Crohn’s disease

Symptoms Of Crohn’s disease 

The symptoms of IBD vary from person to person, may change over time, and can range from mild to severe. 

• Chronic diarrhea (for more than 4 weeks)
• Stomach pain or cramps
• Fever
• Fatigue
• Mouth sores 
• A loss of appetite
• Sensation of incomplete evacuation
• Nausea and vomiting
• Rectal bleeding 
• Anemia (a condition in which you have fewer red blood cells than normal)
• Swelling in inner lining of stomach
• A feeling of fullness 
• Constipation 
• Weight loss
• Rectal bleeding
• Mucus in stool
• Blood stains in stool
  

During a flare of Crohn’s disease symptoms, a person may also develop

• Arthritis
• Uveitis (eye inflammation)
• skin rash and inflammation
• liver or bile duct inflammation
• Abscess (a collection of pus, which can develop in the abdomen, pelvis, or around the anal area)
• Fistula (intestinal ulcers that extend and form a tunnel (fistula) to another part of the intestine, the skin, or another organ)
• Intestinal obstruction, a blockage in the intestine
• Anal fissures (small tears in your anus that may cause itching, pain, or bleeding)
• Ulcers, open sores in your mouth, intestines, anus
• Malnutrition (it  occurs when your body does not receive the necessary vitamins, minerals, and nutrients).
• Inflammation in other areas of your body, such as your joints, eyes, and skin

Types of Crohn’s disease

There are five types of Crohn's disease including: 

• Crohn's colitis: When disease affects only the colon.
• Gastroduodenal Crohn's disease: It is characterized by chronic inflammation of the stomach and the first part of the small intestine, or the duodenum.
• Ileitis: It is a condition that affects the ileum, or small intestine.
• Ileocolitis: It is the most common type of Crohn's disease, affecting the ileum and colon.
• Jejunoileitis: The disease affects the upper half of the small intestine.

Causes Of Crohn’s disease

The exact cause of IBD is unknown, but it is thought to involve a combination of genetic predisposition, infectious, immunological, dietary, and environmental factors.

Crohn's disease causes inflammation (swelling) anywhere from the mouth to the anus. However, the disease most commonly affects the junction of the small intestine and the colon (ileum). It begins with lesions near the intestinal crypt (a gland found in intestines). It eventually spreads to form ulcers, first in the superficial layer and then in deeper intestine tissues.

As the swelling worsens, non-caseating granuloma (cell swelling without cell death) forms, which is very common in Crohn's disease. This ongoing swelling causes bowel obstruction and stricture formation (a narrowing of the bowel which can lead to an intestinal blockage).

Risk Factors For Crohn’s disease

Risk factors for Crohn's disease may include:

1. Genetic predisposition

Genetics may also play a role, since Crohn's disease can run in families. Having a close relative with Crohn's disease increases the likelihood of developing the condition. If both parents have inflammatory bowel disease (IBD), the risk of developing Crohn's disease rises to 35%.

Note: As per study it has been found that children who have one parent with Crohn's disease have a 7 to 9 percent lifetime risk of developing the condition. 
They also have a 10 percent chance to develop some form of inflammatory bowel disease. 

2. Age 

CD can occur at any age but the condition mostly develops before or around 30 years of age. 

3. Immunity

Crohn’s disease is an autoimmune-mediated inflammatory condition. Foreign invaders such as bacteria, viruses, fungi, and other microorganisms are typically attacked and killed by the immune system.

An autoimmune reaction occurs when your immune system incorrectly attacks healthy cells in your body, causing an abnormal response to the intestinal tract and swelling. This causes chronic inflammation (swelling), ulceration, intestinal wall thickening, and, eventually, Crohn's disease symptoms.

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4. Stress 

Stress may also have an important role in the pathogenesis of IBD. It has been proposed that stress may initiate or reactivate the gastrointestinal inflammation leading to the deterioration of clinical symptoms of IBD. 

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5. Environmental factors

There are several environmental factors that can increase the risk of developing and flaring up Crohn’s disease, such as:

1. Painkillers: Long-term use of painkillers or Nonsteroidal anti-inflammatory drugs such as aspirin, and ibuprofen especially in women increases the risk of IBD (Inflammatory Bowel Disease).
   
