Recent Topics: Crohn's Disease
Thomas A. Dalton, M.D.
Introduction
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal (GI) tract. It most often involves the lower small intestine (Ileum) and the colon but any part of the GI tract from mouth to anus may
be affected. The inflammation causes ulceration in the lining of the GI tract resulting in the common
symptoms of pain, diarrhea, and possibly bleeding.
Crohn’s disease and ulcerative colitis are the two most common inflammatory bowel diseases (IBD). Men
and women are affected equally and there is a tendency for these conditions to run in families. About 20% of those with Crohn’s disease will have a close relative with IBD.
Causes
The cause(s) of Crohn’s disease is not known. There seems to be a genetic predisposition in many patients.
A popular theory involves the immune system and its reaction to bacterial, viral, or other environmental exposures within the GI tract. Smoking has been shown to aggravate Crohn’s disease. Stress is not felt to cause the disease.
Symptoms
The most common symptoms of Crohn’s disease are abdominal pain, rectal bleeding, and diarrhea. Pain is frequently in the right lower part of the abdomen. Less common symptoms include weight loss, fever, constipation, and loss of appetite. Occasionally the condition will present as an intestinal blockage or mimic appendicitis. Inflammatory conditions at or near the anus such as fissures, fistula tracts, or abscesses can also be seen with CD. Other organs including the skin, eyes, and bones are sometimes involved in the disease. Frequently, symptoms are mild or vague and develop gradually over months or even years resulting in delayed diagnosis.
Diagnosis
The diagnosis of CD involves a combination of medical history, physical examination, blood tests, stool studies, x-rays, and examination of the GI tract with colonoscopy. The blood tests may show evidence of anemia, chronic inflammation, or nutritional deficits. Stool studies are used to look for infection or unapparent bleeding. X-rays of the small intestine and computed tomography (CT) scans are frequently helpful. Colonoscopy is the examination of the large intestine with a flexible light and is used to evaluate the extent and severity of the disease. Biopsy of the lining of the GI tract obtained during colonoscopy often confirms the diagnosis. Several other conditions may have findings similar to CD and include celiac disease or sprue, irritable bowel syndrome, chronic infectious enteritis or colitis, collagenous colitis, and lymphocytic colitis.
Complications
Chronic inflammation in the intestines can result in a number of complications. Chronic bleeding may result in anemia. Scarring causes narrowing of the bowel known as strictures which may produce blockage or obstruction. The inflammatory process can extend deep into the walls of the intestines and tunnel through to adjacent structures such as the bladder, vagina, abdominal wall, or tissues around the anus. These tunnels are called fistulas and can cause a variety of infections. Nutrition can be affected by CD. Decreased dietary intake, poor intestinal absorption, or intestinal losses can result in a variety of protein, calorie, or vitamin deficiencies. Gallstone and kidney stone formation are increased in CD. Arthritis, skin disorders, and inflammatory conditions of the eyes are also known to complicate CD.
Risk
The risk of colon cancer is increased in both Crohn’s disease and ulcerative colitis. The risk is greater for ulcerative colitis than CD and is eight to ten times that of the general population. Because of this increased risk, individuals with inflammatory bowel disease are recommended to begin regular colonoscopy on a periodic basis after seven or eight years with the condition.
Treatment
The treatment of Crohn’s disease is usually with medications directed at controlling the inflammatory response and any infections that might arise. The goals of therapy are to relieve symptoms and induce and maintain remission from the disease. Treatment may be quite different for individual patients and depends on their particular symptoms, extent, and severity of disease. There is no cure for CD. Medications are frequently used in combination and may include antidiarrheals, antibiotics, anti-inflammatory drugs, pain medications, nutritional supplements, and drugs that directly suppress the immune system. Surgery may be required to manage complications such as internal infections, blockage, or fistulas. With any individual, the course of disease tends to wax and wane. The duration of remission is unpredictable. No special diet has been shown to prevent, treat, or particularly aggravate CD. Generally, individuals are recommended a prudent diet and to avoid foods that reliably worsen their symptoms.
Some individuals suffer psychological, social, or sexual difficulties related to the chronic and occasionally unrelenting nature of their illness. However, most are able to have a fully productive and good quality of life with appropriate and timely medical therapy.
Dr. Thomas A. Dalton is a board certified gastroenterologist at Cabarrus Gastroenterology Associates, LLP in Concord, NC. Cabarrus GI provides high quality, personalized care to patients in Cabarrus and surrounding counties. Thomas T. Long, M.D., Frank S. Pancotto, M.D., David F. Rhodes, M.D., Thomas A. Dalton, M.D., Robert T. Foust, M.D., Mark D. Aldous, M.D. and Alan W. Chiemprabha, M.D. are available for appointments Monday-Thurs, 8:30 a.m. to 4:30 p.m. and Fridays 8:30 - 3:00. Call 704-783-1840 for further information.
