Symptoms
The symptoms of Crohn’sare often very similar to ulcerative colitis, but the two diseases are different.
Symptoms include:
Abdominal cramping. Inflammation can make food move slower through the bowels and cause cramping. Pain can range from mild to severe.
Diarrhea. Crohn’s disease causes diarrhea. Cramping of the bowels can worsen this symptom.
Bloody stools. Crohn’s can cause blood in the stools. There may be fresh bright red blood or dark red blood in the stools. The doctor may find occult blood in a stool test. Occult blood cannot be seen.
Sores in the mouth. Sores may show up in your mouth that are like cold or canker sores.
Fatigue and low-grade fevers. An inflammatory response can causea low-grade fever. Some people also have fatigue and lack of energy during flares.
Weight loss. Crohn’s causes poorer absorption of the nutrients from food and may cause weight loss. Abdominal cramping can also lower your appetite and thus lead to weight loss.
Drainage. You may suffer symptoms of perianal disease that causes drainage near the anus. This can be painful.
Joint pain. Inflammation can also affect your joints and cause joint pain.
Risk Factors
Age. Most common in people ages 15 to 35 years of age.
Genetics. There is about a 20 to 25 percent increase in risk if you have someone else in the family with Crohn’s.
Appendectomy. People who have had their appendix removed tend to have a high risk of Crohn’s. However, patients who had the surgery before the age of 10 have a decreased risk.
Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, and antibiotics can disrupt the intestinal barrier and cause inflammation in the intestines.
Smoking. There is a higher incidence of Crohn’s among smokers.
Stress. May lead to gastrointestinal inflammation due and slow GI tract motility.
Poor nutrition. High-fat and low-fiber intake show a higher incidence of IBD, including Crohn’s disease.
Microorganisms. Microorganisms, such as E. coli (escherichia coli), are associated with the development of inflammatory bowel diseases like Crohn’s.
Diagnosis
Your doctor will ask about your symptoms. Often, this is enough to make a diagnosis. Crohn’s is a diagnosis of exclusionbecause it is difficult to positively diagnose the disease. Symptoms of Crohn’s often mimic other things. For this reason, the doctor will have to rule out other causes of your symptoms before a Crohn’s diagnosis can be made. This takes time. Here are a few tests you may have done:
- Blood tests
- Fecal (stool) tests
- Barium x-rays
- Endoscopy (looking into the upper colon with a lighted camera)
- Colonoscopy (looking at the lower colon with a lighted tube)
- Chromo endoscopy (colonoscopy with a dye that can check intestinal tissues)
- Imaging of small intestines (involves drinking an oral contrast solution with x-rays, CT scan, or MRI scan)
Treatments
Since Chron’s cannot be cured, treatments often focus on reducing inflammation in the body and the bowels during flare-ups and maintaining remission periods.
Possible treatments include:
Corticosteroids. Corticosteroids help to lower inflammation in the body, butthey can have many sideeffects including fluid retention, increased appetite, reduced absorption of calcium, and risk of infection.
Sulfa drugs. Some sulfa drugs can help Crohn’s, but only in the large intestine. They also have sideeffects which include diarrhea, vomiting, headache, and heartburn.
Immune system suppressants. These will suppress the immune response and reduce inflammation. They do require careful monitoring by your doctor to make sure your immune system is not too suppressed.
Biologics or TNF inhibitors. These suppress a protein in the immune system called, tumor necrosis factor. They can help the disease go into remission or at least suppress many of the disease symptoms. There are risks of infection with these drugs.
Antibiotic therapy. Antibiotics can help reduce bacteria in the intestines and may help reduce the inflammation bacteria causes. They can also be used if infections develop due to fistulas.
Nutrition. You may need to be fed with a feeding tube if you have trouble absorbing nutrients. This allows the colon to rest and heal. You may also need to see a dietician for a low-fiber and low-residue diet to prevent strictures and blockage.
Surgery. As a last resort, the doctor may need to do surgery if other treatments do not work for you. They will surgically remove the part of the colon that is unhealthy, possibly close up any fistulas, and put the colon back together. They can also widen areas with strictures.
Medications may be used to relieve symptoms, including:
- Pain medication
- Anti-diarrhea medication
- Vitamin supplementation (iron, calcium vitamin D, and B-12)
Alternative Treatments and Home Remedies
Some herbal remedies may help reduce inflammation in the colon. Check with your doctor if you would like to add them to your treatment plan. These herbs include:
Boswellia. This herb is a natural anti-inflammatory and some studies show it may have positive effects for people with Crohn’s.
Slippery elm. This herb may have properties that can help heal irritated intestinal tissues.
Cat’s claw. Cat’s claw is often used as an anti-inflammatory. Use caution with this herb. It can cause blood pressure to drop and worsen other autoimmune disorders.
Marshmallow. Marshmallow can help soothe irritated colon tissue. It can interact with the drug lithium and affect diabetes. It needs to be taken apart from other medications.
Prevention
There is no known way to prevent the onset of Crohn’s, but new research does show that a semi-vegetarian diet may help prevent flare-ups of the disease. The best way to manage and prevent flare-ups is by eating a healthy diet, taking any medications prescribed, quitting smoking, and leading a healthy lifestyle.
Lifestyle Changes
Reduce stress. Stress can trigger inflammation in the body and make Crohn’s worse. Learn techniques that can reduce the stress in your daily life.
Increase fluid Intake. People with Crohn’s can become dehydrated easily due to poor absorption of fluids in the colon. Drink extra fluids, especially if you exercise.
Quit smoking. Smoking makes Crohn’s worse. Talk to your doctor about medications to help you quit smoking or join a program.
Diet. Eat a diet rich in fiber and poor in fats, especially PUFAs (poly-unsaturated fats).
References
Dresden, D. (2019, March 05). Crohn’s disease: The facts. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/324622#cost
Knutson, D., Greenberg, G. & Cronau, H. (2003, August 15). Management of Crohn’s disease: A practical approach. American Family Physician, 68(4), 707-715. Retrieved from American Association of Colleges of Pharmacy: https://www.aafp.org/afp/2003/0815/p707.html#sec-2
Kúsulas-Delint, D, et, al. (2016, March 10. Crohn’s disease: Review and current concepts. Retrieved from Médica Sur: https://www.medigraphic.com/pdfs/medsur/ms-2016/ms161b.pdf
Mayo Clinic Staff. (2020, October 13). Crohn’s disease. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
Ye, Yulan., et. al.(2015, December 15). The epidemiology and risk factors of inflammatory bowel disease. International Journal of Clinical and Experimental Medicine, 8(12), 22529-22542. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730025/#