   
2. Smoking: Cigarette smoking also increases the likelihood of developing Crohn's disease. Active smokers are more than twice as likely to develop Crohn's disease as nonsmokers.
   
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3. Poor diet: Poor dietary habits such as diets high in sugar, omega-6 fatty acids, polyunsaturated fatty acids, total fat, oil, meat etc. have also been associated with an increased risk of developing CD (Crohn’s disease).
   
   Note: IBD or Crohn’s disease are not triggered by eating any one particular food. But for some people, certain foods can aggravate symptoms.
   
   
4. Appendicitis: Children who have their appendix removed are less likely to develop ulcerative colitis later in life, but they may be more likely to develop Crohn's disease.
   
   
5. Oral contraceptives or HRT(hormone replacement therapy): Both hormone replacement therapy and oral contraception may increase the risk of IBD in women.
   
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6. Antibiotics: Antibiotic exposure during childhood may increase the risk of IBD or Crohn’s disease.
   
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Diagnosis Of Crohn’s disease

To diagnose Crohn's disease, doctors typically use combination of tests. Before undergoing a physical examination, you must inform your doctor about your medical history, including any medications you are taking and your family history.

1. Physical examination

• Examines your abdomen for bloating
• Using a stethoscope, listens for sounds within your abdomen.
• Taps on your abdomen to detect tenderness and pain, as well as to determine whether your liver or spleen is abnormal or enlarged.

2. Lab tests

 It includes blood tests (RBC and WBC’s count) and stool test.

• Blood test-:This test checks for high levels of white blood cells, which are indicative of inflammation or infection. The test also looks for anemia, or a low red blood cell count.
  

• Stool test: It checks for bacteria or parasites. It is useful in ruling out infections that cause chronic diarrhea.
  
  

3. Imaging tests

Intestinal endoscopy- It includes the following

• Endoscopy, colonoscopy : These are invasive tests in which a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time.
  
  
• Biopsy: During the biopsy, a small piece of tissue is removed from the inside of the intestine for further testing and analysis. Biopsy sample is also taken in the case of cancer. 
  
  
• Chromoendoscopy: A blue liquid dye is sprayed into the colon to highlight and detect minor changes in the lining of the intestine. Polyps can also be then removed and/or biopsied.
  
  
• Capsule endoscopy: In capsule endoscopy, a capsule is swallowed  containing a tiny camera that allows the doctor to visualise inside the digestive tract.
  
  
• X-rays and fluoroscopy: For the procedure, you will be asked to stand or sit in front of an x-ray machine and drink barium. On an x-ray, the barium will make your upper GI tract more visible. The radiologist will then observe the barium moving through your upper GI tract on x-ray and fluoroscopy. 
  
  
• CT Scan and Magnetic resonance enterography (MRE) : A CT scan (also known as computed tomography) is a machine that takes a series of x-rays to make a picture of the digestive tract. 
  MRE is an imaging test which produces detailed pictures of your small intestine.
  
  

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Prevention Of Crohn’s disease

The "treat to target" or "tight control" approach is quickly becoming the approach in the treatment and management of many chronic conditions, including IBD and Crohn's disease.

Certain lifestyle modifications can help prevent the condition as follows-

1. Follow a few dietary rules

Such as limiting dairy products, having a fibrous diet comprising fruits, vegetables, legumes and whole grains. Restrict foods with low amounts of fiber such as processed and packaged foods, milk and meat products.

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2. Drinking plenty of water

Drink a minimum of 8 glasses of water during a day. Restrict intake of alcohol and caffeine in the form of coffee and soft drinks as they tend to dehydrate the body.

3. Quit smoking

Cigarette smoking flare up the Crohn’s symptoms or even worsen them.

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4. Get screening for colorectal and cervical cancer

Consult your doctor about getting screened for colorectal cancer. Patients with IBD may need to begin colorectal cancer screening before the age of 50. Talk to your doctor about how to prevent cervical cancer if you are a woman with IBD. Cervical cancer is more common in IBD patients.

5. Immunize yourself

Immunizations against infectious diseases are part of primary prevention efforts. IBD patients are more likely to contract vaccine-preventable illnesses such as influenza, pneumococcal pneumonia, and shingles. As a result, following vaccination guidelines for inactivated vaccines can help to reduce these infectious complications.

