CONDITIONS

What Is Crohn’s Disease

According to the Crohn’s & Colitis Foundation of America, about 700,000 Americans have Crohn’s disease. Since 1992, there has been a 74% rise in medical visits due to Crohn’s, and in 2004, the condition resulted in 57,000 hospitalizations.

Crohn’s disease causes inflammation to the lining of the digestive tract; though it is typically found in the intestines, Crohn’s inflammation can be found anywhere in the digestive tract from the mouth to the anus. Inflammation can cause scarring and permanent damage to the digestive tract, and often results in diarrhea, intense abdominal cramps, fever, and fatigue. Crohn’s disease symptoms may appear in flare-ups of varying intensity.

According to guidelines for Crohn’s disease management outlined by the Cleveland Clinic, the degrees of flare up severity are:

  • Mild to moderate– Individuals can tolerate oral intake without dehydration, high fever, abdominal pain, abdominal mass or obstruction.
  • Moderate to severe– Individuals are unresponsive to treatments for mild to moderate flare-ups and/or experience fevers, weight loss, nausea, vomiting, anemia, and abdominal pain without obstruction.
  • Severe or fulminate – Individuals experience persistent symptoms despite all treatment attempts or experience high fever, persistent vomiting, severe abdominal pain, severe weight loss/muscle loss, abdominal obstruction or abscesses (a collection of infected tissue and fluid within the gastrointestinal tract)

In addition to being categorized by degree of intensity, cases of Crohn’s diseases are categorized by location of inflammation and pattern of inflammation.

According to the Crohn’s and Colitis Foundation of America, there are 5 categorizations of Crohn’s disease based on inflammation location:

  • Ileocolitis, the most common form of Crohn’s, which affects the end of the small intestine (known as the ileum) and the colon (large intestine).
  • Ileitis, which affects only the ileum.
  • Gastroduodenal Crohn’s disease,which affects the stomach and the duodenum (the beginning of the small intestine).
  • Jejunoileitis, which affects areas of the last two segments of the small intestine (the jejunum and ileum).
  • Crohn’s (granulomatous) colitis, which affects only the colon.

Crohn’s disease can also present itself in three patterns:

  • Inflammatory. This pattern is typical in early stages of the disease, and is characterized by inflammation of the intestinal wall.
  • Fibrostenotic. This pattern is seen later on in the disease, when continuous inflammation has caused extensive scarring of the gastrointestinal tract. If scar tissue is thick enough, temporary or permanent intestinal obstruction may occur.

Perforating/Fistulizing. This is the most severe pattern, occurring when excessive inflammation has caused a perforation (hole) in the wall of the gastrointestinal tract. The perforation allows for the leakage of waste into the body cavity, which may result in fistulae, unordinary tubes/tissue connection that the body forms to allow for the drainage of waste. Among the most common fistulae are entero-vesical fistulae, in which waste passes from the intestine to the bladder, entero-vaginal fistulae, in which waste passes from the intestine through the vagina, and entero-enteric fistulae, in which waste passes from one section of the intestine to another.

Changes in Crohn’s Disease Management Outlook

There have been tremendous advances in treatment options for Crohn’s disease, especially in the last 10 years and has opened up new successful approaches to management and treatment of this disease.  Since symptoms and manifestation of Crohn’s disease can vary significantly from person to person, with symptoms ranging from no symptoms at all to diarrhea, to bleeding and pain—treatment is very tailored to the individual.  Scientific advances have resulted in a much more promising, predictable, and nuanced condition management. Research has uncovered important genetic and environmental causes of this disease—and the Food and Drug Administration, or FDA, has approved four additional therapies that have had a big impact on the treatment of Crohn’s. Outcomes for treatment have improved greatly, especially for those that suffer from more considerable inflammation and bowel involvement, or possible malnutrition, which can lead to delayed growth and development. Ability to monitor progress and efficacy of therapeutic choices has allowed us to enter a new era of positive outcomes and disease control.

