is Crohn's disease?
Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal
(GI) tract. It affects the ileum (small intestine) and the
colon (large intestine) in most cases, but can occur in any
section of the GI tract from the mouth to the anus. Areas
of inflamed tissue are often separated by areas of normal
tissue. The large intestine is inflamed in 65% of the people
who have Crohn's disease. The small intestine is inflamed
in 35% of people with the disease. Crohn's disease generally
occurs in young adults.
does it occur?
The cause of Crohn's disease is unknown. In Crohn's disease,
the inflammation occurs in all the layers of the small or
large intestine as well as nearby tissues and lymph nodes.
The sores and swollen areas may thicken and eventually block
the intestines. The inflammation can cause holes and sores
in the bowel walls. Because the inflammation also affects
the outer intestinal walls, the loops of bowel may attach
to each other.
are the symptoms?
Symptoms of Crohn's disease include:
pain or cramping
fistula (abnormal opening at or near the anus)
fissure (a painful crack in the mucous membrane of the anus)
is it diagnosed?
To diagnose Crohn's disease, your doctor will review your
symptoms and examine you. The exam usually includes a sigmoidoscopy
or colonoscopy (a procedure in which the doctor uses a scope
to look at the inside of your intestine or colon). Often the
doctor will take a small piece of bowel tissue for testing.
The doctor may also want a sample of your stool (bowel movement)
for testing. Other tests may include a blood test and a barium
x-ray study to examine the colon and small bowel (particularly
the end section of the bowel). Computerized
axial tomography (CAT or CT) scanning is a computerized x-ray
technique that allows imaging of the entire abdomen and pelvis.
It can be especially helpful in detecting abscesses.
is it treated?
There is no cure for Crohn's disease. [SCD Editors' note:
wake up and check out the SCD]
The best treatment is frequent checkups with your doctor to
control the disease. The doctor will probably prescribe one
or more medications for you to take. If you have diarrhea,
avoid certain foods that have a laxative effect, such as raw
fruits and vegetables and concentrated fruit juices. You can
rest your bowel by not eating solid foods for a while. Drink
just clear fluids frequently during the day (electrolyte or
rehydrating fluids are best). It is important to drink often
so that you do not become dehydrated. When an attack of diarrhea
is over, eat small frequent meals. Return to your normal diet
gradually. Limit or avoid food additives and stimulants such
as caffeine (in coffee, tea, or chocolate). Avoid eating or
drinking milk products. Enzyme supplements may help if you
develop an intolerance to lactose (a sugar in dairy products).
Ask your doctor if you should reduce the amount of roughage
in your diet. If you have cramps or abdominal pain, it may
help to put a hot water bottle or electric heating pad (set
on low) on your abdomen. If your condition is more serious,
hospital treatment may include:
feeding (into a vein) to replace lost nutrients and fluids
transfusions to restore lost blood
of medications such as antibiotics and steroids to reduce
suction (through a tube passed through the nose to the stomach)
to drain out acidic digestive juices.
disease is not kept under control you may get sores, tears,
or abnormal openings in and around your intestines. In this
case you may need surgery.
is the front line for treating CD, drug treatments can include
one or more of the following:
Prednisone, medrol, methylprednisolone, hydrocortisone have
been used since the 1950's for acute flare ups. Patients should
take a calcium supplement to prevent osteoporosis.
Imodium and Lomotil can help to reduce some symptoms, great
care should be used to avoid blockage.
Asacol, Pentasa, Dipentum and Rowasa enema, deliver the 5-aminosalicylate
molecule which has anti-inflammatory properties to the intestine
wall. 5-ASA is a topical anti-inflammatory. 5-ASA are usually
Imuran, 6-MP, and Purinethol work by blocking the immune system
from causing inflammation, but may take up to six months before
being effective. Methotrexate may work quicker, but pregnancy
needs to be avoided if either partner has taken methotrexate
in the past three months.
Ciprofloxacin (Cipro), metronidazole (Flagyl), are used primarily
to fight intestinal infections that can lead to a flare, they
are also helpful in healing fistulas. RMAT (Rifabutin and
macrolide antibiotic therapy) treatment consists of clarithromycin
(Biaxin) and rifabutin (Mycobutin) plus a probiotic (good
bacteria). In limited studies the remission rate for RMAT
is around 70%. Any antibiotic treatment should be coupled
with a good probiotic.
or supplement: Probiotics, Omega 3, and certain herbs have
shown promise in the treatment of CD or the relief of the
symptoms. Please remember that herbs and supplements act with
in your body as drugs. It is important to inform your doctor
before attempting any herbal or supplement treatment.
antibody: Infliximab (Remicade) an anti-tumor necrosis factor.
This antibody blocks the production of tumor necrosis factor-alpha
(TNF-alpha). Studies show that TNF-alpha plays a role in inflammation.
The long term side effects have not been determined.
Normally reserved for strictures or blockages. The chances
of a recurrence of the disease after surgery is very high.
can I take care of myself?
It is important to follow your doctor's instructions. If your
symptoms persist or if you develop new symptoms, tell your
doctor. In addition, you can:
aware of the possibility of the symptoms coming back. Otherwise
a recurrence may make you feel discouraged, anxious, fearful,
a healthy, positive attitude.
to use relaxation techniques such as mental imaging, muscle
relaxation exercises, and deep breathing.
with a mental health professional about how to manage events
in your life that trigger anxiety.
a positive support system (family, friends) for talking
about the normal stresses of daily life.
a balanced, nutritious diet, but avoid raw fruits and vegetables
and milk products during a flare-up.
20 minutes at least three times a week.
enough rest even if you cannot sleep.
time each week for play and recreation.
the full course of treatment your doctor prescribes.
information you may also want to write or call:
Crohn's and Colitis Foundation of America 444 Park Avenue
New York, New York 10016 Phone: (212) 685-3440