Crohn's disease is a form of inflammatory bowel disease (IBD), which involves ongoing (chronic) inflammation of the gastrointestinal tract. Crohn's-related inflammation usually affects the intestines, but may occur anywhere from the mouth to the anus (the end of the rectum).

Causes

     While the exact chain of events that lead to Crohn's disease is unknown, the condition is linked to a problem with the body's immune system response. Normally the immune system helps protect the body from harmful substances. But in patients with Crohn's disease and other types of inflammatory bowel disease (IBD), the immune system can't tell the difference between good substances and foreign invaders. The result is an overactive immune response that leads to chronic inflammation. This is called an autoimmune disorder.

     Symptoms depend on what part of the gastrointestinal tract is affected. Symptoms range from mild to severe, and can come and go with periods of flare-ups.

     The main symptoms of Crohn's disease are:

• Crampy abdominal (belly area) pain

• Persistent, watery diarrhea

• Fever

• Fatigue

     Other symptoms may include:

• Rectal bleeding and bloody stools

• Loss of appetite

• Unintentional weight loss

• Constipation

• Abdominal fullness and gas

• Gastrointestinal bleeding

• Foul-smelling stools

• Tenesmus (pain with passing stool)

• Fistulas (usually around the rectal area, may cause draining of pus, mucus, or stools)

• Liver inflammation

• Joint pain

• Skin rash

• Swollen gums

• Eye inflammation

• Kidney stones

• Clotting problems (deep vein thrombosis)

Screening and Diagnostics

     A physical examination may reveal an abdominal mass or tenderness, skin rash, swollen joints or mouth ulcers. The doctor may use a stethoscope to listen to the belly area. Abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine) may be heard.

     Tests to diagnose Crohn's disease include:

• Endoscopy

• Colonoscopy

• Sigmoidoscopy with small bowel biopsy

• Small bowel x-ray series

• Barium enema

• Upper GI series

• Stool guaiac test

     A stool culture may be done to rule out other possible causes of the symptoms.

     This disease may also alter the results of the following tests:

• Fecal fat

• Liver function tests

• Albumin

Treatment

• Diet -- specific low-fiber or high-fiber may be prescribed depending on symptoms and location of the disease

• AntiDiarrheal medications as needed, e.g., Lomotil

• Antispasmodic medication as needed, e.g. Hyoscyamine

• Medications for treating Crohn's:

1. Sulfasalazine

2. Corticosteroids, e.g., Prednisone

3. Immune therapy drugs, such as Azathioprine or Mercaptopurine

• Surgery may be needed for fistulas, abscesses (infections), or bowel obstructions.

Prognosis

     There is no cure for Crohn's disease. However, it is not considered a deadly illness. The condition is marked by periods of improvement followed by flare ups of symptoms.

     Persons with Crohn's disease have an increased risk of small bowel or colorectal cancer.

Complications

• Fistulas in the following areas:

  • Bladder

  • Vagina

  • Skin

• Bowel obstructions

• Abscess

• Nutritional deficiencies (particularly vitamin B12 deficiency)

• Complications of corticosteroid therapy

• Inflammation of the joints

• Erythema nodosum

• Pyoderma gangrenosum

• Lesions in the eye

• Impaired growth and sexual development in children