Crohn's disease is a chronic
inflammatory process primarily involving the intestinal tract.
Although it may involve any part of the digestive tract from the
mouth to the anus, it most commonly affects the last part of the
small intestine (ileum) and/or the large intestine (colon and
rectum).
Crohn's disease is a chronic
condition and may recur at various times over a lifetime. Some
people have long periods of remission, sometimes for years, when
they are free of symptoms. There is no way to predict when a
remission may occur or when symptoms will return.
What are the
symptoms of Crohn's disease?
Because Crohn's disease can affect
any part of the intestine, symptoms may vary greatly from
patient to patient. Common symptoms include cramping, abdominal
pain, diarrhea, fever, weight loss, and bloating. Not all
patients experience all of these symptoms, and some may
experience none of them. Other symptoms may include anal pain or
drainage, skin lesions, rectal abscess, fissure, and joint pain
(arthritis).
Common Crohn's
symptoms:
Who does it
affect?
Any age group may be affected, but
the majority of patients are young adults between 16 and 40
years old. Crohn's disease occurs most commonly in people living
in northern climates. It affects men and women equally and
appears to be common in some families. About 20 percent of
people with Crohn's disease have a relative, most often a
brother or sister, and sometimes a parent or child, with some
form of inflammatory bowel disease.
Crohn's disease and a similar
condition called ulcerative colitis are often grouped together
as inflammatory bowel disease. The two diseases afflict an
estimated two million individuals in the U.S.
What causes
Crohn's disease?
The exact cause is not known.
However, current theories center on an immunologic (the body's
defense system) and/or bacterial cause. Crohn's disease is not
contagious, but it does have a slight genetic (inherited)
tendency. An x-ray study of the small intestine may be used to
diagnose Crohn's disease.
How is Crohn's
disease treated?
Initial treatment is almost always
with medication. There is no "cure" for Crohn's disease, but
medical therapy with one or more drugs provides a means to treat
early Crohn's disease and relieve its symptoms. The most common
drugs prescribed are corticosteroids, such as prednisone and
methylprednisolone, and various anti-inflammatory agents.
Other drugs occasionally used
include 6-mercaptopurine and azathioprine, which are
immunosuppressive. Metronidazole, an antibiotic with immune
system effects, is frequently helpful in patients with anal
disease.
In more advanced or complicated
cases of Crohn's disease, surgery may be recommended. Emergency
surgery is sometimes necessary when complications, such as a
perforation of the intestine, obstruction (blockage) of the
bowel, or significant bleeding occur with Crohn's disease. Other
less urgent indications for surgery may include abscess
formation, fistulas (abnormal communications from the
intestine), severe anal disease or persistence of the disease
despite appropriate drug treatment.
Not all patients with these or
other complications require surgery. This decision is best
reached through consultation with your gastroenterologist and
your colon and rectal surgeon.
Shouldn't
surgery for Crohn's disease be avoided at all costs?
While it is true that medical
treatment is preferred as the initial form of therapy, it is
important to realize that surgery is eventually required in up
to three-fourths of all patients with Crohn's. Many patients
have suffered unnecessarily due to a mistaken belief that
surgery for Crohn's disease is dangerous or that it inevitably
leads to complications.
Surgery is not "curative,"
although many patients never require additional operations. A
conservative approach is frequently taken, with a limited
resection of intestine (removal of the diseased portion of the
bowel) being the most common procedure.
Surgery often provides
effective long-term relief of symptoms and frequently limits or
eliminates the need for ongoing use of prescribed medications.
Surgical therapy is best conducted by a physician skilled and
experienced in the management of Crohn's disease.
