IBDLiving - Crohn's Disease

crohn's disease

Crohn's Disease(CD) is a chronic disease that causes inflammation in the gastrointestinal (GI)
tract and can affect anywhere in the GI tract from the mouth to the anus. In most cases the small
intestine and colon are affected. Crohn's disease in the colon is referred to as Crohn's colitis. CD
is a non-infectious and non-contagious disease. There is no known cause or cure.

Symptoms vary person to person but may include:

Abdominal Pain
Fever
Nausea and/or vomiting
Diarrhea - often times persistent
Constipation
Loss of appetite
Weight loss
Rectal bleeding
Fatigue
In children, delayed growth

It is estimated that Crohn's Disease affects close to one million Americans and more than one
million more throughout Canada, Europe, Australia, Japan, South America and other countries.
It is worldwide. It seems to affect men and women equally and is more commonly diagnosed in
young adulthood between the age of 20-30. However, it does occur in people over 60 and in
children under 18.

Crohn’s Disease affects over 100,000 children under the age of 18. Nearly 75 percent of these
children will be forced to have at least one operation. Many have delayed or stunted growth.

Research has shown that the disease primarily affects Caucasians and those of Eastern
European descent. It is a rising diagnosis in the African American population but is not prevalent
in Hispanics or Asians.

Crohn's Disease is genetic but not in every case. Actually, only in about one quarter of all cases
is it genetic. There is a higher risk of developing Crohn's if you have a family member with the
disease, especially if it is a sibling. There was a recent genetic breakthrough in which
researchers located the first Crohn's Disease gene, NOD2/CARD 15. The research found an
abnormal mutation on the gene in those with Crohn's twice more often as then in the normal
population.

Crohn's Disease is chronic which means it is a lifelong disease. There will be periods of time that
the disease is quiet and there are periods that the disease is active. The active times are
"flares" or "flare-ups" and are when symptoms are present. The flares can be mild to severe and
can last for days to months. There are medicines to help keep flares at bay but there is no
cure. Not yet at least.

Complications
There are complications from the disease that may arise. These include fistulas(tunnels that
develop and connect areas of the intestine to other organs, intestinal areas or out to the skin),
hemorrhoids, strictures(narrowing of the intestines), intestinal blockages, abscesses, bowel
perforations and toxic megacolon. Long-standing Crohn's colitis poses a greater risk factor for
developing colon cancer.

Fistulas
Fistulas are abnormal connections between organs. In IBD, fistulas will connect part of the
intestine to another part of the intestine, other organs, and/ or to the skin. There are four types
of fistulas; blind (open on one end of connection), incomplete (unopen and not connected),
horseshoe (goes around rectum and connects anus to the skin surface) and complete (open at
both ends of connection). Fistulas may require IBD patients to cease from using steroids as they
will not allow fistulas to heal. For more info on fistulas, please click here.

Hemorrhoids
Hemorrhoids are swollen and inflamed veins around the lower rectum and anus. There are
internal hemorrhoids which are inside the anus and there are external which are under the skin
around the anus. Common symptoms include itching, burning, and bright red blood on the toilet
paper after wiping, on the stool and/or in the toilet. Hemorrhoids are usually caused by chronic
diarrhea and constipation in those with IBD. Treatments range from sitz baths, over the counter
meds to prescription meds. For more info on hemorrhoids, please click here.

Strictures
Strictures are areas of the intestines that are narrowed. The narrowing may be due to
inflammation or it may be due to prolonged inflammation that has caused scar tissue to form.
Strictures may pose risks of perforation if they are severely narrowed and an obstruction results.
Symptoms of strictures may include nausea, vomiting, distention, pain, cramping and inability to
have a bowel movement. If the narrowing is not causing significant blocking in the section of
bowel, symptoms may not be present.

Treating strictures depends on the severity of the stricture and the location. If the stricture is
caused by inflammation, corticosteroids may be given to reduce the inflammation. If the stricture
is caused by scar tissue, procedures may be needed to relieve the narrowing. These
procedures include scoping the area and dilating a balloon catheter to open up the area, a
bowel resection to remove the strictured area or stricturoplasty which the strictured section is cut
open and sewn back in a crosswise manner to widen the passageway.
For more information on IBD related strictures, please click here.

Intestinal Blockages (Obstructions)
Intestinal obstructions are either partial blockages of the bowel or complete blockages of the
bowel. Blockages can occur in the large and small intestine. Symptoms include distention, pain,
cramping, spasming, failure to pass gas, failure to pass stool, diarrhea(common for partial
blockage), nausea and sometimes fever. Stool may be passed if it was below the obstructed
area.

