Crohn's disease

DEFINITION: A chronic disease process in which the bowel becomes inflamed, leading to scarring and narrowing of the intestines.

ALSO KNOWN AS: Regional enteritis

ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, intestines

CAUSES: Unknown; may be an abnormal immune reaction

SYMPTOMS: Diarrhea, abdominal pain, rectal bleeding, fever, weight loss, anal sores, hemorrhoids, fissures, fistulas, abscesses, nausea, vomiting

DURATION: Chronic

TREATMENTS: Medications for symptom alleviation

Causes and Symptoms

Crohn’s disease is a chronic disease of the digestive system. It is one of two diseases labeled as inflammatory bowel disease (IBD); the other is ulcerative colitis. With both diseases, patients suffer from diarrhea, abdominal pain , bleeding from the rectum, and fever. The cell lining of the bowel (usually the small intestine) becomes inflamed, leading to erosion of tissues and bleeding.

Crohn’s disease may affect areas of the system from the mouth to the anus. The inflammatory process may spread to include the joints, skin, eyes, mouth, and sometimes liver. In children, IBD involves a substantial risk of slow or interrupted growth.

The most common early sign is abdominal pain, often felt over the navel or on the right side. Diarrhea and subsequent weight loss often follow. Other early signs of Crohn’s disease include sores in the anal area (skin tabs), hemorrhoids, fissures (cracks), fistulas (abnormal openings from the to the skin surface or other organs), abscesses (uncommon in children), and and vomiting, especially in young children. Children as young as ten may develop this disease; however, in the majority of cases the onset is between the ages of thirteen and twenty-five. Some sources report that Crohn’s disease is slightly more common in women. The incidence is greater in persons of Jewish ethnic origin.

Diagnosis often is made after a series of abdominal X-rays, an upper gastrointestinal series, or a (visual inspection of the intestines with a camera). The gastrointestinal (GI) tract is best pictured as a continuous tube that begins at the mouth and ends at the anus. The mucosal layer of intestine that absorbs contains immune cells that act as defenders of the body (antibodies). Sometimes, this mucosal layer breaks down, and harmful enter the deep layers of the intestine. The resulting inflammatory process can entail swelling (edema), increased blood flow, and ulcerations (disruptions in the intestinal lining). In Crohn’s disease, these ulcerations involve the full thickness of the intestinal lining.

When the inflamed intestine heals, it may become scarred around the areas previously inflamed. This may lead to a narrowing of the bowel, or stricture, which can lead to partial or total blockage of the intestinal flow (bowel obstruction).

Treatment and Therapy

Crohn’s disease is a baffling, unpredictable disease for which a truly successful treatment has not been found. Some of the medications used in treatment are corticosteroids , such as prednisone and adrenocorticotropic hormone (ACTH), and sulfasalazine-type drugs, such as Azulfidine. Both have limited benefits and some side effects. Prednisone-type drugs reduce tissue and thereby relieve symptoms such as rectal bleeding, abdominal pain, and fever. They may cause side effects, including rounding of the face, increased facial hair, retention, bone loss (osteoporosis), high blood pressure, and high blood sugar levels. These drugs also may cause mood swings. They are prescribed conservatively by most doctors. Sulfasalazine contains two active ingredients, a sulfa preparation(sulfapyridine) and an aspirin-like drug (5-aminosalicylic acid, or 5-ASA), which are bonded together. The 5-ASA medication is thought to act on the surface of the lining of the intestine, suppressing tissue inflammation.

The drug 6-mercaptopurine, or 6-MP, is an immunosuppressive, a substance that alters the body’s normal to a disease or antigen. Immunosuppressive drugs have been used to treat autoimmune diseases, conditions in which the immune system attacks healthy tissues, among them Crohn’s disease. It is believed that these drugs can stop the mechanism that causes the body to attack itself.

Drugs can offer relief of symptoms, but no drug has yet been found to alter the long-term progression or natural course of Crohn’s disease. Following a special diet may help to alleviate some of the symptoms of Crohn's disease, as certain foods, such as alcohol or high-fiber foods, may irritate the lining the bowel further. Surgical removal of the diseased intestine is usually reserved for cases in which medical treatment has failed. The rates of Crohn’s disease following surgery are high.

Perspective and Prospects

Unlike ulcerative colitis, which affects only the inner lining of the intestines, Crohn’s disease affects the full thickness of the bowel wall. Both types of IBD occur in predominantly Western or developed countries, especially Scandinavia, the United Kingdom, Western Europe, Israel, and the United States. IBD has been reported in Japan. IBD is seen rarely in Africa, most of Asia, and parts of South America. IBD seems to cluster in families, suggesting a genetic factor. Up to 20 percent of people with IBD have one or more blood relatives with the disease.

American gastroenterologist Burrill B. Crohn first identified Crohn’s disease in 1932. The prognosis for those affected was poor, and their quality of life was limited. Prednisone was the first of the above-mentioned medications to be used to treat Crohn’s disease. Investigation into the causes and treatment of IBD continues in many areas, including genetic studies. Current research offers reason for optimism that the causes of IBD will be found and that a cure will follow.

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