Crohn’s disease is a chronic, recurrent inflammatory disease of the intestinal tract. The two primary sites for Crohn’s disease are the ileum, which is the last portion of the small bowel (ileitis, regional enteritis), and the colon (Crohn’s colitis). The lining of the bowel can become inflamed, ulcerated and the bowel wall gets thickened. Eventually, the bowel may become narrowed or obstructed.
There is now evidence of a genetic link as Crohn’s frequently shows up in a family group. In addition, there is evidence that the normal bacteria that grow in the lower gut may, in some manner, act to promote inflammation. The body’s immune system, which protects it against many different infections, is known to be a factor. There are still a number of unknowns about the cause of the disease. The condition occurs in both sexes and among all age groups, although it most frequently begins in young people. Jewish people are at increased risk of developing Crohn’s, while African Americans are at decreased risk.
Crohn’s disease symptoms depend on where in the intestinal tract the disorder appears. When the ileum (ileitis) is involved, recurrent pain may be experienced in the right lower abdomen. At times, the pain mimics acute appendicitis. When the colon is the site, diarrhea (sometimes bloody) may occur, along with fever and weight loss. Crohn’s disease often affects the anal area where there may be a draining sinus tract called a fistula. When the disease is active, fatigue and lethargy appear. In children and adolescents there may be difficulty gaining or maintaining weight.
The patient’s medical history, physical exam, certain blood and stool tests are performed to arrive at a diagnosis. Small bowel series and CT scan of abdomen are routinely used tests but CT enterography and capsule endoscopy which are latest development are more sensitive tests. In addition, a visual examination the entire colon and terminal ileum with colonoscopy can give biopsy proof of the disease.
Effective medical and surgical treatment is available for Crohn’s disease. It is particularly important to maintain good nutrition and health with a balanced diet. Steroids are powerful drugs which provide highly effective results but can not be given long term due to side effects. Anti-inflammatory drugs such as sulfasalazine (Azulfidine), Colozal, Asacol, Rowasa, and Pentasa useful in maintaining a remission, once the disease is brought under control. Imuran and Purinethol suppress the body’s immune system, which appears to be overly active and aggravates the disease. These drugs are particularly useful for long-term care. Infliximab (Remicade) is the first of a group of medications that blocks the body’s inflammation response. It is given by intravenous infusion. This medication is particularly useful in fistulous disease. Two common antibiotics: ciprofloxacin and metronidazole are also useful. Crohn’s disease surgery is commonly needed at some time during the course of Crohn’s disease treatment. It may involve removing a portion of diseased bowel, or simply the draining of an abscess or fistula.
For more information on Crohn’s disease, visit our clinic in Riverdale New Jersey.