Crohn's Disease | Research & Encyclopedia Articles

Crohn's disease (pronounced krohnz) is a type of inflammatory bowel disease. It results in swelling of the intestinal tract. It may also restrict the function of the intestinal tract.

The term inflammatory bowel diseases (IBD) refers to a large group of disorders that affect the gastrointestinal (digestive) system. The gastrointestinal (GI) system includes the stomach, small intestine, and large intestine. For reasons that are still not understood, portions of the GI system sometimes become inflamed. Researchers think that the body's immune system may sometimes cause this inflammation. It attacks the lining of the GI system the way it normally attacks invading foreign bodies.

Two of the most important of these disorders are Crohn's disease and ulcerative colitis (see ulcerative colitis entry). These disorders differ from each other in two primary ways:

• The inflammation caused by Crohn's disease may occur in patches separated from each other on the GI lining. Ulcerative colitis produces one large area of inflammation.
• The inflammation of Crohn's disease can penetrate deep into the wall of the intestine. Ulcerative colitis affects only the lining of the intestine.

Crohn's disease can affect people of all ages and both sexes. It occurs most commonly in individuals between the ages of fifteen and thirty-five. About 2 to 4 out of 10,000 people develop the condition. Crohn's disease occurs more commonly among whites, especially people of Jewish ancestry. Crohn's disease is a chronic (ongoing) disorder. Its symptoms may improve, but a person is never completely cured.

The cause of Crohn's disease is unknown. Some researchers believe that it may be triggered by an infection. But no infectious agent, such as a bacterium or virus, has ever been discovered. There is some evidence that the disease may be an autoimmune disorder (see autoimmune disorder entry). An autoimmune disorder is a condition in which the body's immune system becomes confused. It begins to attack body tissue just as it would attack invading organisms, such as bacteria or viruses. However, no proof for this theory has yet been obtained.

The first symptoms of Crohn's disease include diarrhea, fever, abdominal pain, inability to eat, weight loss, and fatigue. The abdominal pain is somewhat like that experienced by an individual with appendicitis (see appendicitis entry). An ongoing symptom of Crohn's disease may be malnutrition. Inflammation caused by the disorder interferes with the absorption of nutrients in foods and a patient may slowly become more and more malnourished.

Crohn's disease also can lead to a number of complications. These complications include:

• Obstructions. An obstruction is a blockage of the intestine. Partially digested food is not able to pass through the intestine. It may back up, causing constipation, vomiting, and intense pain.
• Abscesses. An abscess is a pocket of infection within tissue. Abscesses in the intestine may cause fever and severe abdominal pain.
• Fistulas. A fistula is an abnormal tube-like passage in tissue. Fistulas may allow fluids to drain out of the intestine into another part of the body. When they do so, bacteria that live in the intestine may cause infections in other areas of the body.
• Gallstones and kidney stones
• Kidney damage
• Arthritis (see arthritis entry)
• Inflammation of the vertebrae, the bones of the spine
• Ulcers of the mouth and skin
• Painful, red bumps on the skin
• Inflammation of the eyes, liver, and gallbladder

An individual may be suspected to have Crohn's if he or she begins to experience the described symptoms. Blood tests may provide some additional information by showing the presence of infection or malnutrition. Stool samples may be needed to rule out other GI disorders, such as ulcerative colitis, that have symptoms similar to those of Crohn's disease.

The most reliable method for diagnosing Crohn's disease is with a colonoscopy (pronounced KO-lon-OSS-kuh-pee). A colonoscope (pronounced ko-LON-o-skope) consists of a long, flexible tube with a light attached to the end. The tube is inserted into the patient's rectum. It is then threaded upward into the colon. With the colonoscope, a doctor is able to examine the walls of the colon. The presence of inflammation suggests a diagnosis of Crohn's disease.

The colonoscope may also have a small, sharp knife attached at the end. With the knife, a doctor can remove a tiny sample of tissue, which can then be examined under a microscope. Certain distinctive characteristics of cells indicate the presence of Crohn's disease.

