Crohn's disease is a type of inflammatory bowel disease. It typically affects the terminal ileum (last portion of the small intestine) and colon (large intestine) but it can affect any part of the digestive tract from mouth to anus. The inflammation is transmural and affects all the layers of the intestinal wall. There are typical pathological features that distinguish Crohn's disease from other intestinal disorders. Patients often present with abdominal pain, fever, weight loss or diarrhea. Delayed growth and maturation can occur in children with inflammatory bowel disease. Rectal bleeding is less common. Perirectal involvement with fissures and abscesses are also a prominent feature of Crohn's disease. Extraintestinal manifestations (features of inflammatory bowel disease affecting areas outside of the intestine) include skin rashes, joint pains and inflammation, eye problems and sclerosing cholangitis (disorder of the bile ducts). Colon cancer is more common in patients with inflammatory bowel disease as compared to the general population. The development of colon cancer depends upon the extent of colonic involvement and the duration of the disease.
The diagnosis of Crohn's disease is established with x-rays and endoscopic procedures during which biopsies are taken from the intestinal lining. Gastroenterologists generally perform endoscopic procedures. Typical small intestinal x-ray findings that would suggest Crohn's disease are narrowing in the small intestine especially in the region of the terminal ileum and ulcerations of the intestine. A CT scan of the abdomen can diagnose abdominal abscesses and fluid collections that may also be associated with Crohn's disease. A colonoscopy (test where a tube with a light and a video camera is inserted into the rectum and advanced up the large intestine and sometimes to the terminal ileum) can directly visualize the intestinal lining. Inflammation, ulceration, masses and narrowing can be viewed and biopsied during the colonoscopy. Colonoscopy is the best way to define the extent of colonic involvement and the easiest way to obtain tissue for diagnosis. The pathologist who reviews these biopsies can determine if the typical features of Crohn's disease are present and thus confirm the diagnosis with a high degree of certainty.
Once Crohn's disease is diagnosed several treatment options are available. These include medications, nutritional therapy and surgery. For mild attacks medications such as sulfasalazine (Azulfidine), aminosalicylates (Asacol, Pentasa) may suffice. If an exacerbation is more severe then oral or intravenous steroids such as prednisone are usually employed. Other medications such as antibiotics or immunosuppressive medications are sometimes used as well. New medications are also being developed for inflammatory bowel disease. These medications generally focus on modifying the inflammatory response. Every patient's case needs to be treated individually so that the best medical regimen can be prescribed. It is difficult to predict what will happen in an individual patient. The goals of treatment are to suppress inflammation, relieve symptoms, prevent complications and to maintain remission. Oral nutritional supplements such as Ensure have been shown to help patients with Crohn's disease. These supplements are generally considered adjuncts to standard therapy and are not to be used as primary therapy. Total parenteral nutrition (intravenous nutrition) is sometimes used in hospitalized patients or in patients who have severe malabsorption secondary to inflammation or extensive surgery. Finally, surgery is usually reserved for patients with strictures (narrowing), mechanical obstruction (blockage of intestine) or cancer.
I hope you find this information helpful. If you are seen at our institution I look forward to meeting you in person.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
Keywords: Crohn's disease, inflammatory bowel disease, diagnosis, treatment
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