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Crohn's disease is a type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people, most commonly the small intestine. This inflammation often spreads into the deeper layers of the bowel. Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complications. There's no known cure for Crohn's disease, but therapies can greatly reduce its signs and symptoms and even bring about long-term remission and healing of inflammation. With treatment, many people with Crohn's disease can function well.
What are the First Signs of Crohn's Disease?
Early signs of Crohn's disease can easily be mistaken for other conditions. They may include:
- Frequent diarrhea
- Abdominal pain and tenderness
- Unexplained weight loss
- Blood in your poop
What is the Life Expectancy of Someone with Crohn's Disease?
Crohn’s disease isn’t fatal, and people with Crohn’s disease can live just as long as people without it. Still, managing your condition to prevent complications is important since Crohn’s can increase your risk of certain conditions. For example, regular colonoscopies can catch colon cancer early when it’s treatable.
Is Crohn's Disease Contagious?
Crohn’s disease is not contagious. Experts believe it occurs because a person’s immune system mistakenly attacks their body’s healthy cells. Genetics may also play a role. Some scientists also link certain bacterial infections with the onset of Crohn’s disease. Such bacteria include E. coli and MAP. However, experts need to conduct more research to determine whether these bacteria can cause the disease to develop.
Is Crohn's an Autoimmune Disease?
Crohn’s is an autoimmune condition – meaning that the immune system mistakenly attacks healthy cells. As the immune system interacts with different organisms, this may trigger inflammation and intestinal damage. There are many theories about why Crohn’s develops, including genetic factors, problems with the gut microbiome, and environmental exposure.
Is Crohn's Disease Hereditary?
Brothers, sisters, children, and parents of persons with IBD, including Crohn's disease, are slightly more likely to develop the disease themselves. About 10% to 20% of people with Crohn's disease have at least one other family member who also has the disease. The condition is more common in certain ethnic groups, such as Jews, and is more prevalent in Caucasians.
Scientists have identified a gene associated with Crohn's disease. This gene helps the body decide how to react to certain microbes. If the gene has changed or mutated in some way, your body's reaction to microbes may also be different from the normal reaction. Over time, IBD or Crohn's disease may develop. People with Crohn's disease have this mutated gene twice as often as people who do not have the disease.
How Serious is Crohn's Disease?
Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complications. There's no known cure for Crohn's disease, but therapies can greatly reduce its signs and symptoms and even bring about long-term remission and healing of inflammation. With treatment, many people with Crohn's disease can function well.
How Many People Have Crohn's Disease?
Researchers estimate that more than half a million people in the United States have Crohn’s disease. Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world. Experts do not know the reason for this increase. Crohn’s disease can develop in people of any age and is more likely to develop in people
- between the ages of 20 and 292
- who have a family member, most often a sibling or parent, with IBD
- who smoke cigarettes
Is Crohn's Disease a Disability?
The answer to that is yes – many people with Crohn’s do qualify for long-term disability benefits. However, your odds of benefit approval will depend on the severity of your condition and how you present your claim to your insurance company. The symptoms of Crohn's disease vary from case to case. Your insurance company won't automatically believe your Crohn's is a disability on diagnosis alone. You will need to show your insurance company how your condition affects your ability to work.
How Long Does a Crohn’s Flare-Up Last?
A period of Crohn’s flare-ups can last a few days or even a few months, depending on the severity. It’s important to keep your doctor informed of changes in your symptoms, especially if they get worse.
Which is Worse Ulcerative Colitis or Crohn's Disease?
Crohn's disease and UC (ulcerative colitis) are types of inflammatory bowel disease (IBD) that cause chronic inflammation of the digestive tract. While symptoms of Crohn's disease and UC are similar, there are some differences between the two conditions.
1. Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus, while ulcerative colitis affects only the colon (large intestine).
2. People who have Crohn's disease can have healthy parts of the intestine interspersed with the inflamed areas while ulcerative colitis is characterized by continuous inflammation of the colon.
3. Crohn's disease can affect all layers of the bowel walls while ulcerative colitis only affects the innermost lining of the colon.
4. In Crohn's disease, pain is felt throughout the entire abdomen while in ulcerative colitis, the pain is usually localized to the left side of the abdomen.
One form of IBD is not necessarily “worse” than the other. It depends on each patient and the severity of their disease. Ulcerative colitis may sometimes be considered “worse” because severe UC may require surgery more often than Crohn’s.
Types of Crohn’s Disease
Crohn’s disease can affect any part of your digestive tract, from your mouth to your anus (butthole). Most commonly, it causes inflammation in your small and/or large intestines. Types of Crohn’s disease include:
1. Ileocolitis: Inflammation in your lower small intestine and part of your large intestine. Ileocolitis is the most common type of Crohn’s disease.
