Crohn’s disease is an inflammatory bowel disease. It’s an autoimmune disorder. We don’t know exactly all the details of why people get Crohn’s disease, but we’ve come a long way over the last decade or two.
Crohn’s disease can affect anywhere from the mouth all the way down to the anus. We have what we call Crohn’s Colitis, which is Crohn’s Disease specifically of the colon. There’s Crohn’s ileocolitis, which means Crohn’s Disease that affects the last portion of the small intestine as well as the colon. And then there’s just small bowel Crohn’s Disease. That’s the most common type of Crohn’s Disease that affects anywhere in the small bowel. A minority of patients have Crohn’s Disease that is isolated to the upper digestive tract, so the esophagus, the stomach, or the upper digestive intestines.
Approximately 1.4 million people in the United States have inflammatory bowel disease. This is distributed about 50/50 between Crohn’s Disease and ulcerative colitis, which is another form of inflammatory bowel disease.
Crohn’s Disease can be a very serious condition if not dealt with and treated appropriately. However, there are so many great medications nowadays that most patients with Crohn’s Disease are able to lead relatively normal lives. Decades ago, patients with Crohn’s Disease would end up in the hospital when they had a flare of their disease. Now patients can see their physicians and usually get outpatient care to control their symptoms.
An abscess is a collection of pus or bacteria. In patients who have the fistulizing type of Crohn’s Disease with inflammation, this essentially causes a burrowing type of a hole through their intestines, and the bacteria from the digestive tract collects into an abscess in this hole. That can be very dangerous and may require antibiotics and even potentially surgery to drain the area.
Common symptoms of Crohn’s Disease include abdominal pain, diarrhea, and weight loss. Because Crohn’s Disease affects the entire digestive tract, it can potentially interfere with absorption of nutrients. In children, that may mean stunted growth and malnutrition.
If someone suspects they have Crohn’s Disease, they should seek specialized medical attention, whether it’s in the form of a gastroenterologist who specializes in Crohn’s disease or seeing an inflammatory bowel disease specialist. These specialists can ensure that all the pieces of the puzzle are put together, and the diagnosis is accurate before starting on any type of medication, such as immunosuppressants.
Smoking is an extremely important risk factor that anyone with Crohn’s Disease should absolutely eliminate. A smoker with Crohn’s Disease is much more likely to develop strictures, blockages, or fistulas. They’re more likely to have complications that require surgery. Crohn’s Disease can affect people of all ages; there is no risk factor based on age. Symptoms can start at a very early age; however, Crohn’s Disease typically presents in the second or third decade of life.
Patients should visit either a gastroenterologist who specializes in Crohn’s disease or an inflammatory bowel disease specialist.
There are a number of conditions that can mimic Crohn’s Disease. In certain parts of the world, tuberculosis is very prevalent and it can mimic symptoms of Crohn’s Disease. Inflammatory diseases of the bowel, such as microscopic colitis, can cause symptoms that may be similar to Crohn’s disease, such as abdominal pain or diarrhea. Celiac disease is another condition that can present with similar symptoms, such as weight loss, diarrhea, and abdominal pain. However, on imaging, blood tests, and endoscopy or colonoscopy, a specialist can differentiate among these conditions.
Crohn’s Disease can be treated by various over-the-counter medications and home remedies, including probiotics, turmeric, curcumin, and omega-3 fatty acids. Prescription medications can also be used to treat Crohn’s Disease. The starting treatments include five ASAs, or aminosalicylates. These are mild forms of immunosuppressants that target the digestive tract directly. The next set of medications that are often used are antibiotics. With certain types of Crohn’s Disease, antibiotics such as Ciprofloxacin and Flagyl have been shown to be very effective. Steroids, whether they be systemic conventional corticosteroids such as prednisone or non-systemic steroids such as budesonide, are also very helpful, especially in the acute phase where patients are extremely sick. Steroids have a lot of potential side effects, so their long-term use should be avoided. However, in the short term, they’re very effective at getting control over a patient’s disease.
Over-the-counter medications and home remedies can help people with Crohn’s Disease. Additionally, there are five medications called aminosalicylates that target the digestive tract specifically. Antibiotics and steroids may also used in the treatment of Crohn’s Disease.
Long-term medication is often needed because Crohn’s Disease is a chronic autoimmune condition. However, some people are able to carefully reduce and/or eliminate the medications they are using with their doctor’s help.
Unfortunately, there is currently no cure for Crohn’s disease. However, there is a large selection of treatment options to choose from to relieve symptoms, including over-the-counter medication, home remedies, aminosalicylates, antibiotics, and steroids.
There are several over-the-counter options that can help treat Crohn’s Disease. Probiotics have been studied and seem to be helpful in modulating the gut microbiome. Anti-inflammatory home remedies such as turmeric and curcumin have been studied and found to be very helpful in inflammatory bowel diseases. Omega-3 fatty acids are also helpful for treating inflammatory bowel diseases, especially Crohn’s Disease.
A moderate amount of social alcohol is generally fine for most people with Crohn’s Disease. However, there are certain diets and dietary plans used to help Crohn’s Disease that may call for complete elimination of alcohol during the diet, such as exclusive enteral nutrition. During that period, you’re essentially only eating protein shakes to rest the bowel. In that specific treatment algorithm, alcohol is not recommended. However, when patients are in remission and their disease is well controlled, social drinking may be acceptable.
A woman with Crohn’s Disease who is thinking about becoming pregnant must get the Crohn’s disease well under control. Certain medications can affect fertility in men or women, so if either partner is taking medications for Crohn’s Disease, they should discuss their pregnancy plans with their doctor.
Diet is very important in managing Crohn’s Disease. Research shows that what you eat plays an extremley important role in your response to medications and in the overall course of Crohn’s Disease. The SCD (specific carbohydrate diet) is a diet that is lactose free, grain free, and gluten free. It also includes many other components such as avoiding processed food. When patients adhere to the SCD, they see remarkable improvements in their overall energy, their disease severity, and their response to treatment.
Complications of Crohn’s Disease vary from individual to individual. Complications include problems such as nutritional and vitamin deficiencies. Other complications of Crohn’s Disease include intestinal blockages called strictures. Infections are another potential complication. If patients develop an abscess, that needs to be addressed with antibiotics or sometimes with surgical drainage.
Thanks to developments in the area of inflammatory bowel disease, patients with Crohn’s disease can lead very normal lives. We now have very effective and safe treatments for patients with Crohn’s Disease. We have learned a lot over the years about Crohn’s Disease, and we’re now able to educate our patients better, treat them better, and monitor their disease in ways that we weren’t able to do before.
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