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Crohn Disease

by Robert S. Dinsmoor

A chronic condition that causes inflammation of the lining of the digestive tract, most commonly the small intestine and colon. A type of inflammatory bowel disease (the other major type is ulcerative colitis), Crohn disease can bring about abdominal pain and severe diarrhea and requires vigilant treatment to prevent serious complications.

Crohn disease tends to run in families. Up to 20% of people with Crohn disease have a relative with the condition or with another type of inflammatory bowel disease. It commonly develops in people between 20 and 30 years of age and is equally common in men and women. White people are at a greater risk for Crohn disease than are other populations, and people of Ashkenazi Jewish descent have a particularly high rate of Crohn disease.

Crohn disease is an autoimmune condition, in which the immune system malfunctions and attacks part of the body. Researchers theorize that in Crohn disease the immune system mistakes foods and naturally occurring bacteria in the digestive tract for “invaders.” It launches an attack on them, causing white blood cells to accumulate in the lining of the intestines and leading to swelling and damage.

The symptoms of Crohn disease can vary. In addition to abdominal pain and diarrhea, some people have rectal bleeding, which can cause low levels of red blood cells (anemia) and tiredness. People with Crohn disease may also lose weight and develop skin problems, fevers, and joint pain. Children with Crohn disease may grow and develop more slowly than other children.

Crohn disease can also cause a number of complications. If the intestinal wall swells from inflammation and scar tissue, the intestine can become blocked (this may require surgery to correct). Ulcers can cause tunnels called fistulas to form through the intestine, potentially allowing food to leave the digestive tract and creating pockets of infection known as abscesses. Fistulas can sometimes be treated with medicine, but other times surgery is needed. People with Crohn disease sometimes experience malnutrition because they are unable to eat much or are unable to properly absorb nutrients from their food. Crohn disease may also lead to swelling in the eyes or mouth, kidney stones, and gallstones. Some of these complications may be resolved with general treatment for Crohn disease, but others must be specifically targeted with additional medicines.

To diagnose Crohn disease, doctors take a detailed medical history and make a physical examination. Blood tests can uncover anemia or high levels of white blood cells, a sign of inflammation in the body. A stool sample may be used to detect bleeding and to rule out an infection. X-rays or magnetic resonance imaging (MRI) may be needed as well. In a test called an upper gastrointestinal (GI) series, a person drinks barium and then is given an x-ray. The barium looks white on x-ray film and helps the doctor see ulcers and other problems in the digestive tract.

Tests known as sigmoidoscopy and colonoscopy may be used to get a better look inside the intestines. In both tests, the doctor inserts a flexible tube into the intestines via the anus. At the end of the tube is a small camera whose images are relayed to a television screen, allowing the doctor to see any inflammation, ulcers, or bleeding in the intestines. The doctor may also take a biopsy, a sample of tissue, from the lining of the intestine and look at it under a microscope to confirm the diagnosis of Crohn disease.

Treatment of Crohn disease consists of drug treatment, nutritional therapy, and surgery and is usually overseen by a gastroenterologist. Many of the drug treatments for Crohn disease are similar to those for rheumatoid arthritis. Sulfasalazine (Azulfidine), mesalamine (Asacol, Rowasa), and corticosteroid drugs such as prednisone can all tamp down the inflammation of Crohn disease. Drugs that target the immune system, such as azathioprine (Imuran), mercaptopurine (Purinethol), and the biologic drugs infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia), are also used as treatments for Crohn disease. The immune-surpressing drugs methotrexate (Rheumatrex, Trexall) and cyclosporine (Neoral, Sandimmune) are sometimes prescribed when other medicines aren’t working. Finally, antibiotics, laxatives, antidiarrheals, and the pain reliever acetaminophen (Tylenol) may all be prescribed in some cases. However, pain relievers such as ibuprofen (Advil, Motrin) and aspirin should be avoided.

People with Crohn disease may have to avoid foods, such as hot spices, alcohol, greasy foods, and milk products, that can make pain and diarrhea worse. A doctor may prescribe a special diet to ensure that a person with Crohn disease gets enough of certain nutrients. High-calorie liquid supplements are sometimes used to provide extra calories and the right amount of vitamins and minerals. In severe cases, people with Crohn disease may be given food through a feeding tube or nutrients through an injection into a vein.

Last Reviewed on March 7, 2012

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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