Partial obstructions are usually treated in the hospital and may require medicines to alleviate the
pain and nausea. You are not allowed to eat or drink as you wait to see if the blockage resolves
itself. IV fluids are usually given to prevent dehydration.

A complete obstruction is almost always a surgical emergency. Most surgeries are
laproscopically performed. A resection is commonly the first attempt to remove the damaged
area. An ostomy may be performed if the resection is not possible.
For more info on intestinal blockages, please click here.

Abscesses
An abscess is a collection of pus due to an infection. They may occur around the anus and
appear as a red, swollen lump. The are painful. In IBD, abscesses may occur deep in the
rectum. Sometimes these require surgery. Abscesses on the anus may be treated with pain
meds, antibiotics and draining. Symptoms include pain, the presence of the lump on the anus,
fever and sometimes constipation. For more info, click here.

Bowel Perforation
A perforation occurs when there is a hole in the intestinal wall. This is a medical emergency. A
hole in the intestinal wall allows the bowel contents to spill in to the abdominal cavity causing
peritonitis. Peritonitis is inflammation of the tissue lining the abdominal wall. Symptoms of a
perforation include severe pain, nausea, vomiting and fever. Treatment commonly involves
surgery. For more info, please click here.

Toxic Megacolon
When inflammation is severe, the colon can dilate to a very large size, creating life-threatening
toxic megacolon. Symptoms include abdominal pain, abdominal distention, fever, dehydration,
and malnutrition. Unless medications can improve the patient rapidly, surgery is usually
necessary to prevent the colon from rupturing. For more info, please click here.

Colon Cancer Risk
After eight to ten years of having IBD, the increased risk of colon cancer rises 20%. Colon
cancer in IBD patients usually develops from a polyp but may develop from pre-cancerous cells
developing in the intestinal tissue. Yearly colonoscopies are recommended to look for dysplasia
(pre-cancerous cells) and remove them. A colectomy (removing the colon) can also be
performed surgically to prevent cancer. The risks are more associated with ulcerative colitis
because it only involves the colon. However, beings as Crohn’s affects the colon in patients as
well, colon cancer risks remain high with Crohn’s disease too. For more info on colon cancer,
please click here.

Extraintestinal Manifestations
There are extraintestinal manifestations of Inflammatory Bowel Disease that develop frequently
along with the intestinal and perianal disease. In patients with one extraintestinal manifestation,
the likelihood of developing another increases. These manifestations include forms of arthritis,
eye inflammation, skin conditions, manifestations in the mouth and liver abnormalities.

Arthritis and IBD
Arthritis is a common manifestation in Crohn’s Disease patients. It presents as ankylosing
spondylitis, sacroiliitis and most commonly as peripheral arthritis of the large joints. The course
of these arthritis manifestations runs independently of the disease and may occur years before
the intestinal disease presents.

Ankylosing Spondylitis (AS) primarily affects the spine, but may involve other joints. It causes
inflammation of the spinal joints and can lead to chronic pain. Pain and discomfort associated
with AS is often times severe. Other areas that may be affected by AS include the hips, ribs,
shoulders, heals and the hands and feet.

Sacroiliitis is inflammation of the sacroiliac joint which connects your lower spine and your
pelvis. This manifestation can be extremely painful and uncomfortable. Sacroiliitis may present
months or years before any symptoms of IBD appear.

Arthritis of the large joints, peripheral arthritis, is characterized by inflammation in large joints
of the arms and legs such as the knees, ankles and wrists. It may be the first sign of a flare as it
occurs during the period of active inflammation in the intestines.

For more information on AS and the other arthritis manifestations, you can visit :
http://www.spondylitis.org/main.aspx

Eye Inflammation Manifestations
Inflammation of the eye may also occur during the course of IBD. The most common
manifestations are iritis and episcleritis.

Inflammation of the iris is known as iritis. Iritis is often referred to as uveitis as the uvea is the
layer of the eye that contains the iris. Symptoms include pain, blurred vision, sensitivity to light,
decreased vision and red, teary eyes. Only one eye is usually affected during an iritis attack.
For more information on iritis, please click here.

Episcleritis is inflammation of the episclera. The episclera is the membrane that covers the
sclera, or white outer wall, of the eye. Symptoms include pain, sensitivity to light, tearing and a
pink or purple coloring of the white of the eye. For more information on episcleritis,
please click here.

