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Crohn's disease is a type of inflammatory bowel disease. It produces areas of patchy inflammation, primarily in the small intestine, but it can also produce inflammation in any part of the digestive tract, including the mouth, esophagus, stomach, and colon. Where inflammation exists, it extends into all the tissue layers. This results in abdominal pain, diarrhea, gastrointestinal bleeding, and poor absorption (malabsorption) of nutrients from food.
Although the disease is chronic, usually lasting a lifetime, it produces inflammation intermittently and can be in remission for long periods.
The cause of Crohn's disease is unknown (idiopathic), but an immune system abnormality may play a role. Because the disease seems to run in families, there may be a genetic component to its development. Stress is believed to aggravate the disease.
Risk: The disease affects men and women equally and typically develops before the age of 30 years. It is most common in white and Jewish individuals ("Introduction"). Incidence and Prevalence: In the US, approximately 500,000 people have Crohn's disease ("Introduction"). |
Source: Medical Disability Advisor
| History: Symptoms vary according to the severity of the disease, the location of the inflammation, and whether intestinal complications have developed. Typically an individual experiences intermittent periods of fever, diarrhea, pain in the abdomen, fatigue, and weight loss.
Sometimes, symptoms develop outside the digestive tract. Joint pain, swelling, and tenderness are common extraintestinal symptoms. Physical exam: The exam may reveal tenderness, distention, or a mass upon examination of the abdomen. During periods of partial obstruction or bloody diarrhea, excessive bowel sounds may be heard. Ulcers may be found in the mouth and abscesses or fistulas near the anus and rectum. The tongue may be inflamed (atrophic glossitis).
Joint involvement may be found, as well as enlargement of the liver and spleen. There may be areas of inflammation on the back of the legs (erythema nodosum). Tests: Barium contrast x-rays taken of the intestine reveal patchy areas of inflammation ("cobblestone" appearance), ulcers, narrowing (strictures), or abnormal passageways due to erosion of the intestine (fistulas).
Endoscopy of the small intestine (esophagogastroduodenoscopy) or colon (colonoscopy) enables visualization of these intestinal abnormalities. Thick, firm areas of inflammation (granulomas) may be discovered. Biopsy of these areas can confirm the diagnosis.
Laboratory tests are done to measure and monitor the effects of inflammation, such as anemia, infection, and malabsorption. An increased erythrocyte sedimentation rate ("sed" rate) indicates active inflammation. An increased white blood cell count (WBC) indicates inflammation and possible infection. Microbiologic cultures disclose a bacterial or parasitic infection.
Chronic bleeding may lead to anemia and will cause the hematocrit and hemoglobin to be decreased. Chronic diarrhea results in low blood levels of potassium, magnesium, calcium, and albumin. Malabsorption results in low vitamin B12 and folate levels. A positive fecal occult blood test (FOBT) indicates hidden blood in the stool. |
Source: Medical Disability Advisor
| Crohn's disease cannot be cured, but its symptoms can be controlled through nutrition and diet modifications, medication, and sometimes surgery.
Nutrition is important in this disease, so a diet adequate in calories, vitamins, and protein is recommended. Diet modifications vary according to the symptoms of the disease. During periods of diarrhea, a low-fat, high-fiber diet should be followed. In contrast, early in the relapse of the disease, or if symptoms of obstruction are present, a low-fiber diet is needed. During acute stages of the disease, no food should be taken by mouth in order to rest the colon.
Sometimes, especially with advanced disease, nutritional supplementation is needed. Nutrients may be placed directly into the stomach or intestine through a tube (enteral therapy) or into the bloodstream intravenously (total parenteral nutrition, or TPN).
Anti-inflammatory drugs of the 5-amino salicylic acid group are given to reduce inflammation. Corticosteroids reduce inflammation during an acute attack but are given for only a few months at a time because they may cause significant long-term adverse effects. Immunosuppressive drugs are given to help relieve symptoms in individuals with severe progressive disease who have not responded to other treatments.
Iron may be needed to treat anemia, and vitamin B12 injections may be needed to reverse malabsorption, particularly if there is advanced disease of the small intestine. When abscesses are present, antibiotics are given to fight the infection. Bile salt binding agents or other antidiarrheal medications may be helpful during episodes of diarrhea but should be used with caution.
Many individuals gain significant relief from surgery in which a portion of the intestine is removed (resection). In cases of severe disease, the entire colon may be removed (colectomy). Depending on how much of the intestine is removed, a temporary or permanent passageway may need to be created through which waste materials can be emptied. Surgery may also be needed to remove a fistula (fistulectomy) or to open an obstructed portion of the intestine (stricturoplasty).
