Understanding Crohn’s Disease
What is Crohn’s disease?
Crohn’s disease is a type of inflammatory bowel disease. As many as 780,000 Americans have the condition, according to the Crohn’s & Colitis Foundation (CCF).
More research on Crohn’s disease is necessary. Researchers aren’t sure how it begins, who is most likely to develop it, or how to best manage it.
Despite major treatment advances in the last three decades, no cure is available yet.
Crohn’s disease most commonly occurs in the small intestine and the colon.
It can affect any part of your gastrointestinal (GI) tract, from your mouth to your anus.
It can involve some parts of the GI tract and skip other parts.
The range of severity for Crohn’s is mild to debilitating. Symptoms vary and can change over time.
In severe cases, the disease can lead to life-threatening flares and complications.
What causes Crohn’s disease?
It isn’t clear what causes Crohn’s disease. However, the following factors may influence whether you get it:
- your immune system
- your genes
- your environment
Up to 20 percent of people with Crohn’s disease also have a parent, child, or sibling with the disease, according to the Crohn’s & Colitis Foundation.
According to a 2012 study, certain things can affect the severity of your symptoms. These include:
- whether you smoke
- your age
- whether or not the rectum is involved
- length of time you’ve had the disease
People with Crohn’s are also more likely to develop intestinal infections from bacteria, viruses, parasites, and fungi.
This can affect the severity of symptoms and create complications.
Crohn’s disease and its treatments can also affect the immune system, making these types of infections worse.
Yeast infections are common in Crohn’s and can affect both the lungs and the intestinal tract.
It’s important that these infections are diagnosed and properly treated with antifungal medications to prevent further complications.
The symptoms of Crohn’s disease often develop gradually. Certain symptoms may also become worse over time.
Although it’s possible, it’s rare for symptoms to develop suddenly and dramatically.
The earliest symptoms of Crohn’s disease can include:
- abdominal cramps
- blood in your stool
- a fever
- loss of appetite
- weight loss
- feeling as if your bowels aren’t empty after a bowel movement
- feeling a frequent need for bowel movements
It’s sometimes possible to mistake these symptoms for the symptoms of another condition, such as food poisoning, an upset stomach, or an allergy.
You should see your doctor if any of these symptoms persist.
The symptoms may become more severe as the disease progresses. More troublesome symptoms may include:
- a perianal fistula, which causes pain and drainage near your anus
- ulcers that may occur anywhere from the mouth to the anus
- inflammation of the joints and skin
- shortness of breath or decreased ability to exercise due to anemia
Early detection and diagnosis can help you avoid severe complications and allow you to begin treatment early.
No single test result is enough for your doctor to diagnose Crohn’s disease.
They will begin by eliminating any other possible causes of your symptoms.
Making a Crohn’s disease diagnosis is a process of elimination.
Your doctor may use several types of tests to make a diagnosis:
- Blood tests can help your doctor look for certain indicators of potential problems, such as anemia and inflammation.
- A stool test can help your doctor detect blood in your GI tract.
- Your doctor may request an endoscopy to get a better image of the inside of your upper gastrointestinal tract.
- Your doctor may request a colonoscopy to examine the large bowel.
- Imaging tests like CT scans and MRI scans give your doctor more detail than an average X-ray. Both tests allow your doctor to see specific areas of your tissues and organs.
- Your doctor will likely have a tissue sample, or biopsy, taken during an endoscopy or colonoscopy for a closer look at your intestinal tract tissue.
Once your doctor has completed reviewing all the necessary tests and ruled out other possible reasons for your symptoms, they may conclude that you have Crohn’s disease.
Your doctor may go on to request these tests several more times to look for diseased tissue and determine how the disease is progressing.
Treatment for Crohn’s disease
A cure for Crohn’s disease isn’t currently available, but the disease can be well-managed.
A variety of treatment options exist that can lessen the severity and frequency of your symptoms.
Several types of medications are available to treat Crohn’s. Anti-diarrheal and anti-inflammatory drugs are commonly used.
More advanced options include biologics, which use the body’s immune system to treat the disease.