2. Colitis: Inflammation in the lining of your large intestine.
3. Ileitis: Swelling and inflammation in your small intestine (ileum).
4. Gastroduodenal: Inflammation and irritation that affects your stomach and the top of your small intestine (the duodenum).
5. Jejunitis: Patchy areas of inflammation in the upper half of your small intestine (the jejunum).
6. Perianal disease: A portion of people have inflammation around the anus, which can cause fistulas and abscesses.
Signs and Symptoms of Crohn’s Disease
Symptoms may develop gradually or come on suddenly. They may be mild to severe. Some people have chronic symptoms until a provider successfully treats them, while others have symptoms that come and go. A “flare” is when symptoms are active. Common Crohn’s disease signs and symptoms include:
- Abdominal pain or cramps.
- Chronic diarrhea (watery stool).
- Loss of appetite and weight loss.
- Bloody stool (rectal bleeding).
- Mouth ulcers or pain in your mouth or gums.
- Fever and fatigue (tiredness that doesn’t improve with rest).
- Abscesses of infections around your anal canal.
Crohn’s can also cause symptoms in body parts outside of your digestive tract, including:
- Arthritis or joint pain.
- Rashes.
- Eye inflammation, such as uveitis and episcleritis.
- Kidney stones.
- Osteoporosis (loss of bone mass).
- Skin tags (usually around your anus).
- Inflammation in your bile ducts.
Crohn’s disease in children can cause growth delays or failure to grow properly.
Causes of Crohn’s Disease
The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate, but don't cause Crohn's disease. Several factors likely play a role in its development.
1. Immune system. A virus or bacterium may trigger Crohn's disease; however, scientists have yet to identify such a trigger. When your immune system tries to fight off an invading microorganism or environmental triggers, an atypical immune response causes the immune system to attack the cells in the digestive tract, too.
2. Heredity. Crohn's disease is more common in people who have family members with the disease, so genes may play a role in making people more likely to have it. However, most people with Crohn's disease do not have a family history of the disease.
1. Age. Crohn's disease can occur at any age, but you're likely to develop the condition when you're young. Most people who develop Crohn's disease are diagnosed before they're around 30 years old.
2. Ethnicity. Although Crohn's disease can affect any ethnic group, whites have the highest risk, especially people of Eastern European (Ashkenazi) Jewish descent. However, the incidence of Crohn's disease is increasing among Black people who live in North America and the United Kingdom. Crohn's disease is also being increasingly seen in the Middle Eastern population and among migrants to the United States.
3. Family history. You're at higher risk if you have a first-degree relative, such as a parent, sibling, or child, with the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease.
4. Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Smoking also leads to more severe disease and a greater risk of having surgery. If you smoke, it's important to stop.
5. Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. While they do not cause Crohn's disease, they can lead to inflammation of the bowel that makes Crohn's disease worse.
Complications of Crohn’s Disease
Crohn’s disease can cause complications that may require more treatment or, possibly, surgery.
1. Abscesses: Infected pus-filled pockets that form in your digestive tract or abdomen.
2. Anal fissures: Small tears in your anus that cause pain, itching and bleeding.
3. Fistulas: An abnormal tunnel-like opening that connects two body parts that don’t normally connect. For example, with Crohn’s disease, fistulas sometimes cause an opening between your rectum or anal canal inside your body and the skin surrounding your anus outside your body (anal fistula).
4. Bowel obstructions: A partial or total blockage in your intestine. Obstructions can develop when scar tissue forms or abnormal narrowing called strictures occur.
5. Malnutrition: Not getting the proper amount of nutrients. Inflammation can make it hard for your body to absorb key nutrients. Symptoms can make it difficult to consume the foods you need for energy.
6. Anemia: Low blood cell counts. Approximately 1 in 3 people with Crohn’s disease have anemia.
Crohn’s disease can also increase your risk of colon cancer and blood clots.
Foods to Avoid with a Crohn's Disease Diet Plan
The foods that trigger symptoms differ for each person with Crohn's disease. To know which foods to leave out of your diet plan, you'll need to determine which foods, if any, trigger yours. Many people with Crohn's disease find that one or more of the foods on the following list aggravate symptoms during disease flares. At least some of these listed foods may trigger your symptoms:
- Nuts and seeds (peanut butter, other nut butter)
- Raw fruits
- Raw vegetables
- Red meat and pork
- Spicy foods
- Whole grains and bran
Once you've identified foods that cause your symptoms to flare, you can choose either to avoid them or to learn new ways of preparing them that will make them tolerable. To do that, you'll need to experiment with various foods and methods of preparation to see what works best for you. For instance, if certain raw vegetables trigger a flare, you don't necessarily need to give them up. You may find that steaming them, boiling them, or stewing them will allow you to eat them without increased GI symptoms. If red meat increases fat in the stools, you could try eating ground sirloin or ground round to see if you can tolerate a leaner cut of beef. Or you might decide to rely on fish or low-fat poultry without skin as your main sources of protein.
