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The digestive system.|
Crohn's disease causes inflammation in the small intestine.
Crohn's disease usually occurs in the lower part of the small
intestine, called the ileum, but it can affect any part of the
digestive tract, from the mouth to the anus. The inflammation
extends deep into the lining of the affected organ. The inflammation
can cause pain and can make the intestines empty frequently,
resulting in diarrhea.
Crohn's disease is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the intestines.
Crohn's disease can be difficult to diagnose because its symptoms
are similar to other intestinal disorders such as irritable bowel
syndrome and to another type of IBD called ulcerative colitis.
Ulcerative colitis causes inflammation and ulcers in the top layer
of the lining of the large intestine.
Crohn's disease affects men and women equally and seems to run in
some families. About 20 percent of people with Crohn's disease have
a blood relative with some form of IBD, most often a brother or
sister and sometimes a parent or child.
Crohn's disease may also be called ileitis or enteritis.
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Theories about what causes Crohn's disease abound, but none has
been proven. The most popular theory is that the body's immune
system reacts to a virus or a bacterium by causing ongoing
inflammation in the intestine.
People with Crohn's disease tend to have abnormalities of the
immune system, but doctors do not know whether these abnormalities
are a cause or result of the disease. Crohn's disease is not caused
by emotional distress.
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The most common symptoms of Crohn's disease are abdominal pain,
often in the lower right area, and diarrhea. Rectal bleeding, weight
loss, and fever may also occur. Bleeding may be serious and
persistent, leading to anemia. Children with Crohn's disease may
suffer delayed development and stunted growth.
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A thorough physical exam and a series of tests may be required to
diagnose Crohn's disease.
Blood tests may be done to check for anemia, which could indicate
bleeding in the intestines. Blood tests may also uncover a high
white blood cell count, which is a sign of inflammation somewhere in
the body. By testing a stool sample, the doctor can tell if there is
bleeding or infection in the intestines.
The doctor may do an upper gastrointestinal (GI) series to look
at the small intestine. For this test, the patient drinks barium, a
chalky solution that coats the lining of the small intestine, before
x rays are taken. The barium shows up white on x-ray film, revealing
inflammation or other abnormalities in the intestine.
The doctor may also do a colonoscopy. For this test, the doctor
inserts an endoscope--a long, flexible, lighted tube linked to a
computer and TV monitor--into the anus to see the inside of the
large intestine. The doctor will be able to see any inflammation or
bleeding. During the exam, the doctor may do a biopsy, which
involves taking a sample of tissue from the lining of the intestine
to view with a microscope.
If these tests show Crohn's disease, more x rays of both the
upper and lower digestive tract may be necessary to see how much is
affected by the disease.
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The most common complication is blockage of the intestine.
Blockage occurs because the disease tends to thicken the intestinal
wall with swelling and scar tissue, narrowing the passage. Crohn's
disease may also cause sores, or ulcers, that tunnel through the
affected area into surrounding tissues such as the bladder, vagina,
or skin. The areas around the anus and rectum are often involved.
The tunnels, called fistulas, are a common complication and often
become infected. Sometimes fistulas can be treated with medicine,
but in some cases they may require surgery.
Nutritional complications are common in Crohn's disease.
Deficiencies of proteins, calories, and vitamins are well documented
in Crohn's disease. These deficiencies may be caused by inadequate
dietary intake, intestinal loss of protein, or poor absorption
Other complications associated with Crohn's disease include
arthritis, skin problems, inflammation in the eyes or mouth, kidney
stones, gallstones, or other diseases of the liver and biliary
system. Some of these problems resolve during treatment for disease
in the digestive system, but some must be treated separately.
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Treatment for Crohn's disease depends on the location and
severity of disease, complications, and response to previous
treatment. The goals of treatment are to control inflammation,
correct nutritional deficiencies, and relieve symptoms like
abdominal pain, diarrhea, and rectal bleeding. Treatment may include
drugs, nutrition supplements, surgery, or a combination of these
options. At this time, treatment can help control the disease, but
there is no cure.
Some people have long periods of remission, sometimes years, when
they are free of symptoms. However, the disease usually recurs at
various times over a person's lifetime. This changing pattern of the
disease means one cannot always tell when a treatment has helped.
Predicting when a remission may occur or when symptoms will return
is not possible.
Someone with Crohn's disease may need medical care for a long
time, with regular doctor visits to monitor the condition.
