What is Crohn’s Disease by Aisha Colclasure

Crohn’s Disease is often silent. The people it occupies often are too embarrassed of its symptoms to tell their peers about it because it is not considered socially acceptable to discuss your bowel habits in public or with people other than our doctors. Sadly, sometimes even people affected by this disease are too embarrassed to seek medical help.


Unlike other diseases, there are no outward signs of Crohn’s Disease in its normal form. For instance, cancer patients often lose their hair during treatment, however, a Crohn’s patient looks perfectly healthy on the outside unless the disease is in a more severe form. The symptoms of Crohn’s Disease also make it easy to mistake it for something less serious such as irritable bowel syndrome, food poisoning, and lactose intolerance, among others.

Doctors Crohn, Ginzburg, and Oppenheimer first described the disease in 1932 as inflammation of the ileum. Later it was found that Crohn’s Disease also affects other parts of the gastrointestinal tract. (Steinhart et al., 2008) Crohn’s Disease is one of two types of inflammatory bowel disease. Inflammatory bowel disease simply put is an inflammation of some part of the gastrointestinal tract. The other type of IBD is Ulcerative Colitis which generally affects the colon and rectum only (Mayo Clinic Staff, 2011).
Crohn’s Disease most generally affects the small intestine and/or colon. It is not unheard of though for Crohn’s to affect someone’s entire gastrointestinal tract, from the mouth to the anus. We do not know why Crohn’s Disease happens but we do know the process it takes. Normal bacteria in the gastrointestinal tract are mistaken by the immune system as something harmful to the body. The immune system tries to destroy this supposed harmful bacteria and in the process, white blood cells settle in the intestines and cause inflammation (CCFA, 2009).

Crohn’s Disease can be classified as one of five different types; the most common affecting the ileum and colon is Ileocolitis. When Crohn’s Disease affects only the ileum it is classified as Ileitis. When one’s stomach and the first part of the small intestine (the duodenum) is affected it is called Gastroduodenal Crohn’s Disease. Jejunoileitis produces inflammation in the upper portions of the small intestine (the jejunum) and when only the colon is affected the disease is classified as Crohn’s (granulomatous) Colitis. (CCFA, 2009)

There are many symptoms of Crohn’s Disease, some that are common and some that are more severe. A patient will often seek help from their primary care physician because they have trouble eating because of the pain it causes and the diarrhea afterward. Those two symptoms could be the cause of numerous medical issues. The primary care physician normally tries to rule out common things such as heartburn and lactose intolerance. At that point, he or she will refer the patient to a gastrointestinal physician for further help. The GI doctor will rule out things such as appendicitis and problems with the gall bladder before looking into IBD so often a diagnosis will take quite a while.

The most common symptoms of Crohn’s Disease are diarrhea and abdominal pain. Other symptoms can include blood in the stool, ulcers, and lack of appetite. For patients with more severe Crohn’s Disease, symptoms include the above but also can include fever, fatigue, skin disorders, eye inflammation, arthritis, and sores of the mouth. Children with Crohn’s Disease can experience failure to thrive. (Mayo Clinic Staff, 2011)

Often, many different types of tests are done to obtain a diagnosis of Crohn’s Disease. When someone presents with the common symptoms of Crohn’s Disease that cannot be ruled out by another medical problem, they normally are required to have a blood test, X-rays, CT Scans, and an MRI Enterography among other tests. Generally, if those tests are favorable for Crohn’s Disease, a doctor will order both an endoscopy and a colonoscopy which will confirm if the patient does have Crohn’s Disease and how far advanced it is. During an endoscopy, a tube with a camera is inserted through the mouth into the stomach to look for irritation in the upper GI tract. Likewise, during a colonoscopy, a tube with a camera is inserted rectally into the colon to examine the lower GI tract.

Once a diagnosis is made it is important to start treatment right away to gain control of both the disease and your life again. To understand treatment, it is first important to note that there is no known cause or cure for Crohn’s Disease yet. According to the Crohn’s and Colitis Foundation of America, many factors can contribute to the inflammation caused by irritable bowel disease such as inherited genes, the immune system, and environmental factors.