Note: Immunization is the key to the prevention of diseases.

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6. Exercise regularly

Stay active by exercising regularly. To aid digestion, perform light exercises such as walking after consuming heavy meals.

7. Manage stress

Stress and anxiety can aggravate Crohn's disease symptoms. Stress can also precipitate flare-ups.

Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.Read to know more

Doctor To Visit

The first step is to find a qualified gastroenterologist who is a specialist in treating patients with Crohn’s disease or ulcerative colitis. In order to diagnose and treat the symptoms of Crohn's disease, you need to visit:

• General physician
• Infectious disease specialist
• Gastroenterologist

A gastroenterologist is a  medical practitioner specializing in the diagnosis and treatment of disorders of the gastrointestinal tract and related organs.
An infectious disease specialists is a  physician who diagnoses and treatments acute and chronic diseases caused by bacteria, viruses, fungi, parasites, and even prions.

When to see a doctor?

You must visit a doctor if Crohn's disease becomes a chronic problem and/or is accompanied by one or more of the following symptoms such as:

• Frequent diarrhea
• Vomiting
• Blood or mucus in the stools
• Fever
• Unexplained weight loss
• Severe abdominal pain
• Fatigue
• Night sweats
  
  

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Treatment Of Crohn’s disease

The medical treatment is broadly classified into five groups-

I. Aminosalicylates

It helps control swelling at the wall of the intestine. It is usually prescribed to treat people who are newly diagnosed with Crohn’s disease and have mild symptoms. These drugs include:

• Balsalazide
• Mesalamine
• Olsalazine
• Sulfasalazine 

II. Corticosteroids

These, also known as steroids, help to suppress the immune system and reduce swelling. It is usually given to people who have moderate to severe symptoms. They are effective for controlling flare-ups in the short term. Because of their side effects, they are not recommended for long-term or maintenance use.
Drugs include:

• Budesonide
• Hydrocortisone
• Methylprednisolone
• Prednisone
  

III.  Immunomodulators

These medications suppress the immune system, resulting in less swelling in the digestive tract. These medications are used to keep people in remission who have not responded to other medications or have only responded to steroids. The drugs include:

• 6-mercaptopurine
• 6-MP, azathioprine
• Cyclosporine
• Methotrexate

IV. Biologic therapies

Biologic therapies are indicated for people with with moderate to severe active disease who have not responded well to conventional therapy.The drugs that are used include:

• Adalimumab
• Certolizumab
• Infliximab
• Natalizumab
• Vedolizumab
• Ustekinumab

V. Other medicines

• Acetaminophen:  It is used for mild pain.
• Antibiotics:it is used to prevent or treat complications that involve infection, such as abscesses and fistulas such as  ciprofloxacin and metronidazole.
• Loperamide: It helps to slow or stop severe diarrhea.

VI. Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. There are different types of operations to treat Crohn’s disease such as-

1. Small bowel resection- This surgery often involves removal of the diseased segment of bowel (resection), the two ends of healthy bowel are then joined together (anastomosis). There are two types of small bowel resection-

• Laparoscopic: Laparoscopic surgery is a minimally invasive surgical technique used in the abdominal and pelvic areas. The surgeon inserts a laparoscope to get a close-up view of the small intestine. 
  
  
• Open surgery: When a surgeon makes one incision about 6 inches long in your abdomen to remove the diseased or blocked section of small  intestine and reconnect the intestines again.

2. Subtotal colectomy or large bowel resection- It is done to remove part of your large intestine.It is again of two types-

• Laparoscopic colectomy: In it the surgeon removes the diseased or blocked section of your large intestine and again reconnects the ends of the large intestine.
  
  
• Open surgery: When a surgeon makes one incision about 6 inches long in your abdomen to remove the diseased or blocked section of large intestine and reconnect the intestines again.
  
  

3 Proctocolectomy and ileostomy- It is a surgical procedure that removes your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, created by a surgeon from a section of your ileum.

Complications Of Crohn’s disease

Some people develop complications that may require urgent medical care which includes-

1. Fistulas- Fistulas are ulcers on the intestine's wall that spread and form a tunnel (fistula) to another part of the intestine, the skin, or another organ.

