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Crohn's disease causes inflammation in the small
intestine. Crohn's disease usually occurs in the lower part of the
small intestine, called the ileum, but it can affect any part of the
digestive tract, from the mouth to the anus. The inflammation
extends deep into the lining of the affected organ. The inflammation
can cause pain and can make the intestines empty frequently,
resulting in diarrhea.
Crohn's disease is an inflammatory bowel disease
(IBD), the general name for diseases that cause inflammation in the
intestines. Crohn's disease can be difficult to diagnose because its
symptoms are similar to other intestinal disorders such as irritable
bowel syndrome and to another type of IBD called ulcerative colitis.
Ulcerative colitis causes inflammation and ulcers in the top layer
of the lining of the large intestine.
Crohn's disease affects men and women equally
and seems to run in some families. About 20 percent of people with
Crohn's disease have a blood relative with some form of IBD, most
often a brother or sister and sometimes a parent or
child.
Crohn's disease may also be called ileitis or
enteritis.
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Theories about what causes Crohn's disease
abound, but none has been proven. The most popular theory is that
the body's immune system reacts to a virus or a bacterium by causing
ongoing inflammation in the intestine.
People with Crohn's disease tend to have
abnormalities of the immune system, but doctors do not know whether
these abnormalities are a cause or result of the disease. Crohn's
disease is not caused by emotional distress.
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The most common symptoms of Crohn's disease are
abdominal pain, often in the lower right area, and diarrhea. Rectal
bleeding, weight loss, and fever may also occur. Bleeding may be
serious and persistent, leading to anemia. Children with Crohn's
disease may suffer delayed development and stunted
growth.
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A thorough physical exam and a series of tests
may be required to diagnose Crohn's disease.
Blood tests may be done to check for anemia,
which could indicate bleeding in the intestines. Blood tests may
also uncover a high white blood cell count, which is a sign of
inflammation somewhere in the body. By testing a stool sample, the
doctor can tell if there is bleeding or infection in the
intestines.
The doctor may do an upper gastrointestinal (GI)
series to look at the small intestine. For this test, the patient
drinks barium, a chalky solution that coats the lining of the small
intestine, before x rays are taken. The barium shows up white on
x-ray film, revealing inflammation or other abnormalities in the
intestine.
The doctor may also do a colonoscopy. For this
test, the doctor inserts an endoscope-a long, flexible, lighted tube
linked to a computer and TV monitor-into the anus to see the inside
of the large intestine. The doctor will be able to see any
inflammation or bleeding. During the exam, the doctor may do a
biopsy, which involves taking a sample of tissue from the lining of
the intestine to view with a microscope.
If these tests show Crohn's disease, more x rays
of both the upper and lower digestive tract may be necessary to see
how much is affected by the disease.
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The most common complication is blockage of the
intestine. Blockage occurs because the disease tends to thicken the
intestinal wall with swelling and scar tissue, narrowing the
passage. Crohn's disease may also cause sores, or ulcers, that
tunnel through the affected area into surrounding tissues such as
the bladder, vagina, or skin. The areas around the anus and rectum
are often involved. The tunnels, called fistulas, are a common
complication and often become infected. Sometimes fistulas can be
treated with medicine, but in some cases they may require
surgery.
Nutritional complications are common in Crohn's
disease. Deficiencies of proteins, calories, and vitamins are well
documented in Crohn's disease. These deficiencies may be caused by
inadequate dietary intake, intestinal loss of protein, or poor
absorption (malabsorption).
Other complications associated with Crohn's
disease include arthritis, skin problems, inflammation in the eyes
or mouth, kidney stones, gallstones, or other diseases of the liver
and biliary system. Some of these problems resolve during treatment
for disease in the digestive system, but some must be treated
separately.
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Treatment for Crohn's disease depends on the
location and severity of disease, complications, and response to
previous treatment. The goals of treatment are to control
inflammation, correct nutritional deficiencies, and relieve symptoms
like abdominal pain, diarrhea, and rectal bleeding. Treatment may
include drugs, nutrition supplements, surgery, or a combination of
these options. At this time, treatment can help control the disease,
but there is no cure.
Some people have long periods of remission,
sometimes years, when they are free of symptoms. However, the
disease usually recurs at various times over a person's lifetime.
This changing pattern of the disease means one cannot always tell
when a treatment has helped. Predicting when a remission may occur
or when symptoms will return is not possible.
Someone with Crohn's disease may need medical
care for a long time, with regular doctor visits to monitor the
condition.
Most people are first treated with drugs
containing mesalamine, a substance that helps control inflammation.
Sulfasalazine is the most commonly used of these drugs. Patients who
do not benefit from it or who cannot tolerate it may be put on other
mesalamine-containing drugs, generally known as 5-ASA agents, such
as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine
preparations include nausea, vomiting, heartburn, diarrhea, and
headache.
Some patients take corticosteroids to control
inflammation. These drugs are the most effective for active Crohn's
disease, but they can cause serious side effects, including greater
susceptibility to infection.
Drugs that suppress the immune system are also
used to treat Crohn's disease. Most commonly prescribed are
6-mercaptopurine and a related drug, azathioprine. Immunosuppressive
agents work by blocking the immune reaction that contributes to
inflammation. These drugs may cause side effects like nausea,
vomiting, and diarrhea and may lower a person's resistance to
infection. When patients are treated with a combination of
corticosteroids and immunosuppressive drugs, the dose of
corticosteriods can eventually be lowered. Some studies suggest that
immunosuppressive drugs may enhance the effectiveness of
corticosteroids.