Which medications, or combination of medications, you need depends on your symptoms, your disease history, the severity of your condition, and how you respond to treatment.
The two main types of anti-inflammatory drugs doctors use to treat Crohn’s are oral 5-aminosalicylates and corticosteroids.
Anti-inflammatory drugs are often the first drugs you take for Crohn’s disease treatment.
You typically take these drugs when you have mild symptoms with infrequent disease flares.
Corticosteroids are used for more severe symptoms but should only be taken for a short time.
An overactive immune system causes the inflammation that leads to the symptoms of Crohn’s disease.
Drugs that affect the immune system, called immunomodulators, may reduce the inflammatory response and limit your immune system’s reaction.
Some doctors believe antibiotics may help reduce some of the symptoms of Crohn’s and some of the possible triggers for it.
For example, antibiotics can reduce drainage and heal fistulas, which are abnormal connections between tissues that Crohn’s can cause.
Antibiotics can also kill off any foreign or “bad” bacteria present in your gut that could be contributing to inflammation and infection.
If you have severe Crohn’s, your doctor may try one of a number of biologic therapies to treat the inflammation and complications that can occur from the disease.
Biologic drugs can block specific proteins that may trigger inflammation.
Food doesn’t cause Crohn’s disease, but it can trigger flares.
After a Crohn’s diagnosis, your doctor will likely suggest making an appointment with a registered dietitian (RD).
An RD will help you understand how food may affect your symptoms and what diet changes may help you.
In the beginning, they may ask you to keep a food diary. This food diary will detail what you ate and how it made you feel.
Using this information, the RD will help you create eating guidelines.
These dietary changes should help you absorb more nutrients from the food you eat while also limiting any negative side effects food may be causing.
Read on for more info on diet in the next section.
If less invasive treatments and lifestyle changes don’t improve your symptoms, surgery may be necessary.
Ultimately, about 75 percent of people with Crohn’s disease will require surgery at some point in their lives, according to the Crohn’s & Colitis Foundation.
Some types of surgery for Crohn’s include removing damaged portions of your digestive tract and reconnecting the healthy sections.
Other procedures repair damaged tissue, manage scar tissue, or treat deep infections.
Crohn’s disease diet
A diet plan that works for one person with Crohn’s disease may not work for another.
This is because the disease can involve different areas of the GI tract in different people.
It’s important to find out what works best for you.
This can be done by keeping track of your symptoms as you add or remove certain foods from your diet.
Lifestyle and diet changes may help you reduce the recurrence of symptoms and lessen their severity.
You may need to:
Adjust your fiber intake
Some people need a high-fiber, high-protein diet.
For others, the presence of extra food residue from high-fiber foods such as fruits and vegetables may aggravate the GI tract.
If this is the case, you may need to switch to a low-residue diet.
Limit your fat intake
Crohn’s disease may interfere with your body’s ability to break down and absorb fat.
This excess fat will pass from your small intestine to your colon, which can cause diarrhea.
Limit your dairy intake
Previously, you may not have experienced lactose intolerance, but your body can develop difficulty digesting some dairy products when you have Crohn’s disease. Consuming dairy can lead to an upset stomach, abdominal cramps, and diarrhea for some people.
Crohn’s disease may affect your body’s ability to absorb water from your digestive tract.
This can lead to dehydration. The risk for dehydration is especially high if you’re having diarrhea or bleeding.
Consider alternative sources of vitamins and minerals
Crohn’s disease can affect your intestines’ ability to properly absorb other nutrients from your food.
Eating high-nutrient foods may not be enough.
Talk to your doctor about taking multivitamins to find out if this is right for you.
Work with your doctor to figure out what best suits your needs.
They may refer you to an RD or nutritionist.
Together, you can identify your dietary limitations and create guidelines for a well-balanced diet.
Natural treatments for Crohn’s
Many people use complementary and alternative medicine (CAM) for various conditions and diseases, including Crohn’s disease.
The U.S. Food and Drug Administration hasn’t approved these medicines for treatment, but many people use them in addition to mainstream medications.
