Crohn's Disease

What is Crohn's disease?
Crohn's disease is one of the two types of inflammatory bowel diseases (IBD), also known as an autoimmune diseases.  It may affect any part of the gastrointestinal tract. Inflammation extends through all layers of the intestinal wall and may involve lymph nodes and supporting membranes in the affected area. Ulcers form as the inflammation extends into the peritoneum. It is characterized by chronic inflammation of the intestine with periods of remission interspersed with periods of exacerbation.

What Causes Crohn's Disease?
The actual cause of Crohn's disease is an antigen that has yet to be identified, and contributing factors include:
  • Genetic factors and
  • Environmental factors 
The tissue damage associated with Crohn's disease is due to an overactive, inappropriate, and sustained inflammatory response occurring anywhere along the GI tract from the mouth to the anus, but occurs mostly in the terminal ileum and colon. Crohn's disease commonly occurs during the teenage years, early adulthood, with second peaks in the 6th decade.

Clinical Manifestations and Complications
Manifestations include:
  • Diarrhea 
  • Colicky abdominal pain 
  • Weight loss, when the small intestine is involved 
  • A small mass is sometimes felt in the right iliac fossa 
  • Rectal bleeding 
  • Fever 
  • Fatigue 
Complications include:
  • Hemorrhage 
  • Strictures 
  • Perforation 
  • Fistulas 
  • Colonic dilation 
  • Nutritional problems 
  • Small bowel cancer 
  • Anorexia 
  • Malaise 
  • Arthritis 
  • Ankylosing spondylitis 
  • Eye inflammation 
  • Skin lesions 
  • Thromboembolism 
  • Kidney stones 


How is Crohn's Diagnosed?
The diagnosis of Crohn’s includes ruling out other diseases with similar symptoms and then determining whether the patient has Crohn’s or ulcerative colitis.  The following diagnostic studies are used to provide information about the disease severity and complications:
  • Stool cultures - stool is examined for blood, pus, and mucus (to determine if the cause of diarrhea is of infectious origin, if so, it can be treated) 
  • Complete blood count (CBC) test will show: 
    • Iron-deficient anemia from blood loss 
    • An elevated white blood cell count (indicating mega colon or perforation 
    • Decreases in serum sodium, potassium, chloride, bicarbonate, and magnesium levels (due to fluid and electrolyte losses from diarrhea and vomiting 
    • Hypo-albumenemia (present with severe disease and is due to poor nutrition or protein loss from the bowel) 
    • An elevated erythrocyte sedimentation rate (ESR) (reflects chronic inflammation) 


Is There a Cure for Crohn's Disease?
Crohn’s does not have a cure, however it can be managed using the following medications:
  • Aminosalicylates (treats inflammation) – for mild to moderate Crohn’s, especially when the colon is involved for achieving and maintaining remission. 
  • Antimicrobials (treats fistulas and help lower the amount of bad bacteria in your gut) – to treat infection that may go along with Crohn’s flare. 
  • Corticosteroids (treats inflammation) – for moderate to serious or severe Crohn's; used to achieve remission in acute flares, but given for short periods of time. 
  • Immunomodulators (treats the immune system) – the strongest Crohn's medications and are useful for patients who don’t respond to the above medications. They are very strong and can cause a lot of side effects. 
  • Biologic therapy (treat the immune system's signal to the body) – this signal causes the inflammation, and this natural living cell intercept the signals from the immune system. These medication are given IV to induce and maintain remission in patients with active Crohn’s disease and in patients with draining fistulas. 
IT IS EXTREMELY IMPORTANT TO TAKE ONE'S MEDICATION AS DIRECTED BY YOUR DOCTOR.
  • Surgery is reserved for emergency situations. 
  • Diet is an important component in the treatment of Crohn’s. The goals of diet management are:
    • To provide adequate nutrition without exacerbating symptoms 
    • To correct and prevent malnutrition 
    • To replace fluid and electrolyte losses 
    • To prevent weight loss 


What is a Crohn's Flare?
Any worsening of the signs and symptoms of your Crohn's disease. For most, it's diarrhea, cramps, stomach pain, and fever etc. During this time you can feel out of control, and this is normal. The length of the flare or how long one can go without a flare is unpredictable. Be sure to notify your doctor when you are experiencing a flare, as this enables them to gauge how well your disease is being controlled. The fix could be as easy as changing your medications. Be sure to discuss an "Action Plan" with your doctor in order to combat your Crohn's flares.

What Causes Flares?
There are many things that can cause a flare, but the following can be linked to a flare:
  • Skipping medicine or not taking it the correct way ordered 
  • Injury or surgery (this includes dental procedures), you should not have dental work done unless your Crohn's is under control. 
  • Stress (it may not be external or noticeable stress, but your body is aware of it) 
  • Not getting enough sleep or rest 
  • Infections 


When to Get Help FAST!!!!!
When you experience a flare that is worse than you have experienced before including:
  • Heavy clumps of blood in your bowel movement or diarrhea 
  • Heavy diarrhea that is worse than you normally have with a flare 
  • pain that does not stop or get better 
  • A fever of 2 degrees more than you usually have 
  • When you experience a fissure, which is a tear in the lining of your anus. Since your anus passes stool, this can happen when you have bowel movements a lot.  Look for: 
    • Pain after having a bowel movement 
    • Seeing blood in your stool or when you wipe 
  • When you experience a fistula, which is the inflammation from your Crohn's creating a tunnel that connects your intestines to other parts of your body, causing infection.  Look for: 
    • Stool or mucous or pus that drains from skin near your anus, bladder, or vagina 
  • When you experience a stricture, which happens when inflammation scars the intestines and narrows and block food and waste from passing through.  Look for: 
    • Feeling sick to your stomach (nausea) 
    • Throwing up (vomiting) 
    • Constipation or having trouble passing stool 
  • When you experience an abscess, which is when the inflammation causes pus or fluid to collect causing infection.  Look for: 
    • Pain in your lower stomach 
    • Pain during bowel movements 
    • Fluid draining from the rectum that could be white or yellow in color 
    • Fever 
    • A knot or lump under the skin near your anus 

For additional information regarding Crohn's disease check out the following websites:
  • http://www.ccfa.org/ (has an awesome GI Buddy application) 
  • http://www.nlm.nih.gov/ 








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References
Accordant a CVS Caremark Company. (2011). Could It Be My Crohn's. Accordant . Accordant Health Services.

Accordant a CVS Caremark Company. (2011). Treating Your Crohn's Disease. Accordant. Accordant Health Services.