Symptom managements was the old approach to Crohn’s treatment—this has changed to a goal of achieving both disease control and healing of the bowel. Those living with Crohn’s can now expect to live with very good condition control, allowing for them to plan their lives as they otherwise would, with normal life expectancy,

What Causes Crohn’s Disease

Though there is not yet a definitive cause of Crohn’s disease, recent research suggests that it is caused by an immune response to the body’s natural digestive bacteria, which may be triggered by a combination of environmental factors and genetic disposition.

A healthy gastrointestinal (GI) tract is lined with a mucosal membrane filled with bacteria that assist in digestion, absorption, and even normal immune system functioning. It is believed that in individuals with Crohn’s disease, there is an abnormal immune response against the gut bacteria, interfering with their ability to aid in digestion and compromising the integrity of the protective mucus membrane in which they exist. The immune response attracts immune cells to the affected area in the gastrointestinal tract, causing chronic inflammation and potentially permanent damage to the tissue of the affected areas. Research has shown that this may be caused by a genetic mutation that decreases the natural defense mechanisms of the bacteria or by a genetic pre-disposition to autoimmune diseases.

Risk Factors For Crohn’s Disease

There are several risk factors known to contribute to the likelihood of developing Crohn’s disease. These include:

  • Age. Crohn’s can occur at any age, but most people are diagnosed between the ages of 15 and 30.
  • Ethnicity. The risk is higher for Caucasians, specifically those of Eastern European (Ashkenazi) Jewish descent.
  • Family history. You’re at higher risk if you have a close relative with the disease. About 20% of Crohn’s disease patients have a parent, sibling or child with the disease.
  • Smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. While smoking is not the cause of Crohn’s disease, it does increase your chances of severe flare-ups if you do develop the disease. Studies have shown that non-smokers or quitters are 65% less likely to have flare ups than smokers.
  • Geography. For unknown reasons, if you live in an urban area or in an industrialized country, you’re more likely to develop Crohn’s disease. People living in northern climates also appear to have a greater risk.
  • Genetics. Studies have shown that mutations in the NOD2/CARD15 gene and the ATG16L1 genes are associated with Crohn’s disease. Both genes are involved in the functioning of bodily defense mechanisms.

Diagnosing Crohn’s Disease

There is no single test to diagnose Crohn’s disease. To make a diagnosis, doctors most commonly rely on a combination of diagnostic tests, including:

  • Physical examination. The doctor will check for pain in the abdominal area that may be a sign of Crohn’s disease and any other physical abnormalities that could point to other conditions.
  • Medical history. A medical history is important for the doctor to learn about the patient’s past and recent medical activity. Family history of GI disease, recent travel, and current or recent medication use are all crucial for the doctor to know during the diagnosis process
  • Blood tests. A complete blood count (CBC) can detect anemia (low red blood cell count) or a high white blood cell count (a sign of inflammation or infection).
  • Stool tests. Stool tests will not necessarily signal Crohn’s disease, however they can rule out other causes of gastrointestinal (GI) symptoms, such as bacterial or parasitic infection.
  • Flexible sigmoidoscopy, colonoscopy, and endoscopy are useful to determine the location and severity of GI inflammation. In these procedures, doctors use a small camera mounted on a flexible tube inserted through the mouth or anus to see the inside surfaces of the GI.
  • Computerized tomography (CT) scan uses a combination of x-rays and computer technology to create three-dimensional (3-D) images of the digestive tract.
  • Capsule Endoscopy. New technology allows patients to swallow a pill with an embedded camera that takes footage throughout the digestive process, revealing any inflammation or abnormalities. This method of endoscopy is less favorable for patients with moderate to severe Crohn’s disease, as there is a greater risk that the pill will become lodged within the scar tissue of the intestine, requiring surgical removal.

Symptoms of Crohn’s Disease

The symptoms of Crohn’s disease vary in severity and can be different based on where the inflammation is located in the GI tract.

The main symptoms of Crohn’s are:

  • Abdominal pain, often described as intermittent cramping, is one of the most common symptoms of Crohn’s as it can occur in all locations, patterns, and degrees of severity.
  • Diarrhea
  • Loss of appetite
  • Fever
  • Weight loss
  • Anemia
  • Fatigue
  • Perianal lesions (areas of damaged tissues around the anus)
  • Rectal bleeding (either due to a damaged color or anal fissures, small tears in anal tissues). Rectal bleeding may come and go.