There are six different types of medical treatment one can endure to keep Crohn’s Disease at bay. The first is the 5-ASA, which are anti-inflammatory medication that is used to treat mild to moderate symptoms. An example of the 5-ASA is are medication called Asacol or Pentasa. The second is corticosteroids; they are a short-term anti-inflammatory treatment used to control one’s flare of the disease. The most commonly used corticosteroid is prednisone. The third type of treatment helps to maintain a state of remission. They are called immune modifiers, and the most commonly prescribed is Azathioprine. The fourth type of treatment is antibiotics which are often used when someone develops a fistula or abscess. The fifth treatment of biologic therapies is for the treatment of moderate to severely active Crohn’s Disease. The most commonly heard of are Remicade and Humira which are given intravenously. The last type of treatment for Crohn’s disease is a resection, where the part of the bowel that is diseased is taken out and the two healthy ends are surgically connected. There is also a chance that some Crohn’s patients will have to have an ileostomy. An ileostomy is a procedure where the bowel is brought to the skin’s surface and a small bag is placed on one’s abdomen for waste products to empty into. (CCFA, 2009)

While it is not sure why some people develop Crohn’s Disease and others do not, it is known that it is most common among people of Eastern European Ancestry, people who live in urban areas, people who have a family member with the disease, smokers and people who live in northern climates. (CCFA, 2009)

We are all aware of the major illnesses and problems that smoking can cause us, such as lung cancer and COPD. However, not many are aware that cigarette smoking can cause Crohn’s Disease. Tracey Harris researched studies that have been done regarding this topic a little further. She wondered what the connection is between smoking and irritable bowel disease. She realized that smoking causes tissue death because of an obstruction to the tissue’s blood supply and that IBD could also be caused by an obstruction to the tissue’s blood supply. After reviewing several studies, she found interesting yet astonishing results. While there is no real connection between smoking and Ulcerative Colitis, there is a correlation between smoking and having an increased risk of having Crohn’s Disease. She also found that those who continued to smoke after a diagnosis of the disease had a more severe form of the disease than those who either did not smoke or quit smoking (Harris, 2009).

John White, along with scientists from McGill University and Universitè de Montrèal, have studied how populations in northern climates have a lower Vitamin D level than other populations due to a lack of exposure to sunlight. We know that when one does not get enough sunlight, it affects their immune system. This led these scientists to look into the effect that a lack of Vitamin D has on Crohn’s Disease. They did find that there is a direct correlation between low Vitamin D levels contributing to Crohn’s Disease. Vitamin D helps the body’s immune system function properly, which we know in patients with Crohn’s Disease, the immune system is not functioning at an optimal level. Patients who took extra Vitamin D as a supplement fared better than those who did not. While is it not proven as a prevention, White and his scientists also suggest that siblings of patients with Crohn’s Disease take a Vitamin D supplement as a possible prevention method of Crohn’s Disease. (McGill University Health Center, 2010)
Often when someone is diagnosed with Crohn’s Disease they have many questions. Will I die? Will this cause cancer? Will my peers be able to tell? Can I still live a normal life? The answers to these questions are quite simple. Crohn’s Disease is not a death sentence so long as you take care of yourself. Yes, there is an increased risk of cancer which can lead to death. However, as long as you are taking care of yourself and follow your doctor’s orders you will live a long, relatively healthy life. Since in most cases, there are no outward symptoms of Crohn’s Disease, no one has to know if you do not want them to. Even if you were to get an ileostomy, there are many ways these days to hide it. There are over 1.4 million Americans who are living with Crohn’s Disease every day, so the answer is yes, you absolutely can live a normal life with this disease and there are many support groups throughout the country through the Crohn’s and Colitis Foundation of America (CCFA, 2009).

 

References
About Crohn’s Disease. (2009). Crohn’s and Colitis Foundation of America. Retrieved from http://www.ccfa.org/info/about/crohns [November 12, 2011]

Crohn’s Disease Symptoms. (2011). In Mayo Foundation for Medical Education and Research. Retrieved from http://mayoclinic.com/health/crohnsdisease/DS00104/
DSection=symptoms [November 12, 2011]

Definition. (2011). In Mayo Foundation for Medical Education and Research. Retrieved from http://www.mayoclinic.com/health/ulcerative- colitis/DS00598 [November 20, 2011]

Harris, T. (2009). Does Cigarette Smoking Increase the Risk of Developing Ulcerative Colitis or Crohn’s Disease? The Internet Journal of Academic Physician Assistants. 2009. Volume 6 Number 2. Retrieved from http://web.ebscohost.com.ezproxy.stlcc.edu/ehost/detail?vid=3&hid=111&sid=bc d96ea4-e45a-48c6-ab2f-8d9ef1cf603d%40sessionmgr114&bdata= JnNpdGU9ZWhvc3 QtbGl2 ZQ%3d%3d#db=c8h&AN=2010177103 [November 12, 2011]

McGill University Health Centre (2010, January 27). Vitamin D Supplements Could Fight Crohn’s Disease. Science Daily. Retrieved from http://www.sciencedaily.com/releases/2010/01/100127104904.htm [November 14, 2011]

Steinhart, A.H. & Cepo, J. (2008). Crohn’s & colitis diet guide. Toronto, Ontario, Canada: Robert Rose Inc. Pg. 10.
Crohn’s Disease. (2011). In Wikipedia. Retrieved from
http://en.wikipedia.org/wiki/Crohn’s_disease#Pathophysiology [November 11, 2011]