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Inflammatory Bowel Disease - Crohn's Disease 

Introduction

Crohn’s disease is a chronic autoimmune inflammatory bowel disease.  It is believed to result when the immune system, which usually fights diseases, attacks the cells in the GI tract.  When the cells in the digestive system are attacked, the cell lining becomes swollen and painful.  Crohn’s disease can cause changes in bowel movement patterns, pain, and numerous other medical complications.

The exact cause of Crohn’s disease is unknown.  It cannot be prevented at this time.  Treatment for Crohn’s disease includes medication and potentially surgery.  Although Crohn’s disease is a life long condition, medical treatment and monitoring can help people live a good quality of life.

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Anatomy
After you swallow food, it moves through your esophagus and into your stomach.  Chemicals in your stomach break down the food into a liquid form.  The processed liquid travels from your stomach to your small intestine.
 
The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around.  The duodenum is the first part of the small intestine.  It is a short C-shaped structure that extends off of the stomach.  The jejunum and the ileum are the middle and final sections of the small intestine.

Your small intestine breaks down the liquid from your stomach even further so that your body can absorb the nutrients.  The remaining waste products from the small intestine travel to the large intestine.
 
Your large intestine, also called the large bowel or colon, is a tube that is about 5 feet long and 3 or 4 inches around.  The lower GI tract is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus.  The appendix is located on the cecum, but it does not serve a purpose in the digestive process.
 
The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine.  As the colon absorbs water from the waste product, the product becomes more solid and forms a stool.  The large intestine moves the stool into the sigmoid colon, where it may be stored before being traveling to the rectum.  The rectum is the final 6-inch section of your digestive tract.  No significant nutrient absorption occurs in the rectum or anal canal.  From the rectum, the stool moves through the anal canal.  It passes out of your body through your anus when you have a bowel movement.

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Causes
The cause of Crohn’s disease is unknown.  It appears that genetics may play a role. 
Researchers believe that other factors including diet, the environment, and blood vessel abnormalities, may contribute to the disease.  Scientists also suspect that a virus or bacteria may cause the immune system to overreact.  Researchers do know that Crohn’s disease runs in families and that people with Crohn’s disease have an abnormal autoimmune reaction that harms the bowels.
 
Intestinal inflammation most frequently occurs at the end of the ileum and the beginning of the cecum, where the small and large intestine join.  It is common in the area around the anus.  An ulcer or sore may develop where the inflammation is most severe.  The ulcers may become quite large and are characteristically separated by thin areas of healthy tissue.
 
Malabsorption can be a consequence of damage to the intestinal wall.  This means that nutrients, water, and fats from the food you eat may not be able to be absorbed by your body.  Malabsorption can lead to malnutrition, nutrition deficiencies, dehydration, kidney stones, and gallstones. 
 
Intestinal inflammation can cause the walls of the intestines to thicken.  The thickened wall can cause the space in the intestinal passage to narrow.  This can impede or block the movement of digested food.  Bowel obstruction can be permanent and require medical or surgical treatment.
 
Intestinal inflammation can spread all of the way through the intestinal wall.  The inflammation can adhere to nearby organs and structures, including the bladder and vagina.  The adhesions can lead to serious problems if the contents of the bowel enter other sites and cause infection.
 
Crohn’s disease can affect the skin around the anus.  It can cause tiny cracks in the tissues called anal fissures.  Sores, called fistulas, may spread and lead to adhesions between the intestines and the skin.  Additionally, abscesses, pockets of dead tissue may develop.  These skin conditions can be quite painful and annoying.
 
Crohn’s disease can cause inflammatory conditions in other parts of the body.  It can affect the joints, mouth, eyes, liver, and bile ducts.  Crohn’s disease can affect a child’s development.  A child with Crohn’s disease may experience delayed development and stunted growth.
 
Crohn’s disease is a chronic condition.  Medications tend to become less effective over time.  Many people with Crohn’s disease eventually require surgery.  Further, complications associated with Crohn’s disease can be fatal.  Cancer in the digestive tract is the leading cause of death for people with Crohn’s disease.

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Symptoms
Crohn’s disease is a slowly progressing life long condition.  Symptoms of Crohn’s disease may come and go over time.  There is no way to predict when inflammation may occur and how long it will last.  Most people feel good in between episodes of Crohn’s disease.
 
