Diagnose and Treat Crohn's Disease

Crohn's disease, a type of inflammatory bowel disease (IBD), is a condition in which the lining of your digestive tract becomes inflamed, causing severe diarrhea and abdominal pain. The inflammation often spreads deep into the layers of affected tissue. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating and sometimes may lead to a life-threatening complication.

While there's no known medical cure for Crohn's disease, therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about a long-term remission. With these therapies, many people afflicted with Crohn's disease are able to function normally in their everyday lives.

Steps

Recognizing Symptoms and Confirming Diagnosis

  1. Know the signs and symptoms of Crohn's disease. The symptoms of Crohn's disease are similar to those of other intestinal disorders, such as ulcerative colitis and irritable bowel syndrome. The symptoms may come and go and can vary from mild to severe. They will differ from person to person, depending on what part of the gastrointestinal tract is infected. Some of the most common symptoms include:
    • Diarrhea: The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea.
    • Abdominal pain and cramping: Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping.
    • Blood in your stool: Food moving through your digestive tract can cause inflamed tissue to bleed, or your bowel may also bleed on its own.
    • Ulcers: Crohn's disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into — and sometimes through — the intestinal walls.
    • Reduced appetite and weight loss: Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
    • Fistula or abscess: Inflammation from Crohn's disease may tunnel through the wall of the bowel into adjacent organs, such as the bladder or vagina, creating an abnormal connection called a fistula. This can also lead to an abscess; a swollen, pus-filled sore.
  2. Recognize less common symptoms of Crohn's disease. Aside from the above mentioned symptoms, people with Crohn's disease may experience other, less-common side effects such as joint pain, constipation and swollen gums.
    • People with severe Crohn's disease may experience fever and fatigue as well as problems that occur outside the digestive tract, including arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.
    • Children with Crohn's disease may have delayed growth or sexual development.[1]
  3. Know when to seek medical advice. Call your doctor right away if you experience any of the following symptoms:
    • Feel faint or have a fast and weak pulse.
    • Severe stomach pain.
    • Unexplained fever or shaking chills lasting more than a day or two.
    • Repeated vomiting.
    • Blood in your stool.
    • Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications.
  4. Undergo tests to confirm the diagnosis. If your doctor suspects that you might have Crohn's disease, he/she may refer you to a gastroenterologist (digestive system specialist) to undergo different diagnostic tests. These may include:
    • Blood tests: Your doctor may suggest blood tests to check for anemia, which is a common side effect of Crohn's disease (due to blood loss).
    • Give a Colorectal Exam: This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. With the camera, the doctor will be able to identify any inflammation, bleeding or ulcers on the wall of the colon.
    • Flexible sigmoidoscopy: In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, which is the last {{safesubst:#invoke:convert|convert}} of your colon.
    • Barium enema: This diagnostic test allows your doctor to evaluate your large intestine with an X-ray. Before the test, barium, a contrast dye, is placed into your bowel by way of enema.
    • Small bowel X-ray: This test uses x-ray to examine the part of the small bowel that can't be seen by colonoscopy.
    • Computerized tomography (CT): Sometimes you may need a CT scan, which is a special x-ray technique that provides more detail than a standard x-ray. This test looks at the entire bowel as well as at tissues outside the bowel that can't be seen with other tests.
    • Capsule endoscopy: If you have signs and symptoms that suggest Crohn's disease but the usual diagnostic tests are negative, your doctor may perform capsule endoscopy.