How is Crohn's Disease Diagnosed?
Most people diagnosed with Crohn’s first see a healthcare provider because of ongoing diarrhea, belly cramping, or unexplained weight loss. As part of your workup, you may need to see a doctor who specializes in digestive diseases, called a gastroenterologist.
Your provider will consider your medical history (including your symptoms) and family history. They’ll perform a physical exam to see if you have signs of Crohn’s like swelling or tenderness in your belly. They may perform a series of tests to rule out other conditions before making a diagnosis.
A. Lab Tests
Lab tests check a sample of fluid or tissue for microscopic signs of disease.
1. Blood test: A blood test checks your blood cell counts and blood chemistry for signs of Crohn’s. A high white blood cell count may indicate inflammation or infection. Low levels of red blood cells indicate anemia, common with Crohn’s disease. A protein your liver makes called the C-reactive protein (CRP) may be elevated if there’s active inflammation.
2. Stool test: This test checks a stool (poop) sample for bacteria or parasites. It can rule out infections that cause chronic diarrhea. For example, a calprotectin fecal test measures inflammation in your intestines.
B. Imaging Procedures
Your provider may order imaging tests to take pictures of your digestive tract, such as:
1. Computed tomography (CT) scan: A CT scan creates images of your digestive tract using X-rays. It tells your healthcare provider how severe the inflammation is. You may need a CT enterography, which involves drinking a solution that highlights your small intestine so it stands out more in the images.
2. Magnetic resonance imaging (MRI): An MRI uses a large magnet and radio waves to create images of the inside of your body. It’s especially useful in showing fistulas around your small intestine and anus. You may need to drink a special contrast fluid before the procedure to clarify the images (MRI enterography).
C. Endoscopy
An endoscopy sends a thin tube with a light and camera (endoscope) into your digestive tract to take images or show videos of areas with inflammation. You’ll be sedated for these procedures.
1. Colonoscopy: During this procedure, a provider uses an endoscope to examine the inside of your colon and lower small bowel (ileum). They may remove a tissue sample (biopsy) to test for white blood cells.
2. Upper endoscopy: A provider passes an endoscope through your mouth and into your throat. An attached camera allows your provider to see inside, from your mouth to the start of your small intestine.
3. Capsule endoscopy: You swallow a small plastic capsule with a light and a camera that takes pictures as it moves through your digestive tract.
Treatment of Crohn’s Disease
Crohn’s disease cannot currently be cured but for most people, it can be well managed through medication, lifestyle choices, and sometimes surgery. Treatments may also need to change over time if they become less effective.
A. Medication
Medications for Crohn’s disease are mainly used to reduce inflammation. The main types include:
- aminosalicylates
- corticosteroids
- immunosuppressants
- biologics
- antibiotics
B. Diet
Diet has an important role to play in many aspects of Crohn’s disease, including treating active disease, managing symptoms, ensuring nutritional adequacy and complications of Crohn’s disease. Diet may also potentially support remission.
Examples of dietary treatments include:
- exclusive enteral nutrition
- Crohn’s disease exclusion diet
- low or moderate FODMAP diet
- moderate, low fiber, or low residue diet
- high energy and protein diet
- oral vitamin and mineral supplementation
C. Surgery
Surgery for Crohn’s disease is a treatment, not everyone will need. Sometimes parts of the bowel are too damaged to be healed by medications and the best way to return you to health is with an operation. The goal of surgery is to keep as much of the bowel as possible while restoring quality of life.
Common types of surgery include:
- resection
- stricturoplasty
- creating a stoma.
CAM Treatments for Crohn’s Disease
Some people use complementary and alternative medicine (CAM) to help manage symptoms of various conditions and diseases, including Crohn’s disease. The Food and Drug Administration (FDA) hasn’t approved these for treatment, but some people use them in addition to mainstream medications. Don’t add any new treatments to your current treatment plan without consulting your doctor. Some CAM treatments for Crohn’s disease include:
1. Probiotics: These may help prevent microorganisms from upsetting your gut’s natural balance and causing a Crohn’s flare. Scientific data about effectiveness is limited.