When symptoms occur, you may experience diarrhea.  Your diarrhea may contain mucus, blood, or pus.  At times you may be incontinent; you may have a bowel movement when you do not intend to.  You may experience steady or cramping pain in your abdomen, the area around your belly button, or in the right lower area of your abdomen.  Your pain may temporarily subside after a bowel movement. 
 
You may experience constipation.  Constipation may occur with bowel obstruction.  Bowel movements may be painful.  You may have blood in your stools.  Additionally, your stools may have a very bad odor.
 
You may feel bloated after eating a meal.  Your stomach may sound noisy; it may gurgle or make other noises.  You may lose your appetite and consequently lose weight.  A fistula from the intestinal tract can cause infection in other parts of the body.  You may experience a bladder infection.  Females may develop a vaginal infection. 
 
Some people develop medical conditions associated with Crohn’s disease that affect other parts of the body.  Such areas include the skin, eyes, joints, blood, mouth, liver, and bile ducts.  Crohn’s disease can be associated with skin rashes and eye inflammation.  You may develop joint disease, such as arthritis.  Crohn’s disease can lead to blood clots called deep vein thrombosis.  The gums in your mouth may become swollen.  Additionally, Crohn’s disease can cause liver inflammation, gallstones, and kidney stones.

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Diagnosis
Your doctor can start to diagnose Crohn’s disease after reviewing your medical history and conducting a physical examination.  Tell your doctor about your symptoms, risk factors, family history, diet, and lifestyle.  Your doctor may conduct blood to help diagnose Crohn’s disease, rule out other conditions with similar symptoms, detect inflammation, and check for malnutrition.  Your doctor may test a stool sample as well.  In some cases, imaging tests may help to identify Crohn’s disease.  Common imaging tests include an upper gastrointestinal (GI) series, endoscopic retrograde cholangiopancreatography (ERCP), barium enema, or endoscopy such as colonoscopy or sigmoidoscopy.
 
An upper gastrointestinal series or barium swallow provides a set of X-rays showing the esophagus, stomach, and small intestine. Before the X-rays are taken, barium, a chalky substance, is swallowed.  The barium provides an image of the upper gastrointestinal structures on the X-ray images.  A barium swallow is commonly used to determine the cause of pain, swallowing problems, blood stained vomit, and unexplained weight loss.  A barium swallow is an outpatient procedure that does not require sedation or anesthesia.
 
A lower gastrointestinal series or barium enema test provides a series of X-ray images of the large intestine.  A barium enema is commonly used to screen for colon cancer and bowel diseases.  Prior to taking X-rays, barium, a chalky substance, and air are used to fill and expand the colon.  The barium reveals the bowel’s shape and position on the X-ray images.  A barium enema is an outpatient procedure that is performed at a doctor’s office or a hospital’s radiology department. 
 
An upper gastrointestinal intestinal (GI) endoscopy is a procedure that uses an endoscope to view the esophagus, stomach, and upper duodenum, the first part of the small intestine.  This test is also called an esophagogastroduodenoscopy (EGD) or a gastroscopy.  An endoscope is a long thin tube with a light and a viewing instrument that sends images to monitor.  The endoscope allows a doctor to examine the inside of the upper gastrointestinal tract for bleeding, inflammation, tumors, polyps, and other abnormal conditions.  A tissue sample or biopsy can be taken with the endoscope.  It is also used to treat bleeding.  An upper GI endoscopy is an outpatient procedure.  You will receive a medication to relax you prior to the test.
 
An ERCP uses an endoscope to view the pancreas and nearby structures for people with Crohn’s disease in their pancreas or bile ducts.  An endoscope is a thin tube with a light and a viewing instrument at the end of it.  After you are sedated, the tube is passed through your mouth and into your small intestine. Dye may be administered to enhance viewing.  In some cases, an endoscope is used to remove gallstones or to take tissue samples. 
 
A colonoscopy is a procedure that uses a colonscope to view the inside lining of the entire colon. A colonscope is a long thin tube with a light and a viewing instrument that sends images to a monitor.  The colonscope allows a doctor to examine the inside of your colon for cancer, polyps, and other medical diseases.  A tissue sample or biopsy can be taken with the colonscope.  You will receive medication to relax you prior to and during the test.
 
