The inflammation of the gut and digestive tract is termed Crohn’s disease. It happens due to the body’s reaction towards any irritation or injury. (1)
Understanding Crohn’s disease
It is one of the subtypes of inflammatory bowel disease (IBD). The other one is called Ulcerative Colitis. Crohn’s disease is a long-term chronic disease. In this duration, a patient faces emissions (phase of good health) and relapses (phase of symptoms). It is a non-contagious disease. No specific cure for Crohn’s disease has been introduced yet. But surgeries and medication can provide relief from symptoms.
Symptoms of Crohn’s disease depend upon the severity of the disease and physiology of the patient. The symptoms may distinguish for a specific duration and then flare up again. Crohn’s disease imparts symptoms of different levels. Some people spend their entire life with very mild Crohn’s symptoms and other suffers from chronic and frequent flare-ups. Its symptoms are:
- Abdominal pain
- Diarrhea; sometimes mixed with blood, pus, or mucus
- Fatigue due to illness, surgery, weight loss, and lack ofsleep
- Some people feel high temperature and remain generally unwell
- Weight loss and loss of appetite. Weight loss happens due to poor absorption of nutrients from the gut
- Anemia; which is characterized by low red blood cell count. This happens due to loss of blood in diarrhea, poor absorption of nutrients from an inflamed gut, and loss of appetite. Anemic patients feel tired all the time.
Even after so many researches, the exact cause of Crohn’s disease is yet not identified. However, genetics is considered to be one of the main causes of the condition. Researchers found that Crohn disease is caused by an assortment of several factors:
- Certain medications
Effect of Crohn disease on the gut (2)
The gut is a long tube that starts from the oral cavity and is terminated at the anus. The food we eat enters the stomach via the esophagus where the gastric juice breaks it down to form a mixture. That mixture is transferred to the small intestine, which further breakdowns the food particles and absorbs useful nutrients. These nutrients are then sent to body cells through blood. The remaining unabsorbed food is sent to the large intestine, which allows the absorption of water. Water gets absorbed and the leftover leaves the body through the rectum in the form of feces. In the case of Crohn’s disease, the inflamed gut fails to perform all these functions healthily. This disease can affect any portion of the gut but the ileum is the most targeted one. The inflammation causes patches in the gut that are discontinued by healthy parts of the gut at regular intervals. The patches can be short as well as long. The disease may also affect the deep linings of the bowel causing fistulas and abscesses.
- Ileocaecaland terminal ileal
If Crohn’s disease affects the intestinal last part or ileum then this is known as terminal ileal Crohn. If the condition attacks the first part of the large intestine then this is called ileocaecal Crohn disease. Its symptoms include abdominal pain in the lower right part, particularly after eating, weight loss, and diarrhea. Stools are non-bloody but blackish.
- Small bowel
This type of Crohn’s disease is also known as jejunoileitisor ileitis. Symptoms include deficiency of nutrients, diarrhea, and abdominal pain. This type of Crohn’s disease mostly targets young people and children.
In this type, Crohn’s disease attacks the colon and is termed is Crohn’s colitis. It is not similar to ulcerative colitis. The main symptom includes diarrhea with mucus and blood. Due to inflammation, the colon fails to hold the waste and the patient feels urgency to evacuate it.
In this type, Crohn’s disease attacks the upper gut that includes the stomach, duodenum, and esophagus. Symptoms include vomiting, abdominal pain, indigestion, loss of appetite, anemia, and weight loss.
The continuous relapse and remission phases cause tissue scars that create a narrow segment of the bowel. This is called a “Stricture”. This segment makes it troublesome for the meal to pass through and in severe cases causes complete obstruction.
Its symptoms are nausea, constipation, vomiting, and abdominal pain. Strictures are usually treated surgically, which is known as “stricturoplasty”.
Perforation happens due to severe inflammation or blockage in the bowel. Perforation causes a hole in the bowel, which increases the chances of leakage of bowel content. This requires urgent medical care. Its symptoms include vomiting, nausea, fever, and abdominal pain. In some cases, the abscess is formed due to leakage.
Small fistulas are another complication caused by Crohn’s disease. A fistula is a narrow pathway between skin and gut.
Diagnosis of Crohn Disease
At first, a doctor may diagnose Crohn’s disease by physical examination. If a person is suffering from weight loss, abdominal pain, and diarrhea for many weeks, then he is likely to have Crohn’s disease, particularly if he is an adult and has a family history of this condition. This diagnosis is confirmed by doing further medical tests and investigations.
The goal of medication therapy is to reduce symptoms and flare-ups, achieve and maintain remission. This means a patient has to take medicines continuously for many years.
These drugs lessen the inflammation of the intestinal lining. Examples are olsalazine, sulfasalazine, balsalazide, and mesalazine.
These drugs block agents that stimulateallergic reactions and inflammatory responses in the body. Such drugs include prednisolone, prednisone, budesonide, methylprednisolone, beclometasone, dipropionate, and hydrocortisone.
These drugs reduce inflammation by blocking the immune response of the body. Such drugs include methotrexate, mercaptopurine, and azathioprine.
- Biological drugs
These are the modern drugs used to treat Crohn’s disease. These include ustekinumab, golimumab, adalimumab, and infliximab.
Patients with Crohn’s disease are prescribed enteral nutrition for 2-8 weeks. The patient on this diet does not take normal drinks or food because the recommended liquid diet has all the required nutrients.