2. Prebiotics: These are potentially beneficial materials found in plants that help feed the good bacteria in your gut and increase their numbers.
3. Fish oil: Oily fish like salmon and mackerel are rich in omega-3s. Research is ongoing regarding the use of fish oil in the treatment of Crohn’s disease.
4. Supplements: Some herbs, vitamins, and minerals may help ease the symptoms of Crohn’s disease. Research is ongoing as to which supplements may be beneficial.
5. Acupuncture: Research has found that acupuncture, combined with moxibustion — a type of traditional Chinese medicine that involves burning dried medicinal herbs on or near your skin — may help improve some symptoms.
Tell your doctor if you use any CAM treatments or over-the-counter medications. Some of these substances can affect the efficiency of medications or other treatments. In some cases, an interaction or side effect could be dangerous or even life-threatening.
1. Stopping smoking. Quitting smoking is the best thing you can do to reduce your risk of flare-ups and complications.
2. Avoiding medications that can trigger flare-ups. Taking certain medicines can increase your risk of flare-ups. These include some types of NSAIDs (nonsteroidal anti-inflammatory drugs). Ask your healthcare provider what medicines to avoid if you have Crohn’s.
3. Avoiding foods that may trigger unwanted symptoms. There isn’t a single food that triggers inflammation. Still, some foods may make you more likely to have symptoms. Lactose intolerance can be an issue for some. If this is the case, you may need to avoid dairy. You may need to avoid carbonated beverages. If you have a stricture, your provider may advise you to avoid fiber. It’s a good idea to keep a food diary to know which foods are gentle on your stomach and which ones aren’t.
4. Eating foods that work for you with meals spread out. Eating several small meals instead of fewer large ones can reduce your risk of symptoms. When you eat, choose low-fat foods and drink plenty of water. You may benefit from avoiding caffeine and alcohol. Talk to your provider about a meal plan that’s healthy for you.
5. Caring for your mental health. Getting enough rest and exercising regularly improve your overall well-being, which makes life with Crohn’s more manageable. Caring for your mental health is especially important. Stress and anxiety are normal responses to this diagnosis. Seeing a mental health provider can help.
Ways to Find the Right Crohn's Specialist Near Me
Find the right specialist. It's one of the best things you can do for yourself when you have Crohn's. Because Crohn's is a lifelong illness, you want someone you can count on for the long haul. You also want someone you trust and feel at ease with because chances are you'll see a lot of your doctor over time.
You'll want to look for these 10 things in a Crohn’s specialist:
1. Background in treating Crohn's disease. Your Crohn's may be mild and need a little help. Or it may be severe and require complex treatment. In that case, the number one thing to look for is the right kind of gastroenterologist. A gastroenterologist is a doctor who specializes in digestion and problems in the gut. If you have severe Crohn's, find a gastroenterologist who specializes in inflammatory bowel disease. You can find one at most medical centers and teaching hospitals or through the Crohn's and Colitis Foundation of America. If you can't see a specialist, your primary care doctor may need to consult with one to plan your care.
2. Wants to work with your other doctors. Your Crohn's doctor should be willing to work with your primary care doctor, who is your partner to treat any other medical problems you may have. Your Crohn's doctor should also be able to refer you to people who will help you make other health changes such as quitting smoking, getting more exercise, or improving your diet.
3. Willing to treat Crohn's aggressively if necessary. The better your treatment is at keeping your gut from becoming inflamed, the more likely you are to avoid scarring and other health problems that Crohn's can cause. This helps you avoid hospital stays and surgeries and keep up with your job, family, and the things you enjoy.
4. Someone you can talk to. You want a doctor who can explain your disease or answer your questions fully and clearly. If your doctor doesn't have enough time to answer your questions, make sure a nurse or other person in the office can.
5. A treatment style that works for you. Do you prefer someone who's very direct or more personal? You'll want a doctor who's a good match.
6. Someone you like. Of course your doctor's skills and judgment matter. There's also a personal aspect. People who feel at ease with their doctors are more likely to stick with their doctors' plans and keep up with their prescriptions.
7. Looks beyond drug treatment. Your doctor should also talk to you about more than medications. You also need to discuss food and nutrition, helpful lifestyle habits like exercise and not smoking, and surgery if it could help you.
8. A good office staff. Does the staff answer your calls or return them right away? Are they polite and helpful?
9. Insurance. Is the doctor on your insurance plan?
10. Easy access. If your symptoms get worse, can you get in to see the doctor quickly? Does the doctor respond to your calls or emails? Can you access your results through a patient portal?
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