Overview of Crohn’s disease
Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus. Signs and symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, and weight loss. Other complications may occur outside the gastrointestinal tract and include anemia, skin rashes, arthritis, inflammation of the eye, and tiredness.
About half of the overall risk is related to genetics with more than 70 genes having been found to be involved. Tobacco smokers are twice as likely to develop Crohn’s disease as nonsmokers.It also often begins after gastroenteritis. Diagnosis is based on a number of findings including biopsy and appearance of the bowel wall, medical imaging and description of the disease. Other conditions that can present similarly include irritable bowel syndrome and Behçet’s disease.
Signs and symptoms Crohn’s disease
- Chronic diarrhea, often bloody and containing mucus or pus
- Weight loss
- Abdominal pain and tenderness
- Feeling of a mass or fullness in the abdomen
- Rectal bleeding
Crohn’s disease causes two types of complications:
- Local, which affect just the intestines
- Systemic, which affect your whole body. You might hear them called extraintestinal
Other symptoms Crohn’s disease
- A high temperature (fever)
- feeling and being sick
- joint pains
- sore, red eyes
- patches of painful, red and swollen skin – usually on the legs
- mouth ulcers
- immune system disorder
- environmental factors and
- genetic predisposition.
Crohn’s is the first genetically complex disease in which the relationship between genetic risk factors and the immune system is understood in considerable detail. Each individual risk mutation makes a small contribution to the overall risk of Crohn’s.
How do immune system problems relate to Crohn’s disease?
Is genetics connected to Crohn’s disease?
Brothers, sisters, children, and parents of persons with IBD, including Crohn’s disease, are slightly more likely to develop the disease themselves. About 10% to 20% of people with Crohn’s disease have at least one other family member who also has the disease. The condition is more common in certain ethnic groups, such as Jews, and is more prevalent in Caucasians.
Scientists have identified a gene associated with Crohn’s disease. This gene helps the body decide how to react to certain microbes. If the gene has changed or mutated in some way, your body’s reaction to microbes may also be different from the normal reaction. Over time, IBD or Crohn’s disease may develop. People with Crohn’s disease have this mutated gene twice as often as people who do not have the disease.
Although stress is sometimes claimed to exacerbate Crohn’s disease, there is no concrete evidence to support such claim. Dietary microparticles, such as those found in toothpaste, have been studied as they produce effects on immunity, but they were not consumed in greater amounts in patients with Crohn’s
- Rule out other health problems
- Make a clear diagnosis of Crohn’s disease
- Find out exactly which part of the digestive tract is affected
Physical Exam and History
- Belly pain and cramps
- Blood in your poop
- Drainage from a painful sore near your anus
- Lack of appetite
- Mouth sores
- Urgent bowel movements
- Weight loss
- Antibody tests: These help doctors tell if you have Crohn’s or ulcerative colitis:
- Anti-Saccharomyces cerevisiae antibody test (ASCA): People with this protein are more likely to have Crohn’s.
- Perinuclear anti-neutrophil cytoplasmic antibody test (pANCA): People with this protein are more likely to have ulcerative colitis.
- Complete blood count (CBC): It checks for anemia (low numbers of red blood cells) and infection.
- C-reactive protein: It looks for this protein, which is a sign of inflammation.
- Electrolyte panel: Your body might be low on minerals like potassium if you have Crohn’s-related diarrhea.
- Erythrocyte sedimentation rate: This gauges the amount of inflammation in your system by measuring the amount of time it takes for your blood to fall to the bottom of a special tube.
- Iron and B12 levels: These can be low if your small intestine isn’t absorbing nutrients like it should.
- Liver function: The disease can affect your liver and bile duct.
Computed tomography (CT) scan: CT scanning uses computer-aided X-ray techniques to make more detailed images of the abdomen and pelvis than can be seen in traditional X-rays. CT scans can help find abscesses that might not show up on other X-rays. Abscesses are small pockets of infection.
Leukocyte scintigraphy: White blood cells gather at spots in your body where there’s inflammation. For this test, the doctor will take a little blood from your arm and add a harmless amount of a radioactive substance. He’ll put it back in your body and use a special camera to see if the cells travel to spots in your gastrointestinal tract that could signal Crohn’s. It’s not a commonly used test.
- You have an obstruction in the small intestine. The capsule could get stuck and make the obstruction worse.
- You have a narrowing in the small intestine, such as from Crohn’s disease, previous surgery, or previous radiation therapy. The capsule might become stuck.
- You have an implanted device like a pacemaker or defibrillator for your heart. Some doctors worry that wireless transmissions from the capsule might interfere with them.
Crohn’s Disease Treatment
Your care team may recommend surgery if they think the benefits outweigh the risks or that medicines are unlikely to work.
Surgery can relieve your symptoms and help stop them coming back for a while, although they’ll usually return eventually.
The main operation used is called a resection. This involves:
- Making small cuts in your tummy (keyhole surgery).
- Removing a small inflamed section of bowel.
- Stitching the healthy parts of bowel together.
It’s usually done under general anaesthetic (while you’re asleep). You may be in hospital for about a week and it might take a few months to fully recover. Sometimes you may need an ileostomy (where poo comes out into a bag attached to your tummy) for a few months to let your bowel recover before it’s stitched back together. You may need to take medicine after surgery to help prevent symptoms returning.