What Is Crohn’s disease?

The human digestive tract works hard to digest food and absorb nutrients. The proper function of the digestive tract is crucial for overall health and wellbeing.

While strong enough to break down food and absorb much-needed nutrients, the digestive system is also sensitive and prone to various problems. 

One of the many problems that affect the digestive tract is Crohn’s disease. You’ve probably heard about this disease at some point. But how much do you really know about it?

The reality is that we don’t know enough. This post aims to change that. Read on to learn more about Crohn’s. 

What is Crohn’s disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD). The condition got its name after Dr. Burrill B. Crohn.

Dr. Crohn was the first one to describe the disease back in 1932. The American gastroenterologist did it along with his colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer. 

As the chronic inflammatory condition of the gastrointestinal tract, Crohn’s disease can have debilitating symptoms. 

At the very beginning, it is essential to clarify what IBD really is. The inflammatory bowel disease is a term that refers to two conditions Crohn’s disease and ulcerative colitis. Both conditions involve chronic inflammation of the GI tract. That’s why most people use these terms interchangeably. Crohn’s disease and ulcerative colitis aren’t the same conditions, though. 

It would be impossible to discuss Crohn’s disease without establishing differences between these two conditions. You see, ulcerative colitis is limited to the colon. On the other hand, Crohn’s can develop anywhere in the gastrointestinal tract from mouth to the anus.

In Crohn’s disease, some parts of the intestine are healthy. But, they are mixed in between the inflamed areas. Ulcerative colitis is different. It represents a continuous inflammation of the colon.

While ulcerative colitis only affects the colon’s innermost lining, Crohn’s develops in all the layers of the bowel wall.

Some people can have indeterminate colitis. That’s a condition that includes both ulcerative colitis and Crohn’s disease.

Also, IBD and Crohn’s disease aren’t to be mistaken with irritable bowel syndrome. The IBS resulted from digestive problems and increased gut sensitivity. 

How common is Crohn’s disease?

According to the CDC, in 2015, an estimated 1.3% of US adults were diagnosed with IBD. More precisely, about three million people had either Crohn’s disease or ulcerative colitis. 

The Crohn’s and Colitis Foundation reports that the total number of Crohn’s disease cases diagnosed each year is 10.7 per 100.000 people. Approximately 33,000 new cases of Crohn’s disease are diagnosed each year. The existing prevalence of this disease in the United States is about 780,000 people.

Not all cases of Crohn’s disease are the same. There are different types of this condition. They include:

  • Ilecolitis – the most common type of Crohn’s. It involves inflammation of the ileum and colon (more about that in the symptoms section)

  • Ileitis – refers to inflammation and irritation of ileum only.
  • Gastroduodenal Crohn’s disease – affects the stomach and duodenum (the first part of the small intestine)

  • Jejunoileitis – develops in the jejunum, the second part of the small bowel.

  • Crohn’s colitis (granulomatous) – affects the colon only.

Crohn’s disease symptoms

Every patient experiences Crohn’s differently. The disease doesn’t affect the same part of the intestine in everyone. In some people, Crohn disease affects the ileum.

The ileum is the last segment of the small intestine. Others develop the disease in the colon, part of the large intestine. These two parts of the intestine, colon, and ileum, are most commonly affected by Crohn’s disease. 

Signs and symptoms of the disease develop gradually. As the disease progresses, the symptoms do too. They don’t usually show up out of the blue. That said, some patients may notice their symptoms came suddenly. This is not the case with most patients, but it’s still possible for some.

Some patients may experience mild symptoms. Others can have moderate to severe Crohn’s disease symptoms.

You may go through remission. Remission is a period when a patient doesn’t experience any symptoms of the disease. 

The most common symptoms of active Crohn’s disease include:

  • Abdominal pain and cramps

  • Blood in the stool

  • Decreased appetite and weight loss

  • Diarrhea

  • Fatigue

  • Feeling like the bowels aren’t empty after a bowel movement.

