Crohn disease is really a chronic (long-term) illness of the digestive tract marked by severe inflammation. It may involve any part of the digestive system from the mouth to the rectum, but is most likely to affect the small intestine and also the region around the anus. Crohn illness is comparable to ulcerative colitis, an additional illness of the digestive system that is sometimes categorized together with Crohn disease as inflammatory bowel disease (IBD).
The major distinction between ulcerative colitis and Crohn disease is that ulcerative colitis is usually restricted to the large intestine and involves the upper layers of the bowel lining, while Crohn illness can occur anywhere in the digestive tract and affects deeper layers of tissue. Crohn disease is named for Burrill Bernard Crohn (1884-1983), a gastroenterologist (physician who specializes in diseases of the digestive system) who treated patients at Mount Sinai Hospital in New York City.
Crohn disease is a chronic inflammatory disorder of the digestive system that is thought to be caused by an abnormal response of the body's immune system to bacteria in the digestive tract. A gene was identified in 2006 that may also be linked to the disease. Crohn illness is marked by breaks in the lining of the digestive tract, commonly in the small intestine, that cause cramps, nausea, persistent diarrhea, fever, and rectal bleeding.
The symptoms vary in severity from patient to patient; some individuals might have only occasional episodes of diarrhea, for instance, while others might have twenty to thirty bowel movements in a single day that interfere with sleep, work, school, or other activities. In addition, it's not unusual for patients with Crohn disease to have sections of normal healthy bowel alternating with sections of diseased bowel tissue.
In one kind of Crohn disease, sometimes called penetrating Crohn illness, the underlying layers of intestinal tissue are damaged also, leading to perforation (puncturing) of the intestinal wall. This might trigger a serious infection in the abdomen or the formation of fistulas, abnormal passageways leading from one loop of the intestine to another or from the abdomen to the outside of the body. These fistulas, present in about 30 percent of patients, are most likely to form in the area around the anus, leading to the formation of abscesses. Another subtype of Crohn disease is called stricturing illness.
Stricture is the medical term for an abnormal narrowing of a hollow organ like the bowel. The inflammation and swelling of tissue inside the bowel leads to changes in the size of the patient's stools and eventual blockage of the intestinal passages. Severe abdominal cramping is frequently an indication of stricturing disease, as are nausea and vomiting. In addition to intestinal issues, Crohn illness can produce long-term complications including skin ulcers, mouth ulcers comparable to canker sores, eye disorders, inflammation of the liver, and joint pains or arthritis.
It's estimated that you will find about 500,000 persons with Crohn illness in the United States, with another 500,000 suffering from ulcerative colitis. An additional statistic given by some doctors is seven cases per 100,000 in the general population in Canada and also the United States. Crohn is primarily a disorder of adults, most often beginning in late adolescence or the early adult years. The most common age at onset is between fifteen and thirty years, although the disorder may begin at any age.
The rate of Crohn disease in North America has been increasing since the 1960s, even though the reasons for the increase are unknown. Southern Europe, South America, Africa, and Asia have considerably lower rates of the illness as low as 0.5-0.08 cases per 100,000 people. Around the world, nevertheless, the rates of Crohn disease are higher in cities than in rural areas and higher among people with higher incomes than among lower-income groups.
One argument for suspecting a genetic factor in Crohn disease is that it runs in some families; individuals with siblings who have the disease are thirty times more likely to develop it than the regular population. It is also fairly common among certain ethnic groups, particularly Jews of Eastern European origin. A two- to four-fold increase in the frequency of Crohn disease has been found among the Jewish population in the United States, Europe, and South Africa compared to other ethnic groups. In terms of other ethnic groups in the United States, Crohn disease appears to be slightly more common in non-Jewish Caucasians than in African or Asian Americans. The illness is nearly twice as likely to happen in men than in women.
The causes of Crohn disease aren't totally understood. It is known that smoking is really a risk factor for developing Crohn. At one time it was thought that the illness was caused by emotional stress or by diet, particularly by eating sweet or high-fat foods. The most common theory, nevertheless, holds that the disease is caused by the patient's immune system mistaking bacteria that normally live in the intestine, and possibly certain foods, as foreign substances that should be attacked.
When the immune system overreacts, white blood cells move in large numbers to the intestines, where they accumulate and eventually cause swelling and destruction of tissue. In addition to the symptoms that have already been described, patients with Crohn disease might experience:
No single test could be used to diagnose Crohn illness. In addition to blood tests to check for anemia and stool tests to check for blood in the stool, the four tests most commonly utilized to diagnose Crohn are barium studies, computed tomography (CT) scans, sigmoidoscopies, and colonoscopies. In a barium study, the patient is given barium in enema form to coat the lining of the colon and rectum. Air is then blown into the colon in order to fill it. The resultant x-ray can detect abnormalities in the lining of the intestine. CT scans are helpful in detecting fistulas and abscesses.
Sigmoidoscopies and colonoscopies need special equipment inserted into the patient's body. A sigmoidoscope is really a flexible lighted tube that could be inserted into the rectum and utilized to examine the last 2 feet (0.6 meters) of the colon. This process can be done in a doctor's office but does not offer a view of the whole colon. A colonoscope is really a long flexible tube attached to a video camera and monitor that allows the doctor to examine the entire length of the patient's colon and rectum. The patient must take a laxative the night before to cleanse the bowel and may be given a sedative in the doctor's office to make them more comfortable. The physician can take tissue samples from the lining of the bowel for analysis.
There is no medical or surgical cure for Crohn disease. Treatment consists of managing the patient's symptoms, getting the disease into remission, and preventing relapses.
Patients might be given one or more various kinds of medications to relieve pain and discomfort including cortisone and other drugs that reduce inflammation; drugs that block or lower the body's immune response; antidiarrheal drugs and fluid replacements; antibiotics; and nutritional supplements. Special high-calorie liquid formulas may be prescribed. Although doctors no longer think that diet causes Crohn disease, they usually advise patients who are having a flare-up to steer clear of bulky grains, spicy foods, alcohol, and milk products until their symptoms diminish.
Patients who are not helped by medications or who have structuring Crohn disease are usually treated by surgery. In most cases the surgeon removes the diseased part of the intestine and reconnects the healthy portions. This procedure might have to be repeated, however, if inflammation develops in the region of the intestine next to where a diseased portion was removed. In instances in which the disease is located in the big intestine (colon), the surgeon might need to remove the entire colon in a process known as a colostomy.
In this process, an opening called a stoma is made in the wall of the abdomen, along with a portion of the remaining colon is attached to the stoma. The person's body wastes pass through the stoma and are collected in a special bag attached to the outside of the body. An additional type of surgery for patients with stricturing Crohn illness involves widening the intestine at the point of the stricture.
Most individuals with Crohn illness have periods of remission and are able to hold jobs and generally lead normal lives. Medical treatment of Crohn illness, however, becomes less effective over time; about 80 percent of patients need surgery eventually. In addition, the disease can recur after surgery. The chance of a shortened life span or serious complications increases with the duration of the illness; patients with Crohn illness have an increased risk of colorectal cancer. The illness itself, nevertheless, is rarely fatal.
There is no known way to stop Crohn illness, because its causes aren't yet understood.
It is possible that the incidence of Crohn disease will continue to rise as it has for the past fifty years. New treatments and new diagnostic techniques for the disease are currently at the clinical trials stage; as of spring 2008, the National Institutes of Health was conducting over 200 separate trials of new drugs along with other kinds of treatment for the disorder.
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