2. Stricture- It is a narrowing of an intestine section caused by scarring, which can result in an intestinal blockage.

3. Abscess- A collection of pus that can form in the abdomen, pelvis, or around the anal area. A doctor may drain an abscess with a needle inserted through your skin or through surgery.

4. Perforated bowel- chronic intestine swelling can weaken the wall to the point where a hole forms.

5. Anal fissures- Anal fissures are small tears in the anus that can cause itching, pain, and bleeding. The majority of anal fissures heal with medical treatment, such as ointments, warm baths, and dietary changes.

6. Intestinal obstruction- a blockage in the intestine.

7. Ulcers- open sores in your mouth, intestines, anus, or perineum

8. Malabsorption and malnutrition, including deficiency of vitamins and minerals- You may need IV fluids or feeding tubes to replace lost nutrients and fluids.

9. Swelling (in other parts of body such as your joints, eyes, and skin)

Complications outside the GI tract

Some patients develop symptoms that are related to the disease but affect other parts of the body. The extraintestinal complications include:

• Eyes (redness, pain, and itchiness)
• Mouth (sores)
• Joints (swelling and pain)
• Skin (tender bumps, painful ulcerations, and other sores/rashes)
• Bones (osteoporosis)
• Kidney (stones)
• Anemia, a condition in which you have fewer red blood cells than normal
• Liver ( hepatitis, and cirrhosis)-  occurs rarely
• Cancer- People with Crohn’s disease of the colon or ulcerative colitis have a higher risk for colorectal cancer than the general population.
• Blood clots- People with IBD have about a three times greater risk than the general population for developing blood clots that form in veins and lungs arteries.
• Primary Sclerosing Cholangitis (PSC)- PSC is a form of severe swelling and scarring that develops in the bile ducts.

Alternative Therapies For Crohn’s disease

Along with the medicine your doctor prescribes, you may want to add “complementary” treatments to help with Crohn’s symptoms, boost your immune system, or just feel better every day.

1. Pay attention to diet: Changing your diet can help reduce symptoms. You must try the following diet modifications:

• Avoiding carbonated drinks
• During a flare-up, avoid high-fiber foods, dairy, sugar, high-fat foods, and spicy foods.
• Drinking more liquids
• Eat small meals, boil or steam food instead of frying it.
• Keeping a food diary to help identify foods that cause problems
  

2. Probiotics: Probiotics aim to restore that balance by adding good bacteria in the gut. They can help improve digestion and certain strains have shown they help reduce symptoms of Crohn’s.

Food sources of probiotics include yoghurt, tofu etc.

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3. Prebiotics: Prebiotics provide fuel for the good bacteria growing in your digestive tract. 

Some prebiotic sources include asparagus, legumes, bananas etc.

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4. Anti-inflammatory food: It includes virgin olive oil, green leafy vegetables (spinach, kale), fatty fish (tuna, salmon), fruits (strawberry, cherries, oranges) etc. These foods will help combat free radical damage and encourage less overall inflammation (swelling).

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 5. Herbs:

• Aloe vera juice- Has calming effects that may help digestion and improve immunity
• Glutamine- An amino acid that helps in intestine functioning
• Turmeric (Haldi) It has anti-inflammatory properties and reduces swelling

Read more about 5 other benefits of turmeric for a healthy bodyClick here

Note: Talk to your doctor or dietician if you have any concerns about diet or food. But do not start any supplements or dietary modifications on your own without consulting your doctor or dietician.

6. Exercise and yoga: Any form of exercise or yoga can ease stress is a great way to relax and help your intestines work more normally. That can be key for Crohn’s, since stress can trigger flare-ups and make symptoms worse.

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7. Take proper rest: During flare-ups, you should consume a liquid diet to allow your system to rest and re-set. Aside from bowel rest, try to get extra sleep, go slowly, avoid stress and intense exercise, and take naps as needed. Allow your body to heal.

8. Moxibustion:It is a type of traditional Chinese medicine that is typically administered in conjunction with acupuncture. The two approaches are thought to complement each other best. It's similar to heat therapy.
Dry herbs are burned close to your skin, often near acupuncture points. Moxibustion combined with acupuncture may help with Crohn's symptoms.