 

Prognosis

The prognosis for Crohn’s disease varies from case to case. Some people experience only one episode (flare-up), and others suffer continuously. Up to 20 percent of patients experience chronic Crohn’s disease. In rare cases, disease-free periods last for years or decades. Although Crohn’s cannot be cured even with surgery, treatments are available that can offer significant help to most patients. Crohn’s disease is rarely a direct cause of death, and most people can have a normal lifespan with this condition.

Living With Crohn’s Disease

Living with Crohn’s disease can be stressful. Developing strategies to help you cope with your disease can make life easier. Here are some tips:

  • Maintain a well-balanced, nutritious diet in the interest of overall good health.
  • Find out where the restrooms are in restaurants, shopping areas, theaters, and on public transportation so you’ll be prepared in case you have the urge to have a bowel movement.
  • Speak with your doctor before extended travel. Travel plans should include a long-term supply of your medication, its generic name in case you run out or lose it, and the names of doctors in the area you will be visiting.
  • Try to go about your daily life as normally as possible, pursuing activities as you did before your diagnosis.  By doing so, you will be more likely to maintain a positive attitude about living with your condition.
  • Develop a network of family and friends to help you manage your disease, and consider joining a support group.
  • Follow your doctor’s instructions about taking medication even when you are feeling perfectly well.
  • Try relaxation techniques such as deep breathing, keeping a gratitude journal, or mindfulness meditation. These can all help make your symptoms seem less onerous.

Screening

Because Crohn’s disease is relatively rare—about 700,000 Americans have this condition—and unless symptoms of Crohn’s present themselves early on, screening is not regularly done for the disease. If you experience any of the symptoms of Crohn’s disease, schedule a visit with your doctor. He or she will be able to conduct several diagnostic tests to see if your symptoms are indeed a result of Crohn’s.

You can’t prevent Crohn’s disease since its cause is not known. To learn about what might make you a higher risk for Crohn’s disease, read about its risk factors. 

Prevention

You can’t prevent Crohn’s disease since its cause is not known. To learn about what places you at a higher risk for Crohn’s disease, read about its risk factors. [NOTE: hyperlink to risk factors section]

Medication And Treatment

A combination of treatment options can help you keep your Crohn’s under control, and help you lead a full and rewarding life. While there is no one standard treatment for Crohn’s, your doctor will work with you to find the right course of therapies for your particular case. Treatment for Crohn’s can include:

  • Medication
  • Alterations in diet and nutrition
  • Surgical procedures to repair or remove affected portions of your intestinal tract


MEDICATION

Medication treating Crohn’s disease is designed to suppress your immune system’s abnormal inflammatory response that is causing your symptoms. Suppressing inflammation not only offers relief from common symptoms like fever, diarrhea, and pain, it also allows your intestinal tissues to heal.

In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare-ups (maintaining remission). With proper treatment over time, periods of remission can be extended and periods of symptom flare-ups can be reduced.

Several types of medication are being used to treat Crohn’s disease today. Some over-the-counter medications may help relieve symptoms of Crohn’s, but always speak with your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:

  • Anti-diarrheals.A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective. Anti-diarrheals should only be used after discussion with your doctor.
  • Pain relievers.For mild pain relief, your doctor may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, like ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve, Anaprox). These drugs are likely to make your symptoms worse, and can therefore negatively impact disease outcomes.
  • Iron supplements. Chronic intestinal bleeding may lead to iron deficiency anemia, if this is the case, you may need to take iron supplements.

Medications for mild to moderate Crohn’s:

Antibiotics. There is some evidence suggesting that antibiotics like metronidazole, ciproflaxin, and flagyll may be helpful in treating mild to moderate cases of Crohn’s disease. Metronidazole is the most extensively studied antibiotic in IBD (irritable bowel disease, which is a category of diseases affecting the bowel that includes Crohn’s disease). As a primary therapy for active Crohn’s, this drug has been shown to be superior to placebo (sugar pill) and equal to sulfasalazine—especially when the illness affects the colon. Antibiotics can help stop infections and heal abscesses and fistulas that happen because of Crohn’s disease.