Understanding Treatment Options

  1. Ask your doctor about drug therapies. Many different medications are used to control symptoms of Crohn's disease. The type of medication that works for you will depend on the specific nature of your Crohn's disease and the severity of your symptoms. Some commonly used drug treatments include:
    • Anti-inflammatory drugs: These drugs are often the first step in the treatment of inflammatory bowel disease. They include sulfasalazine (Azulfidine) which is useful mainly in colonic disease , mesalamine (Asacol, Rowasa) which may help to prevent a relapse of Crohn's disease after surgery, and corticosteroids.
    • Immune system suppressors: These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. They include azathioprine (Imuran) and mercaptopurine (Purinethol), infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), methotrexate (Rheumatrex), cyclosporine (Neoral, Sandimmune), and natalizumab (Tysabri).
    • Antibiotics: These can heal fistulas and abscesses in people with Crohn's disease. They include metronidazole (Flagyl) and ciprofloxacin (Cipro).
    • Antidiarrheal agents: Crohn's disease patients who suffer from chronic diarrhea usually respond well to antidiarrheal agents such as loperamide. Loperamide - which is sold commercially as Imodium - can be bought over-the-counter without a prescription.
    • Bile acid sequestrants: Patients with terminal ileal disease or a previous resection of the ileum (end part of the small intestine) may not absorb bile acids normally which can lead to secretory diarrhea in the colon. These patients may benefit from bile acid sequestrants like cholestyramine or colestipol.
    • Other medications: Some other medications that may relieve symptoms of Crohn's disease include steroids, immune system suppressors, fiber supplements, laxatives, pain relievers, iron supplements, vitamin B12 shots, and calcium and vitamin D supplements.
  2. Follow doctor's recommendations regarding diet and nutrition. There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate the disease (especially during a flare-up) while others can help to ease symptoms and prevent future flare-ups.
    • Fiber supplementation is said to be beneficial for patients with colonic disease. This is due to the fact that dietary fiber can be converted to short-chain fatty acids, which help the colon to heal itself.
    • Try to avoid dairy products, as most patients with Crohn's disease (particularly of the small intestine) are lactose intolerant. You may use calcium supplements to make up for any deficiencies and decrease the risk of osteoporosis.
    • Avoid foods which tend to cause gas and bloating such as beans and leafy green vegetables. You should also limit your intake of fatty, greasy or fried foods which can interfere with healthy digestion. In addition, you should try to eat smaller amounts throughout the day, to minimize bloating and avoid putting excess strain on your digestive system.
    • In certain circumstances, your doctor may recommend a special diet given via a feeding tube (enteral) or nutrients injected into a vein (parenteral) to treat your Crohn's disease. This is a temporary way of providing nutrition, usually to people who's intestines need to rest following surgery, or who's intestines are failing to absorb nutrients by themselves.[1]
    • Be aware that every Crohn's patient is different and may have their own unique food intolerances. A good way to identify such intolerances is to keep a daily food journal where you make a note of everything you eat. This can help you to identify food items that exacerbate your symptoms. Once you are aware of which foods cause your symptoms, you can make an effort to avoid them.
  3. Make a number of lifestyle changes. Although Crohn's disease can't be cured, you can minimize symptoms and live a normal, full life by following your doctor recommended treatments and making several healthy lifestyle choices. These include:
    • Reduce stress: Although stress doesn't cause Crohn's disease, it can make your signs and symptoms much worse and may trigger flare-ups. Although it's not always possible to avoid stress, you can learn ways to help manage it.
    • Quit smoking: If you smoke, you are far more likely to develop Crohn's disease. In addition, smoking worsens the symptom's of Crohn's disease, and increases the likelihood of complications and surgical intervention.[2]
    • Exercise more: Regular exercise will help you to maintain a healthy weight and reduce stress - two things that can make a huge difference in helping you to control the disease. Try to find a form of exercise that you enjoy doing - whether it's a dance class, rock climbing or dragon boat racing.
    • Avoid drinking alcohol: Symptoms of Crohn's disease can be worsened as a result of drinking alcohol. Therefore, it is recommended that you drink only in moderation, or cut out alcohol completely.
  4. Research surgical treatments. If diet and lifestyle changes, drug therapy or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract or to close fistulas or remove scar tissue. The three mains types of surgery Crohn's patients undergo are as follows:
    • Proctocolectomy: This procedure involves the removal of the rectum and all or part of the colon. It is performed with the patient under general anesthetic by a specialized surgeon. Recovery time is usually between 4 and 6 weeks.
    • Ileostomy: An ileostomy is a second procedure that is performed in addition to the proctocolectomy. It involves attaching the ileum (the end part of the small intestine) to an opening in the abdomen (called a stoma). A small bag (called an ostomy pouch) is attached to the stoma to collect stool. After the surgery, the patient will be shown how to empty and clean the pouch, and can go on to live a healthy, normal life.
    • Intestinal resection surgery: This type of surgery involves the removal of just the diseased section of the intestine. After the removal, the two healthy ends are attached, allowing the intestines to resume normal function. Recovery usually takes 3 to 4 weeks.
    • The NIH estimates that approximately two thirds of people with Crohn's disease will require surgery at some point in their lives, when they fail to respond to other treatments. Unfortunately, the disease often returns following surgery, so further procedures may be required. If Crohn's Disease is presenting with stubborn fistulae (Fistulising Crohn's Disease) then an Ayurvedic Para Surgical Technique known as "Kshar Sutra Therapy" is proved very effective along with Ayurvedic (herbal) medicines.[2]
  5. Try herbs that may be useful in Crohn’s disease: Herbs such as Glycyrrhiza glabra, Asparagus racemosus etc can be beneficial in Crohn’s disease.
    • Studies on Glycyrrhiza glabra (liquorice) suggest that this herb may normalize the environment in the intestines by reducing the inflammation and promote the healing of ulcers.
    • Studies on Asparagus racemosus [3] suggest that this herb may soothe the gastric mucosal lining and promote the repair of damaged and stressed tissues.
    • Studies on Valeriana Officinalis [4] suggest that this Advanced Resonance Homeopathic remedy may relieve symptoms like abdominal pain, constipation, diarrhea, involuntary passing of stools, and nausea.
    • Studies on Veratrum Album suggest that this Advanced Resonance Homeopathic remedy may relieve loose and watery stools.

