A hundred years ago, before Crohn's disease had a name, doctors dismissed it as an untreatable illness or possibly a tumour. Doctors didn't know that patients' immune systems, the weapons for battling disease, were attacking their own digestive tracts.

In people with Crohn's disease, tissues deep within the lining of the digestive system become inflamed. The inflammation usually starts in the colon or the lower part of the small intestine, but it can occur anywhere along the digestive tract, including the anus, stomach, oesophagus, and even the mouth.

Crohn's disease is very similar to another condition called ulcerative colitis -- so similar that it's not always possible to tell them apart. Both Crohn's disease and ulcerative colitis are often called inflammatory bowel disease (IBD).

Although the cure for Crohn's disease is still a mystery, the treatment isn't. Today, with the right arsenal of defences, patients with the disease are not only surviving, they're thriving.

What are the symptoms of Crohn's disease?

In the early stages, the most common symptoms of Crohn's disease are frequent diarrhoea, crampy abdominal pain, fever, and loss of appetite. Because the disease can cause internal bleeding, the stools may be black or tinged with blood. Children with Crohn's disease may not have any gastrointestinal trouble at all. Instead, their main symptoms may be inflamed joints, fever, anaemia, or slow growth.

Crohn's disease tends to be an on-again, off-again malady. After a bout of symptoms, you may go for weeks, months, or even years without any more trouble. Unfortunately, there's no way to predict when the symptoms will return.

What causes Crohn's disease?

Nobody knows for sure, but Crohn's disease seems to be caused by an overactive immune system. When viruses or bacteria invade the digestive tract, the body unleashes powerful antibodies to repel the attack. In people with Crohn's disease, these antibodies may be missing the target and attacking the digestive system instead.

This theory received a major boost in May 2001, when researchers announced the discovery of a faulty gene that may contribute to the disease. Normal versions of the gene help the intestines fight bacterial infections. A damaged version, however, can significantly raise the risk of Crohn's disease.

Research also indicates that Crohn's disease is a disease primarily of the developed world. It may be in part due to a lack of exposure to helminths and bacteria in the early years of life. Research shows that in the developing world, where exposure to such organisms is still the norm, the levels of inflammatory bowel disease are very low.

Contrary to common belief, emotional stress won't cause Crohn's disease (or, for that matter, ulcerative colitis). However, many patients say their symptoms tend to flare up during rough times in their lives. For more information on the link between mood and gastrointestinal trouble, see Gut Feelings: The Surprising Link Between Mood and Digestion.

Several other factors can help bring on attacks or worsen the symptoms of Crohn's disease, including upper respiratory infections, use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), and cigarettes. Some patients find that alcohol, dairy products, spicy foods, and raw vegetables can also cause trouble.

Who is at risk for Crohn's disease?

Crohn's disease can strike people of any age, from toddlers to the elderly, but it most often arises in people in their teens or 20s. It's equally common in men and women. As you would expect from a disease linked to faulty genes, Crohn's disease often runs in families. In fact, if one of your siblings has the disease, your risk increases more than 35-fold.

What are the possible complications?

Crohn's disease isn't fatal, but it can turn into a serious health threat. For one thing, inflamed intestines can't absorb water and nutrients as well as they should. If you aren't careful, you can easily become severely dehydrated or short-changed in proteins, potassium, calcium, and other vital nutrients.

A shortage of nutrients can set off a cascade of other problems; for instance, a lack of calcium can make you especially vulnerable to osteoporosis.

If left untreated, the disease can inflict serious damage to your intestines. Often, the intestines become blocked by scar tissue, causing severe cramps and vomiting. The inflamed lining can become infected, causing pus-filled sores called abscesses.

You may also develop sores that break through the intestinal wall and burrow into adjacent parts of the intestine or other tissues. This results in abnormal tunnels or "fistulas." Some fistulas run all the way to the surface of the skin, especially around the anus. If Crohn's disease affects your colon, you have a greater-than-normal risk for colon cancer.

The longer you've had Crohn's disease, the greater the danger. Your doctor will want to perform regular colonoscopies or other exams to check for early signs of cancer.