       Side effects of use of antibiotics for Crohn’s treatment may include:

  • Metronidazole: Chronic use of metronidazole in doses higher than 1 gram daily can be associated with permanent nerve damage (peripheral neuropathy). Early symptoms of peripheral neuropathy are numbness and tingling in the fingertips, toes, and other parts of the extremities. Patients taking this medication need to avoid alcohol as the combination of the two can cause headache, cramping, vomiting, severe nausea, and more. Other side effects of metronidazole include nausea, headaches,loss of appetite, a metallic taste, and, rarely, a rash.
  • Ciprofloxacin: Side effects may include headaches, nausea, vomiting, diarrhea, abdominal pain, rash, and restlessness, all of which are rare.

5-Aminosalicylates (5-ASAs). 5-ASAs are a class of anti-inflammatory drugs that are thought to work as a topical anti-inflammatory for the GI tract. 5-aminosalicylic acid (5-ASA), is also called mesalamine. 5-ASA can be effective in treating Crohn’s disease and ulcerative colitis, which is the other condition included in the category of IBD. if the drug can be delivered topically onto the inflamed intestinal lining. For example, mesalamine (Rowasa) is an enema containing 5-ASA that is effective in treating inflammation in the rectum. However, the enema solution cannot reach high enough to treat inflammation in the upper colon and the small intestine.

      Side effects of 5-Aminosalicyclates may include:

  • This class of medications has a few side effects which may include nausea,heartburn, headache, anemia, skin rashes, and, in rare instances, hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count. The reduction in sperm count is reversible, and the count usually becomes normal after the sulfasalazine is discontinued or changed to a different 5- ASA compound. They can have a burdensome pill count (anywhere from 4-12 each day.

Common 5-ASAs include:

  • Sulfasalazine (Azufadine), which is one of the longest running drugs on the market for treating irritable bowel disorders. Though it has been used for decades, about 1 in 3 people are unable to sustain sulfasalazine use long-term due to severe side effects. The majority of people who react to sulfasalazine can, however, tolerate the other 5-ASAs, like: Asacol; Asacol HD; Apriso; Lialda

Patients taking 5-ASAs should have regular blood and liver tests to check for potential low cell count and liver complications. Side effects may include abdominal pain, headache, dizziness, and nausea.


Medications for moderate to severe Crohn’s:

Corticosteroids. Have been used for many years to treat patients with moderate to severe Crohn’s disease and ulcerative colitis and to treat patients who fail to respond to 5-ASA. Unlike 5-ASA, corticosteroids do not require direct contact with the inflamed intestinal tissues to be effective. Corticosteroids are anti-inflammatory and immunosuppressant, meaning that they reduce inflammation and work to suppress the immune system. When antibiotics and 5-ASAs fail to treat Crohn’s symptoms successfully, corticosteroids are the next-in-line drug. Corticosteroids are faster-acting than 5-ASA, and patients frequently experience improvement in their symptoms within days of beginning them. Corticosteroids, however, do not appear to be useful in maintaining remission in Crohn’s disease and ulcerative colitis or in preventing the return of Crohn’s disease after surgery. Corticosteroids may be administered in pill form, by intravenous drip (IV), as an enema, or as a rectal suppository. Caution should be used in their prescription because of the risk of the body becoming steroid-dependent.

These include:

Prednisone is one of the most commonly prescribed steroids, and is known to cause remissions in 70-80% of patients. It is not effective for long-term treatment.

      Specific side effects of Prednisone may include:

  • osteoporosis, diabetes, depression, high blood pressure, and adrenal conditions. As well, headaches, nausea, vomiting, diarrhea, abdominal pain, rash, and restlessness, all of which are rare.

Budesonide is another corticosteroid that was created with the goal of having fewer side effects than prednisone and other corticosteroids. Instead of travelling throughout the whole body, budesonide is released only in the end of the small intestine and ascending colon, limiting its affects to those areas. This prevents more widespread side effects, but limits its use to only patients who have Crohn’s inflammation in those areas.

      Side effects of budesonide may include:

  • headache, dizziness, and nausea.