Tips

  • Educate yourself and connect to organizations to provide you access with support groups.
  • Follow up closely with your doctor and have your blood checked regularly to look for side effects of the medications you are taking.
  • You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.
  • Alcohol also has an intense effect with Crohn's disease. It is recommended, even in everyday lifestyle, to drink moderately or not at all to lessen the symptoms of Crohn's.
  • If you smoke, you are far more likely to develop Crohn's disease.
  • Take only medications prescribed by your doctor or gastroenterologist.
  • Crohn's disease can strike at any age, but you're likely to develop the condition when you're young.
  • Although whites have the highest risk of the disease, it can affect any ethnic group.
  • If you live in an urban area or in an industrialized country, you're more likely to develop Crohn's disease.
  • Consistent exercise in your regimen also helps with maintaining a healthy diet that contributes to staying stress free.
  • Make a daily food journal that lists your food intake which helps to keep track of the items that increase your symptoms and try to ween yourself off of them. (Every Crohn's patient is different.)

Warnings

  • Don't use non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve). These are likely to make your symptoms worse.
  • Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system.
  • Use anti-diarrheals with great caution and only after consulting your doctor, because they increase the risk of toxic megacolon, a life-threatening inflammation of your colon.

Related Articles

  • Live With Inflammatory Bowel Disease
  • Feed a Child With Crohn's Disease
  • Reduce Inflammation in Crohn's Disease
  • Explain Cystic Fibrosis
  • Live with Arthritis
  • Eat Out with Crohn's Disease

Sources and Citations

  1. ↑ 1.0 1.1 http://www.nlm.nih.gov/medlineplus/ency/article/000249.htm
  2. ↑ 2.0 2.1 http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/
  3. ↑ http://ijpcsonline.com/files/55-197.pdf
  4. ↑ https://www.google.com/patents/US8716353

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