The U.S. Food and Drug Administration has
approved the drug infliximab (brand name, Remicade) for the
treatment of moderate to severe Crohn's disease that does not
respond to standard therapies (mesalamine substances,
corticosteroids, immunosuppressive agents) and for the treatment of
open, draining fistulas. Infliximab, the first treatment approved
specifically for Crohn's disease, is an anti-tumor necrosis factor
(TNF) substance. TNF is a protein produced by the immune system that
may cause the inflammation associated with Crohn's disease. Anti-TNF
removes TNF from the bloodstream before it reaches the intestines,
thereby preventing inflammation. Investigators will continue to
study patients taking infliximab to determine its long-term safety
and efficacy.
Antibiotics are used to treat bacterial
overgrowth in the small intestine caused by stricture, fistulas, or
prior surgery. For this common problem, the doctor may prescribe one
or more of the following antibiotics: ampicillin, sulfonamide,
cephalosporin, tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often
relieved when the inflammation subsides, but additional medication
may also be necessary. Several antidiarrheal agents could be used,
including diphenoxylate, loperamide, and codeine. Patients who are
dehydrated because of diarrhea will be treated with fluids and
electrolytes.
The doctor may recommend nutritional
supplements, especially for children whose growth has been slowed.
Special high-calorie liquid formulas are sometimes used for this
purpose. A small number of patients may need periods of feeding by
vein. This can help patients who need extra nutrition temporarily,
those whose intestines need to rest, or those whose intestines
cannot absorb enough nutrition from food.
Surgery to remove part of the intestine can help
Crohn's disease but cannot cure it. The inflammation tends to return
next to the area of intestine that has been removed. Many Crohn's
disease patients require surgery, either to relieve symptoms that do
not respond to medical therapy or to correct complications such as
blockage, perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the
large intestine need to have their entire colon removed in an
operation called colectomy. A small opening is made in the front of
the abdominal wall, and the tip of the ileum is brought to the
skin's surface. This opening, called a stoma, is where waste exits
the body. The stoma is about the size of a quarter and is usually
located in the right lower part of the abdomen near the beltline. A
pouch is worn over the opening to collect waste, and the patient
empties the pouch as needed. The majority of colectomy patients go
on to live normal, active lives.
Sometimes only the diseased section of intestine
is removed and no stoma is needed. In this operation, the intestine
is cut above and below the diseased area and reconnected.
Because Crohn's disease often recurs after
surgery, people considering it should carefully weigh its benefits
and risks compared with other treatments. Surgery may not be
appropriate for everyone. People faced with this decision should get
as much information as possible from doctors, nurses who work with
colon surgery patients (enterostomal therapists), and other
patients. Patient advocacy organizations can suggest support groups
and other information resources.
People with Crohn's disease may feel well and be
free of symptoms for substantial spans of time when their disease is
not active. Despite the need to take medication for long periods of
time and occasional hospitalizations, most people with Crohn's
disease are able to hold jobs, raise families, and function
successfully at home and in society.
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No special diet has been proven effective for
preventing or treating this disease. Some people find their symptoms
are made worse by milk, alcohol, hot spices, or fiber. People are
encouraged to follow a nutritious diet and avoid any foods that seem
to worsen symptoms. But there are no consistent rules.
People should take vitamin supplements only on
their doctor's advice.
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Research has shown that the course of pregnancy
and delivery is usually not impaired in women with Crohn's disease.
Even so, women with Crohn's disease should discuss the matter with
their doctors before pregnancy. Most children born to women with
Crohn's disease are unaffected. Children who do get the disease are
sometimes more severely affected than adults, with slowed growth and
delayed sexual development in some cases.
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Researchers continue to look for more effective
treatments. Examples of investigational treatments
include
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Crohn's & Colitis Foundation of America,
Inc.
386 Park Avenue South, 17th Floor
New York, NY
10016-8804
Phone: 1-800-932-2423 or 212-685-3440
Email: info@ccfa.org
Internet: http://www.ccfa.org
Pediatric Crohn's & Colitis Association,
Inc.
P.O. Box 188
Newton, MA 02468
Phone:
617-489-5854
Email: questions@pcca.hypermart.net
Reach Out for Youth with Ileitis and Colitis,
Inc.
15 Chemung Place
Jericho, NY 11753
Phone:
516-822-8010
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The U.S. Government does not endorse or favor
any specific commercial product or company. Trade, proprietary, or
company names appearing in this document are used only because they
are considered necessary in the context of the information provided.
If a product is not mentioned, this does not mean or imply that the
product is unsatisfactory.
2 Information Way
Bethesda, MD
20892-3570
Internet: http://digestive.niddk.nih.gov/about/contact.htm
The National Digestive Diseases Information
Clearinghouse (NDDIC) is a service of the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is
part of the National Institutes of Health under the U.S. Department
of Health and Human Services. Established in 1980, the Clearinghouse
provides information about digestive diseases to people with
digestive disorders and to their families, health care
professionals, and the public. The NDDIC answers inquiries, develops
and distributes publications, and works closely with professional
and patient organizations and Government agencies to coordinate
resources about digestive diseases.Publications produced by the Clearinghouse are
carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The
Clearinghouse encourages users of this e-pub to duplicate and
distribute as many copies as desired.
NIH Publication No. 03-3410
January 2003
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