A barium enema is sometimes used to confirm a diagnosis of Crohn's disease. A barium enema consists of a white liquid that is injected into the patient's rectum. The liquid moves upward into the colon and coats the lining of the colon. X-ray photographs of the colon are then taken. The white lining produces a clear X-ray photograph that shows the presence of any abnormal structures in the GI tract.

Treatment for Crohn's disease focuses on four major objectives:

• Reduction of inflammation of the intestine
• Dealing with the patient's nutritional problems
• Relieving the uncomfortable symptoms of abdominal pain and diarrhea
• Treating possible complications, such as obstructions, abscesses, and fistulas

Inflammation is usually treated with a drug called sulfasalazine (pronounced SULL-fuh-SAL-uh-zeen). Sulfasalazine consists of two parts. One part is an antibiotic and the other part an anti-inflammatory agent. For patients who do not respond to sulfasalazine, steroids may be used. Steroids are very effective in reducing inflammation. However, they have some undesirable side effects.

Nutritional supplements are used to treat malnutrition. The supplements are chosen because they are easily absorbed through the intestinal wall. Patients may also need to learn which foods they cannot digest (such as milk or spicy foods) and avoid eating those foods. In severe cases, a patient may need to be fed intravenously. Intravenous feeding involves the insertion of a tube into a vein. Nutrients are then given to the patient through the tube.

A number of medications are available to reduce pain and cramping. High-fiber medications may also be helpful.

Complications such as obstructions, abscesses, and fistulas are sometimes treated with antibiotics. The antibiotics kill the bacteria that produce these complications. If antibiotics are unsuccessful, surgery may be necessary. The purpose of surgery is to remove an obstruction or abscess or to repair a fistula. In the most severe cases, a portion of the intestine may have to be removed.

Crohn's disease is a chronic, lifelong illness. The severity of the condition differs for various patients. Some patients go through periods when they have no symptoms. Symptoms then flare up again at a later time.

The complications of Crohn's disease can lead to serious health problems. The risk for these complications increases over time. More than 60 percent of all patients with the disorder require surgery at one time or another. More than half require more than one operation. About 5 to 10 percent of all Crohn's patients die of the disorder. In most cases, death is caused by widespread infection.

Abscess:

A pocket of infection within tissue.

Arthritis:

Inflammation of a joint.

Barium enema:

A procedure in which a white liquid is injected into a patient's rectum in order to coat the lining of the colon so that X-ray photographs of the colon can be taken.

Colonoscope:

An instrument consisting of a long, flexible tube with a light attached to the end, used for examining the lining of the colon.

Fistula:

An abnormal tube-like passage in tissue.

Gastrointestinal system:

The digestive system consisting of the stomach and intestines.

Immune system:

A network of organs, tissues, cells, and chemicals designed to protect the body against foreign invaders such as bacteria and viruses.

Inflammation:

Redness, swelling, and loss of function caused by the body's attempt to fight off an infection.

Inflammatory bowel disease:

A large group of disorders that affect the gastrointestinal system.

Obstruction:

A blockage.

Scientists have known about Crohn's disease for more than two hundred years. The first description of the condition was probably written by the Italian physician Giovanni Battista Morgagni (1682–1771). But the real pioneer of research on this disease was the American physician, Burrill B. Crohn (1884–1983). Crohn was born in New York City and earned his medical degree from Columbia University College of Physicians and Surgeons. He spent most of his professional career at Mount Sinai Hospital in New York. Crohn first described the condition that now bears his name in 1932.

How did Crohn first become interested in digestive problems? When asked this question, he gave an interesting answer. According to Crohn, his father had long suffered from very bad cases of indigestion, so he decided to become a doctor in order to learn what would bring his father relief. Crohn was obviously a very good son and a very good physician!

Long, James W. The Essential Guide to Chronic Illness. New York: Harper Perennial, 1997.

Saibil, Fred. Crohn's Disease and Ulcerative Colitis. Buffalo, NY: Firefly Books, 1997.

Thompson, W. Grant. The Angry Gut: Coping With Colitis and Crohn's Disease. New York: Plenum Press, 1993.

Crohn's & Colitis Foundation of America, Inc. 386 Park Avenue South, 17th Floor, New York, NY 10016–8804. (800) 932–2423.

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