Talk to your doctor if you’re interested in trying any of these treatments alongside your current regimen.
Popular alternative treatments for Crohn’s disease include the following:
- Probiotics. These are live bacteria that can help you replace and rebuild the good bacteria in your intestinal tract. Probiotics may also help prevent microorganisms from upsetting your gut’s natural balance and causing a Crohn’s flare.
Scientific data about effectiveness is limited. You can find a wide selection of probiotic supplements online.
- Prebiotics. These are potentially beneficial materials found in plants, such as asparagus, bananas, artichokes, and leeks, that help feed the good bacteria in your gut and increase their numbers. Prebiotics are also available to buy in supplement form.
- Fish oil. Fish oil is rich in omega-3s. According to a 2017 study, research is ongoing regarding its possible treatment of Crohn’s disease. Oily fish like salmon and mackerel are rich in omega-3s. You can also try fish oil supplements, which you can shop online.
- Supplements. Many people believe certain herbs, vitamins, and minerals ease the symptoms of a variety of diseases, including the inflammation associated with Crohn’s disease. Research is ongoing as to which supplements may be beneficial.
- Aloe vera. People believe that the aloe vera plant has anti-inflammatory properties. Because inflammation is one of the key components of Crohn’s disease, people often use it as a natural anti-inflammatory. However, there is no current research that suggests aloe vera helps with Crohn’s. If you are interested, you can find a selection of aloe vera gels, creams, juices, and more online.
- Acupuncture. This is the practice of strategically sticking needles in the skin to stimulate various points on the body. One theory is that acupuncture may cause the brain to release endorphins, chemicals that block pain and strengthen the immune system.
A 2014 study found that acupuncture, combined with moxibustion — a type of traditional Chinese medicine that involves burning dried medicinal herbs on or near your skin —improves symptoms of Crohn’s disease.
People with active Crohn’s disease reported less stomach pain, diarrhea, and inflammation after getting acupuncture.
Tell your doctor if you use any CAM treatments or over-the-counter medications.
Some of these substances can affect the efficiency of medications or other treatments.
In some cases, an interaction or side effect could be dangerous, even life-threatening.
Surgery for Crohn’s disease is considered a last-resort treatment, but three-quarters of people with this Crohn’s will ultimately need some type of surgery to relieve symptoms or complications.
Once medications are no longer working or side effects have become too severe to treat, your doctor may consider one of the following surgeries.
- Strictureplastywidens and shortens the intestines in an attempt to reduce the effects of scarring or damage to the tissue.
- During a bowel resection, portions of the damaged intestine are removed. A healthy intestine is stitched together to reform the intestines.
- An ostomy creates a hole through which your body can eliminate waste. These are usually performed when a portion of the small or large bowel is removed. They can be permanent or temporary when your doctor wants to give your intestines time to heal.
- A colectomy removes sections of the colon that are diseased or damaged.
- A proctocolectomy is a surgery to remove the colon and rectum. If you have this surgery, you will also need a colostomy (a hole in the large intestine for emptying waste).
Crohn’s disease surgery is helpful for relieving symptoms, but it’s not without its risks.
What are the variations of Crohn’s disease?
There are six variations of Crohn’s disease, all based on location. They are:
- Gastroduodenal Crohn’s disease mainly affects your stomach and the duodenum, which is the first part of your small intestine. About 5 percent of people with Crohn’s disease have this type.
- Jejunoileitis occurs in the second portion of your intestine, called the jejunum. Like gastroduodenal Crohn’s, this variation is less common.
- Ileitis is inflammation in the last part of the small intestine, or ileum. About 30 percent of people with Crohn’s disease are affected at this location.
- Ileocolitis affects the ileum and the colon and is the most common variation of Crohn’s. Approximately 50 percent of people with Crohn’s disease have this variation.
- Crohn’s colitis is found in about 20 percent of people with Crohn’s disease. It affects the colon only. Both ulcerative colitis and Crohn’s colitis impact the colon only, but Crohn’s colitis can affect deeper layers of the intestinal lining.
