestone appearance)
- CT scan
- MRI (Magnetic resonance imaging)
Biopsy confirm the diagnosis of crohn’s disease
What are the complications of Crohn’s disease?
- Internal bleeding
- Bowel perforation
- Bowel obstruction
- Toxic megacolon (this is the life threatening complication where colon is massively distended)
- Increased risk of development of small and colon cancer
- Erythema nodosum
- Arthritis (inflammation of joint)
- Primary sclerosing cholangitis
How is Crohn’s disease managed?
Crohn’s disease can’t be cure; the goal of systematic treatment is to reduce the inflammation process and decrease complications. Treatment includes:
1. Life style changes:
- Decrease dairy foods
- Taking low fat diet
- Eat small amount of food many times a day
- Taking plenty of water
- Stop taking caffeine, cigarette and alcohol
- Taking multivitamins
- Exercise to reduce stress
2. Medical treatments, medications include:
- Anti-inflammatory agents like 5-ASA, Sulfasalazine and corticosteroid
- Immune modulators such as Azathioprine, mercaptourine and Infliximab help to reduce inflammation process
- Certolizumab pegol (Cimzia). This drug inhibits the TNF. (Approved by the Food and Drug administration for the treatment of crohn’s disease)
- Antibiotics such as Metronidazole or Ciprofloxacin can reduce the risk of fistula formation and help to heal fistulas
- Antidiarrheals relive diarrhea
- Laxatives if patients have constipation
- Pain killer acetaminophen is used for pain. Don’t use aspirin, ibuprofen and naproxen because these drugs make symptoms worse.
3. Surgical management of crohn’s disease.
Surgical intervention is not curative, medical therapy is the mainstay of treatment of crohn’s disease. Recurrence rates after surgery is high, and the risk continues with the passage of time. So principle of the surgical management is to resect only enough intestines to improve symptoms .Indications of surgery include:
- Medical management has failed to relive symptoms
- Correct complications such as intractability, intestinal obstruction, intra-abdominal abscess, fistulas, toxic megacolon, massive bleeding, and cancer)
- Surgical methods of crohn’s disease are ileocecal resection, total proctocolectomy with end ileostomy, total abdominal colectomy with ileorectal anastomosis or end ileostomy and segmental colon resection.
What is the prognosis of crohn’s disease?
Prognosis is unsatisfied.
- Sabiston textbook of surgery 18th edi.
Filed Under: GI