Crohn’s Disease is a condition characterized by chronic inflammation of the small bowel (ileum) and part of the large bowel (colon). However, it may also affect any part of the gastrointestinal tract, including the mouth, stomach and the anus. This disease is one of the conditions that belongs to a group of Inflammatory Bowel Diseases, and is sometimes confused with another one of this kind, called ulcerative colitis, which only affects the colon.

Epidemiology of Crohn’s Disease

It is estimated that around 700,000 Americans may have Crohn’s disease. It may occur at any age, but it is more common among adolescents and young adults. Most people who have the disease have a close relative who also has it, but one’s risk is greater if both parents are affected. People of eastern European and African American descent are also more likely to develop the disease. Men and women are equally affected.

It is not clear what causes Crohn’s disease, but research suggests that hereditary, genetic, dietary, and environmental factors all contribute to its development. It is believed that the body’s immune response to otherwise harmless bacteria in the gastrointestinal tract causes an exaggerated attack that leads to chronic inflammation. This results in ulceration and the thickening of the walls of the intestines, which causes symptoms to occur.

Signs and Symptoms of Crohn’s Disease

Most of the symptoms of Crohn’s disease are similar to other conditions, and they may be mistaken for a bacterial infection of the gastrointestinal tract. These symptoms often vary from patient to patient, but they usually include:

• Abdominal cramps
• Chronic diarrhea
• Constipation
• Delayed growth and development
• Fatigue
• Feeling of incomplete evacuation
• Fever
• Irregular menstrual cycle
• Loss of appetite
• Night sweats
• Rectal bleeding
• Urgent need to defecate
• Weight Loss

Symptoms may come and go, and the condition is characterized by flares and remissions. But in severe cases, pain and bleeding can occur due to tears in the lining of the anus during bowel movements. A fistula (tunnel) that connects one loop of the intestine to another, or to the skin, bladder, or vagina, may also develop.

Diagnosis

There is no single test that can confirm the diagnosis, so a thorough evaluation of the patient’s history, physical examination and laboratory tests is necessary. Initial laboratory tests include blood and stool examination, as well as upper and lower gastrointestinal tract X-rays. Special exams may include endoscopic examinations and computed tomography (CT) or magnetic resonance imaging (MRI) scanning.

Treatment

The management for Crohn’s disease includes a combination of dietary changes, medication, and surgical procedures (if necessary).

Medications used to treat Crohn’s disease aim to suppress the immune system’s unusual inflammatory response to reduce symptoms, prevent flare ups, and allow healing of the intestinal tissues. These may include:

• Aminosalicylates like sulfasalazine, balsalazide, mesalamine, and olsalazine,  which are effective in treating mild-to-moderate episodes of the disease and in preventing relapses
• Corticosteroids like prednisone and methylprednisolone, which are used to treat moderate to severe episodes by suppressing the immune response.
• Immunomodulators, which regulate the immune system when aminosalicylates and corticosteroids are not effective.
• Antibiotics to treat infections
• Biologic Therapies, which utilize laboratory-made antibodies to stop certain body proteins from causing abnormal inflammation. These are used for people who do not respond well to conservative therapy.

Surgery may be necessary when medications cannot control symptoms, or if complications, such as a fistula or intestinal obstruction develops.

Medication

We use the following drugs for Crohn’s disease:

• REMICADE (infliximab)