What is Crohn's Disease?

Crohn's Disease was first discovered and named after Dr. Burrill B. Crohn in 1932. It is a chronic, inflammatory disorder that affects the digestive or gastrointestinal (GI) tract. Crohn's Disease can affect any part of the digestive tract from the mouth to the anus but more commonly affects the small intestine and the colon. It is closely related to another chronic inflammatory condition called Ulcerative Colitis. Together the two make up what is more commonly known as Inflammatory Bowel Disease. They afflict approximately five hundred thousand to two million people in the United States.

Men and women are equally affected by Crohn's Disease and it generally begins in adolescence and early adulthood but can also begin in childhood and later in life. It has been shown that certain ethnic groups are more likely to develop the disease than others. Jews that are of European descent are nearly five times more likely than the general population to develop Crohn's Disease. It is also more common among the Caucasian population than it is among Asians and Africans.

What Causes Crohn's Disease?

Although it is not known what causes the disease it occurs more commonly in patients who have relatives with Crohn's Disease or Ulcerative Colitis, thus suggesting a genetic predisposition. Crohn's Disease is marked by an abnormal response in the immune system. Some scientists believe that the immune system mistakes the bacteria that are normally found in the gastrointestinal tract as foreign or invading substances and therefore initiates an attack. White blood cells are sent into the lining of the intestine where they produce a chronic inflammation leading to ulceration and bowel damage. When this occurs the patient experiences the symptoms of inflammatory bowel disease. It is known that Crohn's Disease is not contagious.

What are the Symptoms of Crohn's Disease?

Common symptoms of Crohn's Disease include abdominal pain, persistent diarrhea (loose, watery, or frequent bowel movements), and weight loss. Less common symptoms include loss of appetite, weight loss, fever, night sweats, rectal pain, rectal bleeding, and bowel obstruction. The symptoms of Crohn's Disease are generally dependent on the severity of the inflammation. Symptoms may range from mild to severe with periods of active disease, also known flare ups, and periods of remission in which symptoms decrease or disappear.

Up to 30% of patients will also develop conditions that affect the anal area. These include:

-Ulcers and Fissures (tears): These cause pain and bleeding in the anus, especially during bowel movements.

-Fistulas: Anal fistulas are abnormal tunnels between the anus and the rectum. A fistula may also be defined as a tunnel that goes from one loop of intestine to another. Fistulas can attach the intestine to the bladder, vagina, or skin. When this occurs a patient may notice pus or drainage from the area.

-Abscesses: An abscess is a pocket of pus that is collected in the anal and rectal area. Abscesses will cause a patient to have fevers and experience pain and tenderness around the anus.

-Swelling: The muscle at the end of the colon that controls bowel movements is called the anal sphincter. Patients may experience swelling of the anal sphincter and thus have a problem with being able to control their bowel movements.

Crohn's Disease is not limited to the gastrointestinal tract. It can affect several other aspects of a person's well being. Patients may be subjected to joint problems, including arthritis and osteoporosis, skin and eye problems, and difficulty with liver function.

How is Crohn's Disease Treated?

There is no known cure for Crohn's Disease. The route of treatment varies from one patient to another depending upon the location, extent, and severity of the disease. The goal of treatment is to suppress the inflammatory response, allowing the intestine to heal and also to decrease symptoms. Once symptoms are under control the next goal is to decrease the frequency of flare ups and increase periods of remission, thus improving the quality of life.

Crohn's Disease can be treated with several different types of medication. Classes of medication for treatment include Aminosalicylates (5-ASA compounds), Corticosteroids, Immuno-Modulators, Antibiotics, and Biologic Therapies.

-Aminosalicylates: 5-ASA Compounds are anti-inflammatory drugs including Asacol, Pentasa, Colazal, Rowasa Enemas, and Canasa Enemas. These medications reduce inflammation in the affected areas and are generally used to treat mild to moderate symptoms. Rare side effects include lung and kidney inflammation and therefore should be used with caution in patients who have known kidney disease. Patients that are allergic to aspirin should also avoid 5-ASA Compounds, as they are chemically similar to one another.

-Corticosteroids: These drugs include prednisone, prednisolone, and hydrocortisone and are generally used to treat moderate to severe symptoms, and also to treat patients where 5-ASA drugs have not been effective. Corticosteroids, unlike 5-ASA drugs, do not require direct contact with inflammation. Corticosteroids stimulate an anti-inflammatory reaction throughout the body, including the areas of the intestine that are affected by inflammatory bowel disease. Although Corticosteroids are faster acting than 5-ASA Compounds they are not effective in maintaining remission or preventing flare ups from occurring. Side effects depend on the dosage administered and the duration that the patient is on the medication. Common side effects include water retention (mainly in the face), increased vulnerability to infections, high blood pressure, cataracts, glaucoma, muscle weakness, depression, personality changes, mood swings, and osteoporosis (thinning of the bones).

Immuno-Modulators: Azathioprine, 6-MP (6-Mercaptopurine), also known as Purinethol, and Methotrexate are used to maintain remission. They are also used when Corticosteroids are not working in a patient with moderate to severe Crohn's Disease. These drugs reduce inflammation by reducing immune cells and by obstructing the production of their protein cells. Side effects differ with each immuno-modulator. Azathioprine and 6-MP can cause inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), and bone marrow toxicity. Pancreatitis is a less common side effect when using Azathioprine and only occurs in about 3%-5% of all patients.

Antibiotics: The most commonly used antibiotic in inflammatory bowel disease is Flagyl. It is an antibiotic that is used to treat infections caused by parasites and bacteria. It is also effective in treating anal fistulas. Side effects of Flagyl include nausea, loss of appetite, headaches, and a metallic taste. Less common side effects include peripheral neuropathy in which permanent nerve damage causes a tingling sensation in the hands and feet.

Biologic Therapies: A new biologic therapy called Remicade (Infliximab) was introduced by the FDA in 1998. It is used in patients who have moderate to severe inflammatory bowel disease and are not responding to conventional therapies. It is administered through intravenous infusion and is used to maintain remission. Patients are observed throughout their infusion for adverse reactions, which may include nausea, chest pain, and shortness of breath.

When conventional therapies are not effective a patient has the option of surgery. Sections of the diseased bowel can be removed to reduce symptoms. Although surgery may improve the quality of life, it is not a cure for Crohn's Disease.