  • Fever

  • Frequent need for bowel movements 

  • Mouth sores

It’s not uncommon for people to mistake these symptoms for food poisoning or even Celiac disease. 

Other signs and symptoms of Crohn’s disease include the following:

  • Decreased ability to exercise due to anemia 

  • Inflammation of the joints and skin

  • Joint pain

  • Perianal fistula (pain and drainage near the anus)

  • Shortness of breath

  • Ulcers developing anywhere from the mouth to the anus

Symptoms of Crohn’s disease go beyond the intestine. They can also include arthritis, uveitis (eye inflammation), skin rash, liver, or bile duct inflammation. In children, Crohn’s disease can cause delayed growth and sexual development. 

Some people may also experience malabsorption and anorexia, urinary tract infections. 

Do not ignore the symptoms of this disease. Early detection and timely diagnosis can help prevent complications. We will discuss complications of Crohn disease below in the article. 

Risk factors

This disease doesn’t discriminate. Everyone can develop it. However, some people are at a higher risk than others. The most significant risk factors for this disease include:

  • Age – although the disease can develop at any age, you are more likely to develop it when you are young. Most people get Crohn disease before they turn 30.

  • Ethnicity – whites have a higher risk of this disease. This also includes people of Eastern European (Ashkenazi) Jewish descent. It is essential to mention that the disease is becoming more common among African Americans as well.

  • Family history – the risk of Crohn’s disease increases if your close relative has the condition. About one in five patients have a relative with this disease. It can be your sibling, parent, or even a child.

  • Location – people from urban areas and industrialized countries are more likely to develop Crohn’s disease. Also, people from northern climates are at a higher risk than their counterparts from southern climates.

  • NSAIDs (non-steroidal anti-inflammatory drugs) do not cause the disease but can potentially induce intestinal inflammation and worsen the condition.

  • Smoking cigarettes – smoking is an unhealthy habit. It increases the risk of many health problems. Crohn’s disease is one of them. Additionally, smoking can also worsen the disease and increase the risk of having surgery.

The fact that location plays a role in the Crohn disease risk means environmental factors matter a lot. This condition requires more research and studies. Further research would help identify new risk factors, particularly environmental contributors. 

Some diseases are more common in women than in men. The gender prevalence of Crohn disease varies from one region to another. In some countries, the disease is more prevalent in women and others; it’s vice versa.

The exact etiology of the disease still remains unknown. Scientists explain it is a complex interaction between environmental risk, genetic predisposition, and immune dysregulation to the intestinal microbiota. 

Complications

The risk of complications increases when the symptoms of Crohn’s disease become frequent and severe. The list of complications is truly extensive and includes:

  • Anal fissure – a small tear in the tissue that lines the anus which can cause rectal bleeding

  • Bowel obstruction – intestinal obstruction happens because the disease affects the thickness of the intestinal wall. Due to the disease, parts of the bowel can scar and narrow. This blocks the flow of digestive contents.

  • Colon cancer – the risk of colorectal cancer increases when the disease affects the colon and/or rectum

  • Fistulas – ulcers, sometimes, extend through the intestinal wall and create a fistula. Fistula is an abnormal connection between two body parts. They can form between the skin and intestine or between the intestine and another organ. The most common fistulas are near or around the anal area. 

  • Malnutrition – symptoms of Crohn’s disease such as diarrhea, abdominal cramps, and abdominal pain can make it challenging to eat. Your intestine can struggle to absorb enough nutrients. Anemia, in this case, is common.

  • Ulcers – chronic inflammation creates ulcers or open sores in the intestinal tract.

Crohn’s disease can cause other complications with your health. Besides anemia and arthritis, Crohn’s disease can also worsen osteoporosis, gallbladder, and liver disease. Pyoderma gangrenosum, rare but not contagious condition, can also occur in people with this disease.

Some complications require surgery. These include internal bleeding, fistulas, perforation, and stricture. Perforation refers to the development of a small hole in the wall of the gut.

