CreakyJoints’ guide to:

Crohn’s Disease

IN THIS ISSUE What is Crohn’s Disease? Treatment Options What Causes Crohn’s Disease? Common Symptoms

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What is Crohn’s Disease? rohn’s Disease is a type of chronic inflammatory bowel disease (IBD) that causes inflammation of the lining of the digestive tract. The immune system is believed to be the most likely cause of Crohn’s disease, in that it attacks the body’s intestinal tissue. Crohn’s disease differs from another type of IBD, ulcerative colitis (UC), in that UC most commonly affects the end of the small bowel (the ileum) and the beginning of the colon. However, Crohn’s disease may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.

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Crohn’s disease affects as many as 700,000 Americans. Men and women are equally affected and the disease can strike at any age, though it is more prevalent among adolescents and young adults between the ages of 15 and 35. Since Crohn’s is a chronic disease, people with Crohn’s tend to experience flare-ups followed by periods of remission in which they may not notice any symptoms.

The Treatment Options While there is no known cure for Crohn’s disease, treatment can reduce its signs and symptoms and even bring long-term remission. Treatment typically involves either drug therapy or surgery. The goal of treatment is to reduce inflammation and the risk of complications. With drug therapy, there are two common approaches: “step-up,” in which the health provider prescribes milder drugs first, or “top-down,” which uses stronger drugs earlier in the treatment process. Immune system suppressors can reduce inflammation by targeting the immune system; specifically, they help suppress the immune response that causes inflammation in the intestinal lining. Additional treatments can include anti-diarrheal medications or fiber supplements to add bulk to the stool; over the counter pain relievers for mild pain; iron supplements for those who have anemia due to chronic intestinal bleeding; and calcium and vitamin D supplements to combat the risk of osteoporosis, particularly in those who are taking steroids.

Antibiotics can sometimes heal fistulas and abscesses in people with Crohn’s disease, and some research suggests antibiotics can help reduce harmful intestinal bacteria that may play a role in activating the intestinal immune system, leading to inflammation. Corticosteroids are often prescribed for patients who don’t respond to other treatments, though they can have severe side effects and thus are not recommended for long-term use. Diet may also be used as an adjunct to other treatments. For Crohn’s disease, a doctor may recommend a special diet given via a feeding tube or nutrients injected into a vein. This is to improve overall nutrition and allow the bowel to rest, which can reduce inflammation in the short term. For those with stenosis or stricture in the bowel, your doctor may recommend a low-residue diet – eating foods that are easy to digest while eliminating high-fiber foods that are harder to digest. This will help to minimize undigested food that can lead to an intestinal blockage. For more severe Crohn’s disease, the damaged part of the intestine may be removed surgically and the healthy sections reconnected. Up to half of people with Crohn’s disease will require surgery, though it is not a cure. It’s important to manage stress when you have Crohn’s disease, as stress can worsen symptoms. Biofeedback is a stress-reduction technique that uses a machine to help you enter a relaxed state and slow your heart rate. Exercise, along with relaxation and breathing exercises, such as meditation, also can help you reduce stress in your life.

The Causes While diet and stress have been implicated in the past, today we know that they are not the cause of Crohn’s disease. The exact cause of Crohn’s disease is unknown, but research suggests that malfunction of the immune system, heredity, genetics and environmental factors can all play a role. It is believed that the immune system mistakenly attacks healthy cells of the digestive tract as if they are foreign invaders, damaging the intestinal walls. This immune response may be caused by the body’s own tissue or a combination of bacteria, viruses or antigens. Crohn’s disease also seems to run in families – it is more common in those who have relatives with the disease. Studies have shown that up to 20 percent of affected individuals have a first degree relative with some type of IBD; however, most people with IBD do not have a family history of the disease. Crohn’s disease is most commonly seen in people of eastern European decent. In recent years, an increasing number of cases have been reported in African Americans. Cigarette smoking is the most important controllable risk factor for Crohn’s disease. If you have Crohn’s disease, smoking can cause you to develop more severe disease and increase your risk of needing surgery due to Crohn’s.