The frequency and severity of side effects of corticosteroids depend on the dose and duration of their use. Short courses of corticosteroids, for example, usually are well tolerated with few and mild side effects. Long-term use of high doses of corticosteroids usually produces predictable and potentially serious side effects. Children need to be especially careful with use of corticosteroids as they can stunt growth.

      Common side effects of corticosteroids in general include:

  • Rounding of the face, sometimes referred to as “moon face”
  • Acne
  • Growth of excess body hair
  • Weight gain
  • Weakened muscles
  • High blood pressure
  • Diabetes
  • Cataracts
  • Glaucoma
  • Irritability and increased mood swings
  • Depression
  • Osteopenia or osteoporosis—a thinning of the bones that can lead to increased risk of fracture

Prolonged use of corticosteroids can cause adrenal insufficiency, a condition where the adrenal glands are not able to produce as much cortisol—necessary for proper functioning of the body. Cortisol helps the body manage stress, infections and other functions. Symptoms of adrenal insufficiency include nausea, vomiting, and even shock. Withdrawing corticosteroids too quickly also can produce symptoms of fever, fatigue, and joint pain.  Therefore, when corticosteroids are discontinued, the dose usually is tapered gradually rather than stopped abruptly. It is important to note that even after stopping corticosteroid use, the adrenal glands may continue to be produce less cortisol, which can last for several months up to two years.

Long-term use of corticosteroids can lead to osteopenia or osteoporosis—therefore increasing dietary calcium, along with a calcium supplement is important. It is also important to do regular weight-bearing exercise and not smoke.

Corticosteroids, while very effective, have predictable and potentially serious side effects, and should be used for the shortest possible length of time.

Immunosuppressants, also called immunomodulators or immune modifiers, are medications that affect the immune system—the body’s defense against harmful viruses, bacteria and other foreign invaders. When the immune system is activated, it causes inflammation where the activation occurs—part of the defensive response. Normally, activation only occurs when the body is exposed to foreign invaders, but in patients with Crohn’s, the immune system goes into over-drive and is chronically activated even when there is not invader. This class of drugs works to block actions in the immune system that are involved with the inflammatory response. Immunosuppresants work to decrease inflammation by reducing the number of immune cells—this can increase risk of infection, but can have great benefit in controlling moderate to severe Crohn’s.

Common immunosuppressants include:

  • Azathioprine (AZA). AZA is taken orally, and typically takes 6 to 12 weeks to take full effect. 2 out of 3 patients experience relief from Crohn’s flare-ups. With limited side effects, AZA is an effective treatment, though it can put patients at higher risk of infection and lymphoma; and 2% may be allergic. Regular blood tests can help detect any potentially serious side effects.
  • Methotrexate (MTX). MTX is administered via weekly injection, and typically takes around 6 weeks to take effect. Like AZA, MTX is successful in preventing Crohn’s flare-ups in 2 out of 3 patients. Patients taking MTX should undergo regular blood testing to monitor potential side effects like low cell counts or liver damage. It is recommended to take a folic acid supplement when undergoing treatment with MTX as it can deplete essential fatty acid. MTX should NOT be taken by pregnant women or those looking to conceive.

Medications for severe or fulminate Crohn’s:

Anti-tumor necrosis factor-alpha (Anti-TNF-α). This type of drug works by using antibodies targeted at TNF-α, an inflammatory protein that has been found in high levels in Crohn’s disease patients, and decreases inflammation by blocking tumor necrosis factor (TNF-alpha). 1 out of 3 patients report symptom improvement within the first two doses, around 2-3 weeks. 30-50% of patients continue their success past the one-year mark, and 30-50% will need to change their medication or anti-TNF-α dosage at some point during their therapy. Anti-TNF factors put patients at a slightly higher risk of serious heart disease, autoimmune conditions, and liver disease.

