Crohn’s disease symptoms vary in severity, from mild to severe. They may differ over time and between different individuals and also depending on what part of the digestive tract is affected. Because of the depth of tissue involvement and variable nature of the digestive tract, initial symptoms can be very subtle. People are living with Cohn’s disease experience chronic recurring periods of outbreaks and remission.
Lower abdominal pain and cramps with distension are usually the presenting symptom of Crohn’s disease. Others include frequent and persisting diarrhea, occasional bleeding from the rectum, unexplained weight loss, anorexia, fever, lethargy and night sweats. As the disease progresses, this symptom becomes more regular and severe.
How is it Treated?
While there is no certain remedy for Cohn’s disease, medications and therapies can significantly lessen its signs and symptoms, and even bring about long-term remission. With suitable treatment, most patients can go on to live a normal and healthy life.
A well-balanced diet rich in fiber and fruits should be encouraged among people living with Crohn’s disease. Also, habits such as smoking should be ceased due to its harmful impact on the course of the disease and potentially the oral contraceptive pills.
Medications that are used to treat Crohn’s disease are intended to suppress and control the inflammatory response and induce remission.
Corticosteroids are widely used for the induction but not the maintenance of remission due to increasing resistance over time, adverse side effects, and dependence with prolonged use. They are either given through the mouth, injected subcutaneously or via the rectum. These drugs help to suppress inflammation by repressing the immune system. Prednisone and budesonide are usually used.
The 5-aminosalicylates were once used in the past but now are less used due to their limited efficacy. These drugs include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Asacol HD, Delzicol).
Infliximab and adalimumab are another groups of drugs which fall into the class of Anti-TNF immunosuppressant are generally reserved for patients that are not responsive to standard therapies. Adalimumab is used for the induction and remission of moderate to severe active inflammatory Crohn disease.
Depending on symptoms the patient might be feeling, over-the-counter medications might be recommended. This includes anti-diarrheal, pain relievers and nutritional supplements.
Surgical Management
The majority of patients diagnosed with Crohn disease will have a surgical resection within 10 years of their diagnosis. Surgery is reserved for patients who are not responding to medical therapies, recurrent intestinal obstruction, malnutrition and for septic complications such as perforations and abscesses. Surgical admissions account for more than half of all hospitalizations and account for almost 40% of total financial costs to patients.
What is Crohn’s Disease?
Crohn’s disease is a chronic relapsing inflammatory bowel disease that affects any part of the digestive tract from the mouth to the anus. It primarily causes granulomatous ulcerations (break in the mucosal lining) of the small and large intestine. It is also called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis.
Crohn’s disease shares close similarity to ulcerative colitis but only affects the terminal colon and rectum. Together, Crohn’s disease and ulcerative colitis are both referred to as inflammatory bowel disease.
Its prevalence has continually increased over the past 50 years with the highest incidence being reported in northern Europe, the United Kingdom, and North America. It appears to be rare among Asian and Hispanic children. It most commonly begins during adolescence and early adulthood (usually between the age of 15 and 35).
Patients with long-standing Crohn disease are at risk of developing colorectal cancer later in life. The prognosis is usually very poor with a very low survival rate. As such, it is recommended for every patient to undergo screening and surveillance colonoscopy every 10 years starting at the age of 50. Others might need a colonoscopy as often as every one to two years. This is dependent on the severity and extent of colon involvement.
What Causes it?
The exact cause of the disease is unknown. Researchers and scientists believe it is due to a complex interplay of environmental factors and genetic predisposition. Crohn’s disease is the first genetically complex disease in which the interaction between genetic risk factors and the immune system is understood in great details.
Crohn’s disease tends to be more common in close relatives of patients living with the disease. If a person has a relative with the disease, the individual’s risk of developing the disease is estimated to be at least 10 times that of the general population.
Certain bacteria, the virus may trigger an abnormal immune response. Bacteria’s such as Mycobacterium paratuberculosis, Pseudomonas species, and Listeria species have all been implicated as a cause of Crohn’s disease, suggesting that the inflammations associated with the disease are as a result of dysfunctional, but appropriate response to an infectious source. A previous history of symptomatic mumps and a high dietary intake of fats, polyunsaturated fatty acids, omega-6-fatty acids, and meats have both been associated with an increased risk of Crohn’s disease, while a diet that contains high fiber and fruits has been seen to be protective. Smoking has also been confirmed to impact Crohn’s disease negatively, it increases the risk by more than twice. The oral contraceptive pill has also been associated with the development of Crohn’s disease.
Crohn’s Disease Symptoms
Like many chronic inflammatory diseases, it can also affect other systems of the body and can pose as some of the early signs and symptoms. They can cause the interior portion of the eye to be swollen, a condition known as uveitis, which can cause eye pain and blurred vision especially when exposed to light. People with Crohn disease may develop anemia due to vitamin B12, folate, iron deficiency, or due to anemia of chronic disease. The most common is iron deficiency anemia
Among children, they are first diagnosed with Crohn’s disease based on their inability to grow. As this may manifest at the time of growth spurt in puberty.
References
Crohn Disease: Practice Essentials, Background, Pathophysiology. (2018). Retrieved from https://emedicine.medscape.com/article/172940-overview?pa=0Pjwz84bY0HDG6lqhavMCFL4kT9jdsCJPFhoIQJ99e%2BxIzVIFF62%2FGjUEYkFqH8Nd%2FsGPYa%2BToEoLjuhFnUEHw%3D%3D#a4
Crohn’s disease – Symptoms and causes. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
Crohn’s Disease Symptoms, Diet, Causes, Treatment, Life Expectancy. (2018). Retrieved from https://www.medicinenet.com/crohns_disease/article.htm