As with any chronic disease, living with Crohn's disease is challenging. Psychotherapy or participation in a support group may help the individual cope with the particular difficulties of Crohn's disease and the general difficulties of chronic disease. |
Source: Medical Disability Advisor
| With medical and surgical management, individuals with Crohn's disease can function normally throughout a long life. The disease will have periods of exacerbation and periods of remission but typically does not lead to death.
Drug treatment is effective, but results for some complications may not be evident for a long period of time. For example, drug treatment for fistulas may take 3 to 6 months. For many individuals, surgery brings symptomatic relief that lasts from 5 to 15 years. |
Source: Medical Disability Advisor
| Inflammation can lead to narrowing (stricture) and blocking (obstruction) of the intestines; the development of abnormal passageways (fistulas) leading from the intestine to another part of the body such as the skin, bladder, vagina, or another portion of the intestine; and areas of infection (abscesses). Repeated excision of obstructed segments of intestine can lead to short bowel syndrome, which exaggerates the symptoms of diarrhea, weight loss, and malnutrition.
Although uncommon, bleeding from inflamed areas may develop into severe hemorrhage. Inflammation and diarrhea make it difficult to absorb nutrients through the wall of the small intestine, possibly leading to a state of malnutrition. The colon may expand and develop into a condition known as toxic megacolon.
Individuals with Crohn's disease may develop other disorders outside the gastrointestinal tract, such as arthritis, skin problems, eye and mouth inflammation, kidney stones, gallstones, and liver disease. Crohn's disease increases the risk of colon cancer, a development that significantly influences the severity of the disease.
The long-term use of corticosteroids to reduce inflammation of the bowel may cause osteoporosis, cataracts, diabetes, hypertension, and aseptic necrosis of the hip. |
Source: Medical Disability Advisor
| Flexible and private lavatory access may be needed, particularly during periods of exacerbation. Severe attacks may require a lighter work assignment or time off for recovery or hospitalization. If surgery is performed, individuals may need to be restricted from heavy lifting for a short period. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual, or individual's family, have a history of Crohn's disease?
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Does individual complain of intermittent periods of fever, diarrhea, pain in the lower right abdomen, fatigue, and/or weight loss?
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Has individual experienced symptoms outside the digestive tract (extraintestinal), such as pain, swelling, and tenderness in the joints?
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Does individual complain of sores in the mouth and an inflamed tongue?
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Were barium contrast x-rays taken of the intestine?
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Was endoscopy of the small intestine (esophagogastroduodenoscopy) or colon (colonoscopy) done?
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Was a tissue sample (biopsy) of the intestine taken to confirm the diagnosis?
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Was a complete blood count (CBC) done to rule out anemia and infection?
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Was an erythrocyte sedimentation rate (ESR) done to verify an active inflammation?
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Were blood chemistries done to determine if electrolytes are low due to diarrhea?
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Were vitamin B12 and folate levels tested to determine if the individual has a malabsorption problem?
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Was a stool sample tested for unseen (occult) blood? Has the diagnosis been confirmed?
Regarding treatment:
- Is individual on a diet that is adequate in calories, vitamins, and protein?
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Is individual compliant with the diet and supplement regimens?
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If the disease is advanced, is the individual receiving nutritional supplementation, such as enteral therapy or total parenteral nutrition (TPN)?
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Is individual taking anti-inflammatory medication? Has the individual responded to the medication?
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If individual has not responded to anti-inflammatory drugs, does individual require immunosuppressive drugs?
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If individual is anemic or has pernicious anemia, are iron or vitamin B12 being taken, respectively?
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Does individual require surgery to remove part or all of the colon (partial or total colectomy, respectively)?
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Was a temporary or permanent passageway surgically created through which waste materials can be emptied (colostomy)?
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Would individual benefit from psychotherapy and/or participation in a support group to cope with the illness?
Regarding prognosis:
- Has individual experienced short- or long-term adverse effects from the medication?
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Is individual malnourished, prolonging recovery?
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Did individual require surgery to alleviate symptoms of the disease? If so, what surgery was required? Were there any postsurgical complications?
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Has individual experienced narrowing (stricture) or blocking (obstruction) of the intestines?
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Have abnormal passageways (fistulas) developed from the intestine to another part of the body, such as the skin, bladder, or vagina?
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Source: Medical Disability Advisor
| "Introduction to Crohn's Disease." Crohn's & Colitis Foundation of America. 21 Dec. 2004 <http://www.ccfa.org/research/info/aboutcd>. |
Source: Medical Disability Advisor
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