  • Infliximab is used in cases of severe Crohn’s disease, where symptoms do not respond to any other therapies. While effective, it can lose efficacy over time. Given through an IV, for a two to three hour session, and is given again two to six weeks later. After the first three doses, infliximab is given every 8 weeks. It has proven to be very effective, though it can lose its effectiveness over time in some patients. Infliximab is given via an intravenous drip (IV) during a two to three hour session. Follow up doses are given two and six weeks later. Following the initial 3 doses, the medication is administered every 8 weeks. In August 1998 the United States Food and Drug Administration approved the use of infliximab for the short-term treatment of moderate to severe Crohn’s disease, for patients that fail to respond to other treatments.
  • Adalamumab (Humira). Adalamumab is used in cases of severe Crohn’s disease, where symptoms do not respond to any other therapies, or in cases where patients have lost responsiveness to Infliximab. Adalamumab is given in a single injection every other week, after an initial four injections in the first week of treatment. Two injections are then given in week 3. It has proven to be very effective, though it can lose its effectiveness over time in some patients—which may be partly mitigated by upping dosage to weekly injections. Adalimumab is comparable to infliximab in effectiveness and safety for inducing and maintaining remission in patients suffering from Crohn’s disease. Adalimumab generally is well tolerated.
  • Certolizumab pegol (Cimzia). Certolizumab pegol is a prolonged effect anti TNF agent, and only needs to be administered once monthly by a healthcare professional, often done at a doctor’s office.
  • Natalizumab (Tysabri). Natalizumab was originally created as a treatment for multiple sclerosis, but was found to be effective in treating Crohn’s disease in 2008.

      Specific side effects of Adalamumab may include:

  • The most common side effect is skin reactions at the site of injection with swelling,itching, or redness. Other common side effects include upper respiratory infections, sinusitis, and nausea. The Food and Drug Administration approved Humira (adalimumab) in February 2007, to treat adult patients with moderately to severely active Crohn’s disease. Adalimumab (Humira) is administered subcutaneously every two weeks.

       Specific side effects of natalizumab may include:

  • A significant risk to use of this drug for Crohn’s is risk of developing progressive multifocal leukoencephalopathy, or PML, a potentially deadly brain infection. Risk of developing PML is 1 in 1,000. The good news is that doctors are better able to control the risk of PML today than when the drug was first introduced.


DIET & NUTRITION

While Crohn’s Disease may not be the result of bad reactions to specific foods, paying special attention to your diet may help reduce symptoms, replace lost nutrients, and promote healing.

For people diagnosed with Crohn’s disease, it is essential to maintain good nutrition because Crohn’s often reduces your appetite while increasing your body’s energy needs. Additionally, common Crohn’s symptoms like diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals.

Many people who experience Crohn’s disease flare-ups find that soft, bland foods cause less discomfort than spicy or high-fiber foods. While your diet can remain flexible and should include a variety of foods from all food groups, your doctor will likely recommend restricting your intake of dairy if you are found to be lactose-intolerant.

Diet and Nutritional Therapy for Crohn’s:

Nutritional therapy is a crucial part of Crohn’s treatment—especially in children—because inflammation of the intestines can impede absorption of nutrients, and can cause deficiencies. The Crohn’s and Colitis Foundation of America states that supplements like vitamins and minerals should be used only in addition to conventional medical treatment. Registered nutritionists or dietitians can help you put together a diet and supplement plan that ensures proper nutrition and improves digestive symptoms.

In certain cases, it may be recommended that you go on a special diet given via feeding tube, or have nutrients directly injected into your body to treat a particularly severe case of Crohn’s. This can improve health by allowing the bowel to rest and heal. This is also sometimes done prior to surgery or when other medications fail to control symptoms.

If you have a narrowed bowel, also known as a stricture, your doctor may suggest a low-fiber (sometimes called a low-residue diet) diet to reduce risk of intestinal blockage by reducing size and number of your stools.