The Pain Pain is common in people with Crohn’s disease and can significantly impact quality of life. Sometimes pain is the only sign that the disease is progressing and that a different treatment may be needed. Ongoing inflammation along with ulcers and abscesses in the intestines are common causes of pain. Constipation and the cramping that comes with diarrhea can also cause pain. Crohn’s disease may cause scarring in the lining of the intestinal tract (called adhesions and strictures) that can lead to painful obstructions. In more severe cases, Crohn’s can lead to tears (fissures) in the lining of the anus, which may cause pain and bleeding, especially during bowel movements, as well as infection. The inflammation inherent in Crohn’s disease may also cause a fistula to develop, which is a type of tunnel that can connect the intestines to another part of the bowel, the bladder, vagina, or skin. Fistulas can allow fecal matter to pass out of the intestines to other parts of the body, and is thus a serious condition that requires immediate medical attention.

The Symptoms Symptoms of Crohn’s disease can range from mild to severe and most people experience a cycle of active disease followed by periods of remission. The symptoms usually develop gradually, but sometimes will come on suddenly, without warning. Common symptoms that can occur with Crohn’s disease include persistent diarrhea, rectal bleeding, an urgent need to move your bowels, abdominal cramping and pain, incomplete evacuation of feces and constipation, which can lead to bowel obstruction. Many people with Crohn’s disease experience a low-grade fever, likely due to inflammation or infection. They may also feel tired or have low energy. Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications such as a bowel obstruction or perforation. People with severe Crohn’s disease may also experience inflammation of the skin, eyes and joints; inflammation of the liver or bile ducts; and delayed growth or sexual development in children. Crohn’s can also cause other health problems unrelated to the GI tract, such as anemia, osteoporosis, and gallbladder or liver disease.

Diet While there is no proof that diet can cause Crohn’s disease, some foods and beverages can worsen symptoms, especially during a flare-up. Some people find it useful to keep a food diary as a record of what they eat and how these foods make them feel. Low fat foods can be particularly helpful, as you may not be able to digest or absorb fat normally, which can worsen diarrhea. Butter, margarine, heavy cream and fried foods are particularly important to avoid. You should also limit dairy, as many people with Crohn’s disease find that their symptoms improve when they reduce or eliminate dairy from their diet. While fiber is often recommended to the general public for a healthy digestive system, it can actually worsen Crohn’s symptoms in some people, especially in people who have narrowing in the bowel. Thus, high-fiber foods, such as fresh fruits, vegetables and whole grains, should be steamed, baked or stewed to lower their fiber content.

Studies show that being even 10 pounds overweight will Spicy foods, alcohol and caffeine can also worsen symptoms increase the stress because they tend to stimulate the intestines. Eating several across the kneesmall joint meals daily may make you feel better than eating three large ones, by 30 to 60 pounds because smaller meals are easier for your gut to digest.

In some cases a special diet is given via a feeding tube or injected into a vein to improve overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. Sometimes doctors will recommend a low-fiber diet to reduce the risk of intestinal blockage if there is a narrowed bowel (stricture). The goal of a low fiber diet is reduction of the size and number of stools.

Medicine Often anti-inflammatory drugs are the first step in treating Crohn’s disease. These include aminosalicylates like sulfasalazine, and 5-aminosalicylates including mesalamine and balsalazide, which come in both oral and suppository form. Corticosteroids such as prednisone and hydrocortisone can help reduce inflammation, but come with numerous side effects, including night sweats, insomnia and hyperactivity, and more serious side effects like diabetes and osteoporosis. Also, corticosteroids don’t work for everyone with Crohn’s disease. Doctors generally use them only if the person does not respond to other treatments. Immune system suppressors reduce inflammation by targeting the immune system. Some people require a combination of these drugs rather than taking just one. They include azathioprine and mercaptopurine, which require close monitoring due to the increased risk of lowered resistance to infection or, more rarely, cancer. Cyclosporine also has the potential for serious side effects such as kidney and liver damage, seizures and fatal infections. (TNF)-alpha inhibitors, or “biologics,” typically given to people with arthritis, may be used for people with moderate to severe Crohn’s disease who don’t respond to or can’t tolerate the side effects of other treatments. These medicines suppress a protein produced by the immune system and may be combined with other immunosuppressants. Methotrexate, used mainly to treat cancer, is sometimes given to people with Crohn’s disease who don’t respond to other medications. Because its long term use is associated with serious side effects such as bone marrow suppression, people taking methotrexate must be monitored closely by their doctor.

Antibiotics are sometimes given to people with Crohn’s disease who have infection, and they can heal abscesses in the intestine. They may also reduce the number of harmful bacteria in the intestines. Additional medications may be used as a supplement to stronger pharmaceuticals, such as anti-diarrheal medications and over-the-counter pain relievers like acetaminophen. Ibuprofen and naproxen sodium should be avoided as they can worsen Crohn’s disease symptoms.

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