Digestive Topics : Crohn's Disease
Crohn’s disease is one of the most common forms of Inflammatory Bowel Disease (IBD). Crohn’s disease can affect any part of the intestine – large or small – and can irritate the deeper layers as well as the lining. Download the GIKids Fact Sheet on Crohn’s Disease to learn more about the symptoms, diagnosis and treatment of Crohn’s Disease in children.
What is Inflammatory Bowel Disease (IBD)?
IBD refers to a chronic inflammatory disorder of the intestines that is not due to identifiable causes. There are two main types of IBD: ulcerative colitis and Crohn’s disease. Ulcerative colitis affects only the surface lining of the large intestine (the colon); while Crohn’s disease can involve any part of the gastrointestinal tract, mouth to anus. Crohn’s disease can lead to other complications, such as abscess formation, strictures (narrowing of the intestines), or fistulas (connections between various areas of the bowel, or bowel to bladder, genital organs or skin around the anus).
How common is Inflammatory Bowel Disease?
It is estimated that about 1,000,000 Americans suffer from IBD. Males and females are affected equally. Crohn’s disease may occur at any age, but occurs most often in young adults. Although most cases of Crohn’s disease are diagnosed before age 30, there are around 50,000 patients that belong to the pediatric age group (<18 years of age). Family history is an important risk factor. About 5-8% of patients may have a family member with IBD and about 20-25% of patients may have a close relative with the condition. However, in most cases, it can occur in any ethnic group and in members of families where no one else is suffering from these diseases.
What causes Crohn’s Disease?
It is currently believed that Crohn’s disease occurs as a result of a complex inter-play between genetic and environmental factors. For unknown reasons, the immune system becomes abnormally active against an individual’s own gastrointestinal system. It targets not only the intestine, but sometimes other organs like the skin, the eyes, or the liver.
What are the symptoms of Crohn’s Disease?
The most common symptoms are:
- Diarrhea, sometimes with blood and mucus
- Abdominal pain
- Loss of appetite and weight loss
- Unexplained fevers and tiredness
- Delayed growth and maturation
How is Crohn’s Disease diagnosed?
The diagnosis of Crohn’s disease may be suspected on the basis of the medical history, but the final determination depends on the results from diagnostic testing. The diagnosis of Crohn’s disease involves a combination of the medical history, physical exam, and diagnostic testing which may include the following:
- Blood tests
- X-rays, MRI and CT scans of the intestine
- Endoscopy and biopsies of the upper and lower intestine
- Stool cultures to exclude infection with bacteria, viruses, and parasites
How is Crohn’s Disease treated?
The aim of treatment is to decrease the inflammation causing the damage to the intestines. Even though a cure is not yet possible, control of symptoms can be very effective in most patients. The number of medications available continues to increase, and new treatments can be expected in the future.
The medications most commonly used to treat Crohn’s disease are:
- Antibiotics, such as metronidazole, or ciprofloxacin
- Anti-inflammatories, such as sulfasalazine or mesalamine (these medications can be delivered orally, or in enema or suppository form, but act topically on the surface of the affected intestine)
- Steroids, such as prednisone, prednisolone or budesonide
- Immuno-modulators, such as azathioprine, 6-mercaptopurine, or Methotrexate that serve to dampen the immune system
- Biologicals, such as infliximab or adalimumab that serve to neutralize inflammatory proteins that cause tissue damage
- Nutritional treatments with supplemental liquid formulas. This can be particularly useful in children who eat poorly and are not growing normally
Is there a role for surgery?
About 60% of patients with Crohn’s disease will require surgery at some point in their lives. Because there is high risk of recurrence after surgery, this option is reserved for certain patients with complications such as an obstruction from a narrowed area of the intestine (stricture), abscesses, fistulas, chronic pain, bleeding, or when using medicine does not work. The availability of biological therapies has certainly improved patients’ quality of life and decreased the need for surgical intervention.
IMPORTANT REMINDER: This information from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.