Vitamin and mineral deficiencies are among the most common nutritional deficits that Crohn’s patients suffer. Your doctor or dietitian many recommend the following supplements:

  • Vitamin B-12. Vitamin B-12 is essential to brain and nervous function, and can naturally be found in eggs, fish such as salmon, beef, shellfish, liver, and fortified soy and dairy products. Sometimes B12 injections are administered if blood work shows a deficiency. Vegetarians and vegans must pay closer attention to B12 deficiency.
  • Vitamin D. Vitamin D is essential for good bone formation and for the metabolism of calcium, and deficiency can be common in those with Crohn’s disease.
  • Calcium. Calcium helps fortify bones and promotes healthy muscle and nerve function, certain Crohn’s medications can also negatively impact bone health, particularly with long-term corticosteroid use.
  • Iron. Iron is essential to energy and well-being, as well as protein production in the body. Lack of iron can lead to anemia, which can cause fatigue. Iron is found in beef, fish, poultry, pumpkin seeds, spinach, cooked beans, tofu, and wheat germ among many other foods. Iron deficiency can result from blood loss following intestinal inflammation and ulceration typical of Crohn’s
  • Probiotic supplement. Probiotics help replenish healthy bacteria, because of the inflammation associated with Crohn’s disease; the population of healthy gut bacteria is often decreased. Lactobacillus and bifid bacteria are the most common types of bacteria found in probiotic supplements.

In addition to recommending the proper supplements, your dietitian will be able to help you build a diet plan that avoids foods that exacerbate your Crohn’s symptoms. Typical inflammatory foods that you may want to avoid include:

  • Alcoholic beverages (including mixed drinks, wine and beer)
  • Foods high in fat such as butter, oil, mayonnaise, and fried foods
  • Caffeinated beverages (including coffee, tea, energy drinks)
  • Chocolate
  • Spicy foods
  • Raw fruits and vegetables
  • Foods high in fiber such as whole grains and beans
  • Nuts, nut butters, and seeds

Nutritional therapy can be a critical part of treatment no matter what stage of your condition is in. Make sure that your doctor and dietitian are in communication about what supplements you are taking in order to avoid medication interference.



SURGERY

Even with proper medication and diet, as many as two-thirds to three-quarters of people with Crohn’s disease will require surgery at some point during their lives. While surgery does not cure Crohn’s disease, it can conserve portions of your GI tract and return you to the best possible quality of life.

Surgery becomes necessary when medications can no longer control symptoms, or if you develop a fistula, fissure, or intestinal obstruction. Surgery often involves removal of the diseased segment of bowel (resection); the two ends of healthy bowel are then joined together (anastomosis). While these procedures may cause your symptoms to disappear for many years, Crohn’s frequently recurs later in life.

Crohn’s surgical procedures:

Your doctor may recommend surgery if other forms of therapy if symptoms have not responded to medications, diet and lifestyle modifications, and other therapies. Up to one-half of individuals with Crohn’s disease will require at least one surgery—but it is important to note that surgery does not cure Crohn’s disease.

During surgery, your surgeon may:

  • Perform a strictureplasty—a common procedure for Crohn’s disease that widens a segment of the intestine that has become too narrow.
  • Bowel resection—this procedure involves removing a damaged portion of your digestive tract, and then reconnecting the healthy sections. This is usually successful in reducing symptoms almost immediately; however 50% of patients see symptoms return within 5 years, and 20% will require additional surgeries within 10 years.
  • Proctocolectomy and Ostomy. Used only in the most severe Crohn’s disease cases where the entire colon is affected, a proctocolectomy, or total removal of the colon, may be necessary. After the colon is removed, surgeons redirect waste through the small intestine to a hole in the abdominal wall known as a stoma. Waste then collects in a bag outside of the body, called a colostomy bag, which needs to be emptied several times a day. This is a major surgery that has life-changing implications, but is shown to effectively eliminate all Crohn’s disease symptoms in cases where inflammation was limited to the colon.
  • Surgery may also be used to close fistulas and drain abscesses.

The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. Following surgery with medication can help minimize risk of recurrence.

Complementary and Alternative Treatment

Certain mind – body practices have been shown to reduce stress in some patients with Crohn’s disease, which may help control the severity of symptoms. These practices include:

  • Meditation. The practice of intense focus taught through meditation can help alleviate stress and anxiety that may worsen Crohn’s symptoms.
  • Hypnosis. In a small, 15 person clinical trial of hypnosis treatments for Crohn’s disease, 80% of patients reported an improved quality of life after treatment and 60% were able to reduce medication dosage.
  • Tai Chi. Tai chi is a form of martial arts that focuses on strengthening the mind/body connection in order to reduce stress and anxiety.
  • Biofeedback. Biofeedback is a technique that aims to train the mind to influence the central nervous system in functions like heart rate, muscle tension, and blood pressure in order to reduce stress and anxiety. In biofeedback sessions, electrodes track bodily processes (i.e. heartbeat or body temperature) with
  • Yoga. The meditative qualities of Yoga help it to reduce stress and calm nerves.