Contents from that hole can leak and cause abscesses and infections. Stricture refers to the narrowing of the part of the gut. As a result, the scar tissue builds up. This leads to partial or complete blockage of the intestine.

People with Crohn’s disease may also have other health problems, such as persistent iron deficiency and kidney stones.

Additionally, certain medications for the treatment of Crohn’s can increase the risk of infection. These drugs work to block the function of the immune system. They may increase the risk of skin cancer and lymphoma. 

Crohn’s disease causes

The cause of Crohn’s disease is a subject of many debates in the scientific and medical community. It has puzzled scientists and healthcare professionals for over a century. Even today, the exact cause of the disease is still unclear. 

Generally accepted fact is that the disease results from an aberrant immune response to commensal microflora in genetically susceptible patients. In other words, the condition could stem from the abnormal reaction in the immune system.

The general theory is that the immune system attacks good bacteria, foods, and good substances because they consider them bad or unwanted. During the attack, white blood cells accumulate in the gut lining. This buildup induces inflammation. Bowel injury and ulcerations ensue. 

That being said, it is not clear whether the abnormal immune system response triggers Crohn’s disease or results from it. 

Other potential causes of the disease could be genetics and environmental factors.

Bacteria and viruses could also play a role in the development of the disease. For example, E. coli has been linked with Crohn’s. 

Further research on this topic is crucial. More studies could help pinpoint and identify the exact cause of Crohn’s disease. Identifying the cause would pave the way to new treatment options and easier management. 

Crohn’s disease treatment

Make sure to see your doctor if you experience persistent changes in bowel habits. If you have symptoms of Crohn’s disease mentioned in this article, schedule an appointment to see your doctor. 

Don’t hesitate to see the doctor if you notice blood in the stool or experience abdominal pain. Do the same if you have ongoing bouts of diarrhea that don’t respond to OTC medications. Unexplained weight loss and fever that lasts more than a day or two are good reasons to consult the doctor. 

When you see the healthcare provider, you need to report all symptoms you’re experiencing. Don’t leave out anything. Even the changes and signs you deem irrelevant can help diagnose the problem.

Based on the symptoms you describe, the doctor will suspect Crohn’s disease is to blame. However, there is no specific test that aims to diagnose the condition. The doctor will resort to a combination of tests to rule out other diseases with similar symptoms. These tests include:

  • Blood tests – to check for anemia and infection.

  • Fecal occult blood test – to test for hidden (occult) blood in the stool

  • Procedures – several tests and procedures can help diagnose the disease. The doctor may order a Barium enema, colonoscopy, CT, MRI, capsule endoscopy, and balloon-assisted enteroscopy.

Once the healthcare provider diagnoses Crohn’s disease, they will recommend the most suitable treatment. 

Speaking of treatment, the cure for Crohn’s disease doesn’t exist. The main goal of the treatment is to decrease inflammation. As a result, it can be easier to manage symptoms. The treatment also lowers the risk of complications. 

The exact course of Crohn’s disease treatment depends on the severity of the disease. The doctor may recommend the following:

  • Anti-inflammatory drugs – the first step in the treatment of IBDs. These drugs include corticosteroids to reduce inflammation. In some cases, the doctor may prescribe oral 5-aminosalicylates, although these drugs aren’t as often used as before

  • Immune system suppressors – reduce inflammation, but target the immune system. After all, the immune system produces compounds that cause inflammation. These drugs include azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). Other immune system suppressors are also an option.

  • Antibiotics – decrease the amount of drainage and sometimes heal fistulas and abscesses. 

  • Other medications – the doctor may prescribe other medications to help manage symptoms of Crohn’s disease. These include iron supplements, antidiarrheals, pain relievers, vitamin B-12 shots, calcium, and vitamin D supplements.

Besides medications, the doctor may recommend enteral nutrition or parenteral nutrition. Enteral nutrition is a diet given via a feeding tube. Parenteral nutrition refers to nutrients injected into a vein. Nutrition therapy is usually short-term, and it works in combination with other treatment measures.