Some people with Crohn's disease also have other conditions related to an overactive immune system. When your gastrointestinal symptoms flare up, you may develop arthritis in your joints, inflammation in the whites of your eyes, mouth sores, and blue-red, pus-filled sores on the skin.

Painful inflammation associated with Crohn's disease can develop in other parts of your body, including your spine (ankylosing spondylitis), pelvic joints (sacroiliitis), eye (uveitis), or bile ducts (primary sclerosing cholangitis).

How is Crohn's disease diagnosed?

If your doctor suspects Crohn's disease, he or she may run blood tests to check for anaemia (a possible sign of internal bleeding) or elevated white blood cells (a sign of inflammation). In order to confirm the diagnosis, your doctor will have to take a close look at your digestive system with either a barium X-ray or an endoscope.

Barium tests are especially useful for tracking Crohn's disease in the small intestine and upper digestive tract. If the condition seems to be affecting your colon, your doctor will probably want to conduct a colonoscopy (a medical procedure in which a tube with a light and a tiny camera is inserted into a patient's colon to view the intestinal tract.)

How is Crohn's disease treated?

It takes a team effort under the direction of a consultant gastroenterologist, to control Crohn's disease. Your doctor can prescribe medications to slow the disease and ease your symptoms, but you can do your part to stay healthy as well. Treatment usually starts with oral medications that control inflammation. If you have a mild to moderate case, sulphasalazine is a good first choice. If you're allergic to sulpha drugs or experience side effects like headache and nausea, mesalazine can be an effective substitute. The antibiotic metronidazole is another option, especially if the disease affects your colon.

Some patients have suffered side effects, including weakness or pain in their muscles, when they took metronidazole for more than a few weeks; let your doctor know if you experience these side effects.

If these drugs aren't enough to control the disease, you may need powerful corticosteroids, such as prednisolone. These drugs will make you feel better, but large doses can eventually cause joint damage, acne, mood swings, and other serious side effects.

If your doctor prescribes a corticosteroid, he or she will probably start steadily lowering the dose as soon as your symptoms improve. (Some studies suggest budesonide, a newer corticosteroid not yet approved for Crohn's disease, may offer relief with fewer side effects.)

Medications that suppress the immune system, such as azathioprine, can also help defuse the disease. These drugs are often prescribed in combination with corticosteroids. Some studies show children respond better in the long term to drugs like azathioprine than they do to sulpha drugs or corticosteroids.

Patients who don't respond to any of the standard approaches now have a new option for relief. Infliximab is a new drug for the treatment of moderate to severe Crohn's disease.

This drug, the first ever approved specifically for Crohn's disease, blocks a compound that causes inflammation. Studies have found that a single injection can improve symptoms in up to 82 percent of patients.

Nearly half of all patients were still symptom-free four weeks later. The long-term effects of infliximab are still uncertain, however, and because of that it is often used only as a treatment of last resort.

The most severe cases of Crohn's disease can send a person to the hospital. If heavy diarrhoea has left you malnourished and dehydrated, you may need intravenous fluids.

If the medications no longer work, you may even need to have a section of your intestines or your rectum surgically removed, especially if you are losing large amounts of blood, if sores have broken through the intestinal wall, or if there's a blockage. Unfortunately, surgery won't cure Crohn's disease. Over time, the inflammation usually comes back.

What can I do about Crohn's disease?

Getting the right medical treatment is only part of the battle. You should also talk to your doctor about diet and other lifestyle changes that can speed your recovery.

Many patients find their symptoms improve when they drink plenty of fluids, switch to a lower-fibre diet (this means taking the skin off fruit and vegetables and limiting your consumption of such foods as beans and wheat bran), avoid spicy food, and go easy on alcohol. With your doctor's guidance, you may also need to take supplements of iron, vitamin B12, folic acid, or other vitamins and minerals to replace those lost to diarrhoea. (Your doctor may have additional recommendations as well.)

Finally, you should take care of yourself. Be sure to eat nutritious meals, get plenty of rest, cut back on stress, and avoid cigarettes. This will not only help with Crohn's disease, but improve your overall health as well



Chris Woolston
CONSUMER HEALTH INTERACTIVE
Last Editorial Review: 18/1/2010