Care Guide

Crohn’s disease doesn’t just affect you physically—it can take a real emotional and psychological toll too. If your condition is severe, it’s likely that your life may revolve around a constant need to be near the toilet, and even symptoms, like gas and abdominal pain can make it challenging to be in public. All of these factors may lead to anxiety and depression, but here ere are some things you can do to help:

  • Work closely with your doctor to determine the types of treatment that are best for you.
  • Keep appointments for regular checkups even if you are not having symptoms.
  • Learn more about your condition. One of the best ways to be more in control is to find out as much as possible about Crohn’s disease
  • Join a support group. Support groups can provide valuable emotional support, community, and information about your condition. It can be reassuring to be with others that are living with Crohn’s, and to learn about how they manage their symptoms and daily lives. An added benefit is that group members are often in-the-know about the latest medical treatments or integrative therapies.
  • Talk to a therapist. Some people find it helpful to consult a mental health professional who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause.
  • Keep a food journal. You may find it helpful to avoid certain foods for a while. Depending on your condition, these may include caffeine (coffee, tea, and cola), spicy foods, milk products, and raw fruits and vegetables.
  • Try eating several small meals a day instead of 3 large ones.
  • Take your medications exactly as directed and let your doctor know if you are having uncomfortable side effects.

Living with Crohn’s disease can be challenging, but research is ongoing and treatment options keep improving!

When To Contact A Doctor

Call your doctor right away if you have been diagnosed with Crohn’s Disease and you are experiencing:

  • Severe pain or bloating in your abdomen after meals
  • Sores in your mouth
  • Sores in your anal area (around your rectum)
  • Fever above 101.0F (38.3C) or chills
  • Poor appetite or weight loss
  • Bloody diarrhea
  • Nausea or vomiting
  • Skin rashes or skin that weeps (oozes liquid)

Find a Doctor

Based on your symptoms, your primary doctor will refer you to a gastroenterologist. This is a doctor who specializes in digestive disorders. If your condition requires surgery, you will be seen by a surgeon. A nutritionist or dietician can help with a dietary plan. Be sure to ask your dietitian if he or she has previous experience treating patients with Crohn’s disease before you begin consultation.

To find a gastroenterologist or surgeon in your area, visit our doctor directory. You can also look at:

To find a registered dietitian, visit the website of the American Academy of Nutrition and Dietetics.

Questions For A Doctor

If you’ve been diagnosed with Crohn’s here is a list of questions you might want to bring along on your follow-up visit with your doctor:

  • Could any condition other than my disease be causing my symptoms?
  • What tests do I need to have to get to the root of my symptoms?
  • Should I have these tests during the time of a flare-up or on a routine basis?
  • How will I know if my medication needs to be adjusted?
  • Approximately how long should it take to see some results, or to find out that this may not be the right medication for me?
  • What are the side effects of the medication? What should I do if I notice them?
  • What should I do if the symptoms return? What symptoms are considered an emergency?
  • If I cannot schedule a visit right away, are there any over-the-counter medication options that can assist with my prescribed medication? If so, which ones?
  • Should I change my diet or take nutritional supplements? If so, can you recommend a dietitian or any specific nutritional supplements?
  • Do I need to make any other lifestyle changes?

Resources

World Crohn’s and Colitis Day is May 23rd.

For the latest research information on autoimmune diseases including Crohn’s disease, visit the American Autoimmune Related Diseases Association.

For up-to-date information on digestive disorders, visit the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

For current studies on Crohn’s disease, visit the National Institute of Diabetes, Digestive & Kidney Diseases.

For the contact information of doctors who specialize in digestive disorders in your area as well as connections to support groups and online communities, visit the Crohn’s and Colitis Foundation of America.