- Perianal disease affects about 30 percent of people with Crohn’s. This variation often involves fistulas, or abnormal connections between tissues, deep tissue infections, as well as sores and ulcers on the outer skin around the anus.
Crohn’s disease and ulcerative colitis
Crohn’s disease and ulcerative colitis (UC) are two types of IBD.
They have many of the same characteristics. You may mistake them for one another.
They have the following characteristics in common:
- The first signs and symptoms of both Crohn’s disease and UC are very similar. These can include diarrhea, abdominal pain and cramping, rectal bleeding, weight loss, and fatigue.
- Both UC and Crohn’s disease occur more commonly in people ages 15 to 35 and people with a family history of either type of IBD.
- In general, IBD tends to affect men and women equally, but this can vary depending on age.
- Despite decades of research, scientists still don’t know what causes either disease. In both cases, an overactive immune system is a likely culprit, but other factors likely play a role.
Here’s how they differ:
- UC only affects the colon. Crohn’s disease can affect any part of your GI tract, from your mouth to your anus.
- UC only affects the outermost layer of tissue lining your colon called the mucosa. Crohn’s disease can affect all the layers of your intestinal tissue from superficial to deep.
UC is just one type of colon inflammation. Several other types of colitis exist. Not all forms of colitis cause the same type of intestinal inflammation and damage as UC.
Crohn’s disease statistics
The CCF and the Centers for Disease Control and Prevention (CDC)report the following statistics:
- A total of 3 million Americans have some form of IBD. This total includes over 780,000 Americans who have Crohn’s disease.
- People who smoke are twice as likely to receive a diagnosis of Crohn’s disease.
- If the condition is treated — medically or surgically — 50 percent of people with Crohn’s disease will go into remission or experience only mild symptoms within five years of their diagnosis.
- About 11 percent of people who have Crohn’s will experience a chronically active disease.
The CCF also reports the following:
- In 2004, 1.1 million doctors’ office visits were for the treatment and care of Crohn’s disease.
- In 2010, Crohn’s disease accounted for 187,000 hospitalizations.
- The average person with Crohn’s disease will spend between $8,265 and $18,963 annually to treat or manage their disease, per 2003–04 U.S. insurance claims data.
According to 2016 data:
- Crohn’s disease occurs about as frequently in men as in women.
- Two out of three individuals with Crohn’s disease will be diagnosed before the age of 40.
Crohn’s disease and disability
Crohn’s disease can disrupt your work and personal life.
It can also cause financial stress. If you don’t have health insurance and sometimes even if you do, your out-of-pocket expenses can total several thousand dollars per year.
If the disease becomes severe enough that it’s affecting your daily life in a significant way, consider filing for disability.
If you can prove that your condition prevents you from working or has prevented you from working for the last year, you may be eligible to receive disability income.
Social Security Disability Insurance or Social Security Income can provide this type of assistance.
Unfortunately, applying for disability can be a long and tedious process.
It requires lots of appointments with your doctors.
You may have to pay for multiple doctors’ visits if you don’t have insurance.
You’ll need to take time off of work if you’re currently employed.
Be aware that you may face a lot of ups and downs as you work through the process.
You might even be denied and have to begin the whole process again.
If you feel it’s the right choice for you, you can begin your Social Security application process by doing one of the following:
- Apply online.
- Call the Social Security Administration’s toll-free hotline at 1-800-772-1213 Monday through Friday, 7 a.m. to 7 p.m.
- Find and visit your nearest Social Security office.
Crohn’s disease in children
Most people with Crohn’s disease are diagnosed in their 20s and 30s, but IBD can develop in children, too.
Approximately 1 in 4 people with an IBD show symptoms before age 20, according to a 2016 review.
Crohn’s disease that only involves the colon is common in children and adolescents.
That means distinguishing between Crohn’s and UC is difficult until the child begins showing other symptoms.
Proper treatment for Crohn’s disease in children is important because untreated Crohn’s can lead to growth delays and weakened bones.
It may also cause significant emotional distress at this stage in life. Treatments include:
- diet changes
Crohn’s medications can have some significant side effects on children. It’s vital you work closely with your child’s doctor to find the right options.