What is Crohn’s Disease and How is it Treated?
Dr. Balaji Datti explains Crohn’s Disease, its symptoms, and how it is treated.
What is Crohn’s Disease?
Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. It belongs to a group of conditions called IBD (Inflammatory bowel diseases). First recognized in 1930s, it can involve any portion of the GI tract unlike Ulcerative colitis, which involves the colon or large intestine only. Crohn’s is mostly a disease of Caucasians, but more African Americans are being diagnosed lately. It affects males and females equally.
The likely etiology of the disease is considered to be a genetic predisposition. Previous studies have shown that 5 to 20 percent of affected individuals have a first-degree relative with the condition. Environmental factors are considered contributory, as the disease is seen more in developed countries and northern climates. Diet and stress, although not contributory, can have an influence on exacerbation of symptoms. The disease is considered to be an autoimmune condition, along the lines of Rheumatoid arthritis, although the mechanism is not yet fully understood.
- Rectal bleeding/ rectal pain
- Abdominal pain
- Nausea and vomiting
- Bowel obstruction
- Weight loss
- Unexplained fevers/joint pains/skin rashes
Who should be tested?
Patients presenting with any of the above symptoms should be tested—especially adolescents and young adults between ages 15 to 35 years. Patients with the above symptoms and any immediate family member with same diagnosis should also be tested.
What tests to consider
Endoscopy with biopsy of affected tissue is considered the gold standard in testing for Crohn’s. Colonoscopy is routinely done to examine the colon to find ulcers or areas of inflammation, and biopsy them. If Crohn’s happens in areas of small bowel that cannot be examined via endoscopy, a pill camera test or capsule endoscopy can be used to make a diagnosis. X-rays of the small bowel like small bowel enteroclysis, CT or MR enterography are imaging studies available to evaluate the small bowel.
Blood tests like Prometheus SGI panel are available to test for Crohn’s disease. These tests are able to support the diagnosis, rather than confirm the diagnosis and should not be used alone to diagnose the condition. Regular blood tests like white cell count, C-reactive protein, or ESR can help in disease monitoring.
Treatment of Crohn’s Disease
It is important to understand that the disease is chronic, and has periods of remission and flares when increased symptoms can be noticed. The disease varies from mild to moderate to severe, and can be very different and unpredictable for individual patients. Each patient’s treatment must be tailored based on the disease presentation and clinical course.
Many treatment options are available at this time depending on the disease severity, extent and duration. The most-commonly used oral medications include anti-inflammatory medications like mesalamine-based therapy such as Asacol, Delzicol and Pentasa and others. Oral steroids are also commonly used to gain immediate control of inflammation. Oral immunosuppressive therapies like 6MP, Azathioprine and Methotrexate are available for patients with moderate to severe disease.
Potent immunosuppressives are available via biologic therapy with Humira, Remicaide, Cimzia, Entyvio, or Tysabri, which are all self injectable or IV infusions. These are reserved for patients with severe disease or failing all other medical therapies. Patients have to be monitored closely for side effects while on treatment, which include fatal infections, and risk of the development of certain malignancies.
Surgery is available for patients who present with bowel obstructions, significant small bowel strictures, fistulas, abscesses. Patient with Crohn’s disease who smoke, do poorly compared to non-smokers, and smoking cessation is highly recommended.
If you, or someone you know is experiencing the symptoms of Crohn’s Disease, call KMC Gastroenterology to schedule a consultation at 785-354-8518.