A flexible sigmoidoscopy is a procedure that uses a sigmoidscope to view the inside lining of the rectum and lower section of the colon. A sigmoidscope is a thin tube that is about twenty inches long.  It has a light and a viewing instrument that sends images to an eyepiece or a monitor.  The sigmoidscope allows a doctor to examine the inside of the rectum and lower colon for cancer, polyps, and other medical conditions.  A tissue sample or biopsy may be taken with the sigmoidscope.  A flexible sigmoidoscopy is a procedure that does not require anesthesia or sedation.
 
In some cases, a computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or an ultrasound may be used to identify complications outside of the intestine and examine other organs.  These imaging tests are painless procedures.  The CT and MRI scans simply require that you remain motionless while pictures are taken.  For ultrasound, a technician will gently move a small device on your abdomen.  The device sends images to a monitor for review.

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Treatment
A major goal of Crohn’s disease treatment is to reduce inflammation to reduce symptoms, prevent complications, and maintain adequate nutrition.  Your doctor may prescribe anti-inflammatory, antibiotic, antidiarrheal, or immunosuppressant medication.  If medications do not help or if you experience intestinal blockage, you may need surgery.  Surgery may also be used to treat abscesses and fistulas. 

The most common surgery for Crohn’s disease removes the diseased section of the intestine.  The surgery can improve symptoms of Crohn’s disease, but it does not cure it.  Crohn’s disease commonly comes back after surgery, frequently at the site where the incision is made.

In some cases, a stoma, an opening in the abdomen may need to be surgically created to remove stools.  The procedure is called an ostomy.  An ostomy is necessary if stools can no longer exit the body through the rectum and anus.  The surgery involves attaching the intestine to the stoma.  A collection bag is worn on the outside of the stoma.  The bag requires regular emptying and cleaning.  The term for the ostomy depends on which part of the intestine is attached to the stoma, for instance a colostomy or ileostomy.  People that have a large section of their intestine removed may need to receive intravenous (IV) nutrition for the rest of their lives.

Medical complications associated with Crohn’s disease need to be treated as well.  You will need to make and keep regular appointments with your doctor to monitor your condition.  Although Crohn’s disease is a life long condition, treatment and monitoring can help people live a good quality of life.

The experience of Crohn’s disease and Crohn’s disease treatments can be an emotional process for people with the condition and their loved ones.  It is important that you receive emotional support from a positive source.  Some people find comfort in their family, friends, co-workers, and faith.  Support groups are another good option.  They can be a source of information and support from people who understand what you are experiencing.  Ask your doctor about support group locations in your area. 

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Prevention
The exact cause of Crohn’s disease is unknown.  At this time, there is no way to prevent Crohn’s disease.  You should discuss your risk factors, family history of Crohn’s disease, symptoms, and concerns with your doctor.  You should make and keep all of the appointments with your doctor.  Although Crohn’s disease is a life long condition, consistent treatment and monitoring can help you live a good quality of life.

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Am I at Risk

Risk factors may increase your likelihood of developing Crohn’s disease.  People with all of the risk factors may never develop Crohn’s disease; however, the chance of developing the condition increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

The United States has the highest incidence of Crohn’s disease in the world.  Crohn’s disease occurs most frequently in Caucasians.  In the United States, Europe, and South Africa, Crohn’s disease is more common among people with European-Jewish ancestry.  Most cases of Crohn’s disease are diagnosed in adolescence and early adulthood; however, the condition can develop at any age.

Crohn’s disease risk factors:

_____ Slightly more men than women get Crohn’s disease.
_____ Crohn’s disease appears to have an inherited genetic trait.  If your family members have Crohn’s disease your risk for developing the condition is increased.
_____ Smoking cigarettes increases the risk of developing Crohn’s disease or can worsen the presentation of the disease.

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Complications
Crohn’s disease can cause numerous and variable complications involving other organ systems and parts of the body.  Crohn’s disease is a chronic condition.  Medications tend to become less effective over time.  Many people with Crohn’s disease eventually require surgery.  Further, complications associated with Crohn’s disease can be fatal.  Cancer in the digestive tract is the leading cause of death for people with Crohn’s disease.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.