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One of the most common inflammatory bowel disease (IBD) conditions is Crohn's disease, which causes painful swelling of the small intestine, usually the lower part. It is sometimes called ileitis or enteritis. The inflammation spreads deep into the lining of the intestine, which can cause the patient to have constant severe diarrhea.
Many theories exist about the causes of the condition, although none have been proven yet. Many professionals believe that the body's immune system reacts to a virus or certain type of bacteria, which results in inflammation. People with Crohn's tend to have abnormal immune systems, but doctors do not know whether these abnormalities are a cause or a result of the disease. Crohn's disease in not caused by emotional stress.
This disease affects men and women equally and seems to run in some families. According to the National Institutes of Health, about 20 percent of patients with Crohn's disease have a blood relative with some form of IBD, usually a brother or sister, parent or child.
The most common signs are pain in the stomach area (usually on the right side) and diarrhea. Others include rectal bleeding, weight loss and fever. Bleeding may be serious and lead to anemia. Children with Crohn's disease may experience delayed or stunted growth.
A thorough physical exam and a series of tests may be needed to confirm Crohn's disease, including:
- Blood tests may be done to check for anemia (a sign of bleeding in the intestines) or a high white blood cell count (indicating inflammation in the body).
- Stool samples can reveal bleeding or infection in the intestines.
- An upper gastrointestinal (GI) series may be done to examine the affected area. The patient drinks barium, a chalky solution that coats the lining of the intestine, before X-rays are taken. The barium reveals inflammation or other problems.
- A colonoscopy involves the insertion into the anus of a long, lighted tube linked to a computer monitor. The screen shows the inside of the large intestine and any bleeding or swelling that may be there.
- A biopsy may be performed during a colonoscopy to remove a sample of tissue from the lining of the intestine for inspection under the microscope.
Patients suffering from Crohn's disease may have these complications:
- Blockage of the intestine is the most common complication. This happens because the intestinal wall tends to get thick with swelling and scar tissue, causing the passageway to become narrower.
- Sores or ulcers may tunnel past the affected area and get into nearby areas, such as the bladder, vagina, rectum or skin around the anus. These are called fistulas and can become infected. Usually they can be treated with medicine, but sometimes surgery is needed to remove them.
- Poor nutrition is common among IBD patients. Too little protein, calories and vitamins may result from not eating enough food, intestinal loss of protein or poor absorption of food and nutrients.
- Other complications include arthritis, skin problems, inflammation of the eyes and mouth, kidney stones, gallstones or other diseases of the liver and biliary (ductal) system.
Some of these problems can be taken care of during treatment for Crohn's disease. Others may need to be treated separately.
Treatment for Crohn's disease depends on the location, severity, complications and response to earlier treatment. The goal of the IBD Center's specialists is to control inflammation, correct nutrition problems and relieve symptoms of pain, diarrhea and rectal bleeding.
At this time, treatment can control the disease but not cure it. Some patients have long periods, sometimes years, when the symptoms go away. However, Crohn's disease usually appears several times randomly over the course of a person's lifetime. This makes it hard for doctors to know for certain whether a treatment helped or not. Patients may need medical care for a long time, including regular visits to the doctor's office. Treatment options include:
- Medication. At first, most people are given anti-inflammatory drugs. Some can cause side effects, such as nausea, vomiting, heartburn, diarrhea and headaches. Steroids may also be prescribed. These are very effective during active bouts of Crohn's disease but cause serious side effects, including a greater chance of infection. Certain drugs may be used to block the immune reaction to inflammation. Side effects for this category of drugs include nausea, vomiting, diarrhea and a lowered resistance to infection. Antibiotics may be prescribed to treat bacteria growth. Anti-diarrhea medicines may also be used.
- Nutrition supplements. Special high-calorie liquid formulas may be recommended, especially for children whose growth has slowed because of the disease. Under certain circumstances, a patient may be fed nutritional supplements through a vein.
- Surgery. Removing part of the intestine can help Crohn's patients. Inflammation tends to return near the area surgery was done. One option is a colostomy. For this, the surgeon makes a small opening in the front of the abdominal wall and pulls the tip of the intestine to the surface of the skin where waste products will go out of the body. The opening is usually made on the lower right near the belt line. A pouch is worn over the opening, which the patient empties as needed. Sometimes only the diseased section of the intestine is taken out during surgery. In this operation, a cut is made above and below the diseased area of the intestine and the two ends are then reconnected.