To reduce the risk of intestinal blockage, the doctor may recommend a low-fiber diet.

Surgery is also an option for Crohn’s disease patients. When other treatments don’t work, the doctor may recommend surgery as a last resort. Nearly half of patients with this disease will require at least one surgery, such as bowel resection.

The colorectal surgeon explains the benefits of the surgery and performs it to tackle some complications. Surgery doesn’t cure the condition.

Management

In addition to doctor-recommended treatments, lifestyle measures can aid the management of this disease. For instance, everything starts with a proper diet. Some foods cause flare-ups and aggravate the condition. You may want to keep a food journal.

Write down everything you eat and how you feel afterward. Go through the food journal to identify foods that don’t make you feel well. This is especially important if your symptoms worsen due to some foods you eat.

Eliminate or limit consumption of all foods which induce flare-ups. Some dietary changes that can help you out include:

  • Limit consumption of dairy products

  • Eat low-fat foods

  • Avoid alcohol

  • Limit or avoid consumption of spicy foods 

  • Limit caffeine intake 

You should eat small meals and chew your food thoroughly. Strive to drink plenty of fluids during the day. Consider taking dietary supplements to make up for all the nutrients you’re lacking. Nutritional supplements are available in over-the-counter form. 

Other lifestyle modifications to adopt include:

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Conclusion

Crohn’s is a common condition, especially in developed countries. The exact cause is unclear, but genetics, environmental factors, and immune system abnormalities are likely to play a role. The cure for this disease doesn’t exist. Treatment helps manage symptoms and prevent complications. You can have a quality life with Crohn’s when you’re proactive about the condition.

Sources

  1. Ulcerative colitis vs. Crohn’s disease. UCLA Health. https://www.uclahealth.org/gastro/ibd/ulcerative-colitis-vs-crohns-disease#:~:text=In%20Crohn’s%20disease%2C%20there%20are,layers%20of%20the%20bowel%20walls
  2. Data and statistics – Inflammatory Bowel Disease prevalence (IBD) in the United States. CDC. https://www.cdc.gov/ibd/data-statistics.htm#:~:text=In%202015%2C%20an%20estimated%201.3,%25%20or%202%20million%20adults).&text=Some%20people%20were%20more%20likely,Aged%2045%20years%20or%20older.
  3. The facts about inflammatory bowel disease. Crohn’s and Colitis Foundation America. https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf
  4. The five types of Crohn’s disease. Healthline. https://www.healthline.com/health/crohns-disease/types
  5. Ranasinghe IR, Hsu R. (2020). Crohn disease. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK436021/#:~:text=processes.%5B10%5D-,History%20and%20Physical,cutaneous%20fistulas%20can%20be%20seen.
  6. Ha, F., & Khalil, H. (2015). Crohn’s disease: a clinical update. Therapeutic advances in gastroenterology8(6), 352–359. https://doi.org/10.1177/1756283X15592585
  7. Greenstein, A. J., Janowitz, H. D., & Sachar, D. B. (1976). The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine55(5), 401–412. https://doi.org/10.1097/00005792-197609000-00004
  8. Segal A. W. (2016). Making sense of the cause of Crohn’s – a new look at an old disease. F1000Research5, 2510. https://doi.org/10.12688/f1000research.9699.2
  9. What is Crohn’s disease? Medical News Today. https://www.medicalnewstoday.com/articles/151620#causes
Alternative Text

Dr. Ahmed Zayed

Dr. Ahmed Zayed holds a baccalaureate of Medicine and Surgery. He has completed his degree at the University of Alexandria, Egypt. Founder of ZayedMD, Dr. Ahmed believes in making the knowledge as accessible as possible to patients. He had his work featured in reputable publications such as The Huffington Post. Other than his passion for writing, Dr. Ahmed spends​ his time outside the hospital at the gym or with a good book.

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