Symptoms And Treatments Of Crohn's Disease

A chronic form of inflammatory bowel disease (a group of chronic disorders that cause inflammation or ulceration in the small and large intestines). Crohn's disease causes severe irritation in the gastrointestinal tract. It usually affects the lower small intestine (called the ileum) or the colon, but it can affect the entire gastrointestinal tract. Also called regional enteritis and ileitis. See also Inflammatory Bowel Disease (IBD) and Granuloma.

Most often, IBD is classified either as Colitis (Ulcerative) or Crohn disease. While ulcerative colitis affects the inner lining of the colon and rectum, Crohn disease extends into the deeper layers of the intestinal wall. It is a chronic condition and may recur at various times over a lifetime. Crohn's disease may also be called ileitis or enteritis.

About 20% of cases of Crohn disease appear to run in families. It is a 'complex trait', which means that several genes at different locations in the genome may contribute to the disease. A susceptibility locus for the disease was recently mapped to chromosome 16.

Because some of the genetic factors involved in Crohn disease may also contribute to ulcerative colitis susceptibility, research into Crohn disease may assist in further understanding both types of IBD.

Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn's disease affects males and females equally and seems to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of IBD, most often a brother or sister and sometimes a parent or child.

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.

The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohn's disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery.

Nutritional complications are common in Crohn's disease. Deficiencies of proteins, calories, and vitamins are well documented in Crohn's disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption).

Other complications associated with Crohn's disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.

Treatment for Crohn's disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure.

Drugs are the usual therapy for Crohn's disease and ulcerative colitis. These include anti-inflammatory agents like Azulfidine as well as steroids and immunosuppressant agents borrowed from the cancer arena. All these medications have side effects and are often ineffective. With ulcerative colitis, the ultimate "solution" is removal of the large intestine, with ileostomy (external bag). For Crohn's disease, however, surgery produces less conclusive results. Sometimes patients with Crohn's disease are subjected to multiple surgeries with progressive shortening of their intestines until they are subject to the debilitating end-game of short-gut syndrome.

The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.

Of greatest interest is Omega-3 fish oil, recently demonstrated to be helpful in both ulcerative colitis and Crohn's disease. Antioxidants appeared to play a special role in protection of the intestinal cells from inflammation. It is believed that highly reactive free radicals literally disrupt cell membranes and cause inflammation in the gut. Several studies point to critical depletion of vitamin C, selenium, zinc, and vitamin E in patients with inflammatory bowel disease. Vitamin C and zinc must be supplemented carefully, particularly because of their potential to cause gastrointestinal upset.

Additional vitamins that appear to play a role in repair include folic acid, which may be depleted due to the use of azulfidine or related medication. A significant percentage of patients with IBD may be B12 deficient, especially those who have undergone surgery which removes a critical part of the intestine that absorbs B12. Because of chronic diarrhea fat-soluble vitamins like A and D may be depleted as well.

The loss of magnesium through diarrhea and fat malabsorption usually occurs after intestinal surgery or infection, but it can occur with chronic malabsorptive problems such as Crohn's disease, gluten sensitive enteropathy, and regional enteritis. Individuals with these conditions may need extra magnesium. The most common symptom of fat malabsorption, or steatorrhea, is passing greasy, offensive-smelling stools.

The nutrients mentioned above reflect the major nutritional supplements that may help the condition. Please do remember however that nutritional supplementation is an adjunct to medical treatment and in no way replaces medical treatment.

- Rude RK and Olerich M. Magnesium deficiency: Possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453-61.

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