Crohn's Disease

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KEY POINTS

• Crohn’s disease causes areas of swelling and irritation (inflammation) and sores (ulcers) in your intestine.
• You may have treatment with medicines to help control your symptoms. You may need to stay in the hospital to receive IV fluids or to have surgery.
• Follow your healthcare provider’s treatment plan. Take your medicines exactly as prescribed. Eat a healthy diet and avoid foods that seem to trigger your symptoms.

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What is Crohn's disease?

Crohn's disease is a problem of the digestive tract. It can affect any part of the digestive tract, but most often it affects the small intestine and the first part of the large intestine (colon). Crohn’s disease causes areas of swelling and irritation (inflammation) and sores (ulcers) in your intestine. The ulcers can make holes in the wall of the intestine, which can cause life-threatening infections and bleeding. Swelling and scar tissue from the sores can block the passage of food and bowel movements through the intestines. Crohn's disease may also cause fistulas. A fistula is an abnormal connection between 2 parts of the intestine or between the intestine and other organs, such as the bladder, vagina, or skin. Fistulas can cause infection and leakage of bowel movements.

Crohn's disease is 1 of the 2 illnesses called inflammatory bowel disease. The other disease is ulcerative colitis, which affects only your lower intestine (colon and rectum). Crohn's disease may also be called ileitis or enteritis, if it is just in the small intestine.

Crohn’s disease is a life-long condition, but your symptoms may come and go. There may be times when you have no symptoms. There is no cure, but treatment can help control your symptoms and you should be able have a full and active life.

What is the cause?

The exact cause of Crohn’s disease is not known. It may be an autoimmune disease, which is a disease that causes your body to mistakenly attack your own tissue. The disease is not caused by stress or food choices. However, these things may trigger symptoms or make them worse. You have a higher risk of Crohn's disease if one of your parents or siblings has had inflammatory bowel disease.

What are the symptoms?

Symptoms are related to where the inflamed areas are in your intestine. They may include:

• Crampy pain in your belly, often on the lower right side
• Diarrhea or less often, constipation
• Feeling tired
• Fever
• Loss of appetite and weight loss
• Rectal bleeding and pain with bowel movements

You may have symptoms outside of your intestines such as

• Joint pain
• Eye irritation
• Red tender bumps or ulcers on your skin, most often on the legs but can be anywhere

You may go for weeks, months, or years without symptoms or you may have symptoms every day for a while. When you have gone some time without symptoms, and then suddenly have symptoms again, it’s called a flare-up, or flare.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Rectal exam, which your provider does by gently putting a lubricated and gloved finger in your rectum. Your provider may also place his or her other hand on your belly to feel and check the size and shape of your organs.
• Blood tests
• Barium swallow, which is an X-ray taken of the upper part of your digestive tract after you swallow barium. Barium is a liquid that helps your intestines show up well on the X-ray.
• Barium enema, which is an X-ray taken of the belly after barium is inserted through the rectum to show the walls of the large intestine
• CT scan, which uses X-rays and a computer to show detailed pictures of the intestines
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the intestines
• Sigmoidoscopy or colonoscopy, which uses a thin, flexible tube and tiny camera put into your rectum and up into the colon to look at the inside of your intestine. A biopsy may be taken to help make a diagnosis. A biopsy is the removal of a small sample of tissue for testing.
• Endoscopy of the throat, esophagus, and stomach. The esophagus is the tube that carries food from your throat to your stomach.
• Tests of a sample of bowel movement

How is it treated?

You will likely need to change your eating habits during flares.

Your provider may prescribe medicines to:

• Treat or prevent infection
• Reduce inflammation
• Prevent your immune system from attacking healthy cells
• Treat pain
• Treat and prevent diarrhea
• Treat anemia from blood loss

In some cases you may need to stay in the hospital. Your treatment may include:

• IV feeding instead of eating, which allows your bowel to rest
• Blood transfusions to replace blood you have lost
• IV medicines
• A tube passed through your nose or mouth and down into your stomach. The tube may be used to give fluids or medicine, or to help relieve pressure caused by air or fluids in your stomach and intestine.

You may need surgery to:

• Stop bleeding
• Repair fistulas or holes in the wall of your intestines
• Remove tissue that has caused a blockage in your intestines
• Remove the entire colon and create an opening in your belly for collection of bowel movements

Surgery may give you a period of rest from the disease, but the symptoms will usually come back in a different part of the digestive system.

Some medicines for Crohn’s disease can hurt an unborn baby. Tell your provider if you are thinking of getting pregnant or if you get pregnant while being treated for Crohn’s disease. Your provider may recommend not getting pregnant until your symptoms have been under control for 6 months.

How can I take care of myself?

• Follow your healthcare provider’s treatment plan. Take your medicines exactly as prescribed.
• Eat a healthy diet and avoid foods that seem to trigger your symptoms. Changing your diet will not cure you, but it may help reduce and control your symptoms.
  • Keep a food diary to record what you eat and what causes symptoms. Avoid foods that cause problems.
  • Avoid caffeine and alcohol if they make your symptoms worse.
  • Eat smaller meals and eat more often.
  • Limit fatty, greasy foods since these can cause diarrhea.
  • During flares, try to limit high-fiber foods such as nuts, raw vegetables, berries, and corn. During flares, or after surgery, you may be told to follow a low-fiber diet for a short time. This will reduce the size and number of your stools and help control diarrhea and cramps. Examples of low-fiber foods are white rice, potatoes, white bread and low-fiber cereal and pasta, tender meats, and fish.
  • In between flares, try to add fiber to your diet slowly. You may also need to eat foods high in protein and calories if you could not eat enough during your flares.
  • Talk to your provider about taking a multivitamin supplement. You may need a supplement because your small intestine may have trouble absorbing vitamins and minerals from food.
• When you have diarrhea, rest your bowel for a few hours by just drinking clear liquids, such as water, juice, tea, and bouillon. It’s important to drink small amounts often so you don't get dehydrated. Suck on ice chips if you feel too nauseated to drink anything.
• Avoid nonsteroidal anti-inflammatory medicines (NSAIDs), like aspirin, ibuprofen, and naproxen. NSAIDs can irritate the lining of your intestines and cause flares of symptoms. Ask your provider if you can use acetaminophen for pain relief instead.
• Learn to use deep breathing exercises and other relaxation techniques when you feel stressed. Make sure you get enough rest and sleep.
• Keep a healthy weight and stay physically active according to your provider's recommendation.
• If you smoke, try to quit. Smoking makes your symptoms worse. Talk to your healthcare provider about ways to quit smoking.
• Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover from your current symptoms
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
  • How often you should have a colonoscopy for cancer screening. Crohn's disease of the colon and rectum increases your risk for those cancers.
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

You can get more information from:

• Crohn's and Colitis Foundation of America
  888-694-8872
  http://www.ccfa.org