Skin Conditions Associated with IBD
There are skin manifestations involved with IBD. These include erythema nodosum and
pyoderma gangrenosum.

Erythema nodosum is an inflammatory disorder that causes red, tender bumps under the skin.
They are painful may feel warm to the touch and are nearly an inch across in size. Erythema
nodosum most commonly occurs on the shins but appears elsewhere on the body. Symptoms
also include fever, malaise, swelling of the affected area, joint pain and skin irritation or
inflammation. For more info on erythema nodosum, please click here.

Pyoderma gangrenosum (PG) is a rare manifestation of ulcerative lesions on the legs
(common in classic form) or on the hands (common for atypical form). Although most commonly
in these areas, the lesions may present on other areas of the body. The lesions begin small and
develop in to large ulcerations. They are painful and are often accompanied with joint pain and
malaise. For more information on PG please click here.

Aphthous Ulcers in Mouth
Recurrent aphthous ulcers (RAU) is an inflammatory disease that causes mouth ulcers. The
ulcers occur mostly on the buccal mucosa, the floor of the mouth, the labial mucosa, the lower
surface of the tongue, and the soft palate. The ulcers are painful and may be accompanied by
fever, malaise, nausea, vomiting, headache, sore throat and diarrhea. The ulcers are
particularly concerning with pediatric patients because there may be a decrease in oral intake
and pediatric patients may experience dehydration. Depending on the severity of the ulcer, it
may clear up between 7 – 30 days. For more information on aphthous ulcers, please click here.

Liver Abnormalities
There are several liver abnormalities involved with CD. These include Primary Sclerosing
Cholangitis, Gall Stones, and fatty liver disease.

Primary Sclerosing Cholangitis
Also known as PSC, Primary Sclerosing Cholangitis is a chronic liver disorder that causes
inflammation of the bile ducts outside and often the bile ducts inside the liver. The inflammation
leads to thickening, narrowing and eventually obstruction of the ducts. Symptoms include
jaundice, upper abdominal pain, itching all over the body, and infection.

PSC is progressive and as it progresses it causes cirrhosis of the liver (irreversible scarring) and
liver failure. It is the most common reason for a liver transplant.   Treatment includes medicines
to treat itching, antibiotics to treat infection, and calcium and vitamin D to prevent osteoporosis.
Surgery may be performed to bypass an obstructed duct as well as a balloon dilatation
procedure to stretch the duct open.

According to the CCFA, PSC occurs in only 1% of Crohn's patients. For more info on PSC,
please click here.

Cholelithiasis (Gall Stones)
Gall stones occur in approximately 30% of CD patients with ileal disease and/or ileal resection.
This high incidence is related to a bile salt deficiency (the diseased terminal ileum can’t absorb
bile salts) in CD that causes the composition of bile components, water, salts, lecithin,
cholesterol, and other substances, to change thus forming gall stones. Symptoms are often not
present but if a stone blocks a duct or is large symptoms may include upper abdominal pain,
fever, jaundice, nausea, vomiting, clay-colored stools, excessive gas, heartburn, indigestion and
distention. Treatment includes medications taken to dissolve stones, electrohydraulic shock
waves to break up stones and if symptoms are severe, surgery may be needed. For more info,
please click here.

Steatosis (Fatty liver disease)
Fatty liver disease is characterized by an accumulation of fat in the liver due to an abnormality in
liver metabolism. It is a fairly minor problem and causes no symptoms. Treatment is generally
not required. However, medications used in IBD such as Prednisone, can promote fatty liver
disease and reduction or discontinuance of these meds will usually improve liver back to normal.
For more info please click here.

Please see your doctor if you have any abnormal symptoms.

The goal for Crohn's patients is quality of life. If you can create a quality of life for yourself that
enables you to go about daily activities with normalcy, then half the battle is won. This can be
accomplished with medicines, diet, etc. Everyone is different and everyone's disease is
different.

We notice that for us, the flares seem longer than not. The medicines work at times but we feel
that the choices are bare and stressful. The good news is that there are currently new
medicines in clinical trials and there are more on the horizon. For a list of these trials, please visit
the links page.

Flares are unforgiving and in those times we need to talk to people because we need help. If
you need help, please let us know. We are building a great support community on our
Message Board and you can also email us at anytime. We are always glad to help in any way
that we can!

Last Updated 12/16/07

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