Most people are first treated with drugs containing mesalamine, a
substance that helps control inflammation. Sulfasalazine is the most
commonly used of these drugs. Patients who do not benefit from it or
who cannot tolerate it may be put on other mesalamine-containing
drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or
Pentasa. Possible side effects of mesalamine preparations include
nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take corticosteroids to control inflammation. These
drugs are the most effective for active Crohn's disease, but they
can cause serious side effects, including greater susceptibility to
Drugs that suppress the immune system are also used to treat
Crohn's disease. Most commonly prescribed are 6-mercaptopurine and a
related drug, azathioprine. Immunosuppressive agents work by
blocking the immune reaction that contributes to inflammation. These
drugs may cause side effects like nausea, vomiting, and diarrhea and
may lower a person's resistance to infection. When patients are
treated with a combination of corticosteroids and immunosuppressive
drugs, the dose of corticosteriods can eventually be lowered. Some
studies suggest that immunosuppressive drugs may enhance the
effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the drug
infliximab (brand name, Remicade) for the treatment of moderate to
severe Crohn's disease that does not respond to standard therapies
(mesalamine substances, corticosteroids, immunosuppressive agents)
and for the treatment of open, draining fistulas. Infliximab, the
first treatment approved specifically for Crohn's disease, is an
anti-tumor necrosis factor (TNF) substance. TNF is a protein
produced by the immune system that may cause the inflammation
associated with Crohn's disease. Anti-TNF removes TNF from the
bloodstream before it reaches the intestines, thereby preventing
inflammation. Investigators will continue to study patients taking
infliximab to determine its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small
intestine caused by stricture, fistulas, or prior surgery. For this
common problem, the doctor may prescribe one or more of the
following antibiotics: ampicillin, sulfonamide, cephalosporin,
tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the
inflammation subsides, but additional medication may also be
necessary. Several antidiarrheal agents could be used, including
diphenoxylate, loperamide, and codeine. Patients who are dehydrated
because of diarrhea will be treated with fluids and
The doctor may recommend nutritional supplements, especially for
children whose growth has been slowed. Special high-calorie liquid
formulas are sometimes used for this purpose. A small number of
patients may need periods of feeding by vein. This can help patients
who need extra nutrition temporarily, those whose intestines need to
rest, or those whose intestines cannot absorb enough nutrition from
Surgery to remove part of the intestine can help Crohn's disease
but cannot cure it. The inflammation tends to return next to the
area of intestine that has been removed. Many Crohn's disease
patients require surgery, either to relieve symptoms that do not
respond to medical therapy or to correct complications such as
blockage, perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need
to have their entire colon removed in an operation called colectomy.
A small opening is made in the front of the abdominal wall, and the
tip of the ileum is brought to the skin's surface. This opening,
called a stoma, is where waste exits the body. The stoma is about
the size of a quarter and is usually located in the right lower part
of the abdomen near the beltline. A pouch is worn over the opening
to collect waste, and the patient empties the pouch as needed. The
majority of colectomy patients go on to live normal, active
Sometimes only the diseased section of intestine is removed and
no stoma is needed. In this operation, the intestine is cut above
and below the diseased area and reconnected.
Because Crohn's disease often recurs after surgery, people considering it
should carefully weigh its benefits and risks compared with other treatments.
Surgery may not be appropriate for everyone. People faced with this decision
should get as much information as possible from doctors, nurses who work with
colon surgery patients (enterostomal therapists), and other patients. Patient
advocacy organizations can suggest support groups and other information resources.
People with Crohn's disease may feel well and be free of symptoms
for substantial spans of time when their disease is not active.
Despite the need to take medication for long periods of time and
occasional hospitalizations, most people with Crohn's disease are
able to hold jobs, raise families, and function successfully at home
and in society.
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No special diet has been proven effective for preventing or
treating this disease. Some people find their symptoms are made
worse by milk, alcohol, hot spices, or fiber. People are encouraged
to follow a nutritious diet and avoid any foods that seem to worsen
symptoms. But there are no consistent rules.
Vitamins, Minerals and Natural Health products can help manage the symptoms and we encourage you to take the correct supplements with your doctor's approval.
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Research has shown that the course of pregnancy and delivery is
usually not impaired in women with Crohn's disease. Even so, women
with Crohn's disease should discuss the matter with their doctors
before pregnancy. Most children born to women with Crohn's disease
are unaffected. Children who do get the disease are sometimes more
severely affected than adults, with slowed growth and delayed sexual
development in some cases.
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Researchers continue to look for more effective treatments.
Examples of investigational treatments include
- Anti-TNF. Research has shown that cells affected by Crohn's disease
contain a cytokine, a protein produced by the immune system, called tumor
necrosis factor (TNF). TNF may be responsible for the inflammation of Crohn's
disease. Anti-TNF is a substance that finds TNF in the bloodstream, binds
to it, and removes it before it can reach the intestines and cause inflammation.
In studies, anti-TNF seems particularly helpful in closing fistulas.
- Interleukin 10. Interleukin 10 (IL-10) is a cytokine that suppresses
inflammation. Researchers are now studying the effectiveness of synthetic
IL-10 in treating Crohn's disease.
- Antibiotics. Antibiotics are now used to treat the bacterial infections
that often accompany Crohn's disease, but some research suggests that they
might also be useful as a primary treatment for active Crohn's disease.
- Budesonide. Researchers recently identified a new corticosteroid
called budesonide that appears to be as effective as other corticosteroids
but causes fewer side effects.
- Methotrexate and cyclosporine. These are immunosuppressive drugs
that may be useful in treating Crohn's disease. One potential benefit of
methotrexate and cyclosporine is that they appear to work faster than traditional
- Natalizumab. Natalizumab is an experimental drug that reduces symptoms
and improves the quality of life when tested in people with Crohn's disease.
The drug decreases inflammation by binding to immune cells and preventing
them from leaving the bloodstream and reaching the areas of inflammation.
- Zinc. Free radicals--molecules produced during fat metabolism,
stress, and infection, among other things--may contribute to inflammation
in Crohn's disease. Free radicals sometimes cause cell damage when they
interact with other molecules in the body. The mineral zinc removes free
radicals from the bloodstream. Studies are under way to determine whether
zinc supplementation might reduce inflammation.
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Crohn's & Colitis Foundation of America,
Pediatric Crohn's & Colitis Association,
United Ostomy Association, Inc.
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