Crohn’s disease

The symptoms of IBD vary from person to person, may change over time, and can range from mild to severe.

• Chronic diarrhea (for more than 4 weeks)
• Stomach pain or cramps
• Fever
• Fatigue
• Mouth sores
• A loss of appetite
• Sensation of incomplete evacuation
• Nausea and vomiting
• Rectal bleeding
• Anemia (a condition in which you have fewer red blood cells than normal)
• Swelling in the inner lining of the stomach
• A feeling of fullness
• Constipation
• Weight loss
• Mucus in stool
• Blood stains in stool

During a flare of Crohn’s disease, a person may also develop:

• Arthritis
• Uveitis (eye inflammation)
• Skin rash and inflammation
• Liver or bile duct inflammation
• Abscess (a collection of pus, which can develop in the abdomen, pelvis, or around the anal area)
• Fistula (intestinal ulcers that extend and form a tunnel to another part of the intestine, the skin, or another organ)
• Intestinal obstruction (a blockage in the intestine)
• Anal fissures (small tears in the anus that may cause itching, pain, or bleeding)
• Ulcers (open sores in the mouth, intestines, or anus)
• Malnutrition (occurs when the body does not receive the necessary vitamins, minerals, and nutrients)
• Inflammation in other areas of the body, such as joints, eyes, and skin

The exact cause of inflammatory bowel disease (IBD) is unknown, but it is thought to involve a combination of factors, including:

• Genetic predisposition
• Infectious agents
• Immunological responses
• Dietary influences
• Environmental factors

Crohn's disease causes inflammation (swelling) anywhere from the mouth to the anus. However, the disease most commonly affects the junction of the small intestine and the colon (ileum). It begins with lesions near the intestinal crypt (a gland found in the intestines) and eventually spreads to form ulcers, first in the superficial layer and then in deeper intestinal tissues.

As the swelling worsens, non-caseating granulomas (cell swelling without cell death) form, which is very common in Crohn's disease. This ongoing swelling can lead to bowel obstruction and stricture formation (a narrowing of the bowel that can result in an intestinal blockage).

Risk factors for Crohn's disease may include:

1. Genetic predisposition
   Genetics may play a role, as Crohn's disease can run in families. Having a close relative with Crohn's disease increases the likelihood of developing the condition. If both parents have inflammatory bowel disease (IBD), the risk of developing Crohn's disease rises to 35%. Children with one parent who has Crohn's disease have a 7 to 9 percent lifetime risk of developing the condition and a 10 percent chance of developing some form of inflammatory bowel disease.
2. Age
   Crohn's disease can occur at any age, but the condition mostly develops before or around 30 years of age.
3. Immunity
   Crohn’s disease is an autoimmune-mediated inflammatory condition. The immune system typically attacks and kills foreign invaders such as bacteria, viruses, fungi, and other microorganisms. An autoimmune reaction occurs when the immune system incorrectly attacks healthy cells, causing an abnormal response in the intestinal tract and resulting in swelling. This leads to chronic inflammation, ulceration, intestinal wall thickening, and, eventually, Crohn's disease symptoms.
4. Stress
   Stress may play a significant role in the pathogenesis of IBD. It has been proposed that stress may initiate or reactivate gastrointestinal inflammation, leading to the deterioration of clinical symptoms of IBD.
5. Environmental factors
   Several environmental factors can increase the risk of developing and flaring up Crohn’s disease, such as:
   • Painkillers: Long-term use of painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, especially in women, increases the risk of IBD.
   • Smoking: Cigarette smoking increases the likelihood of developing Crohn's disease. Active smokers are more than twice as likely to develop Crohn's disease as nonsmokers.
   • Poor diet: Dietary habits high in sugar, omega-6 fatty acids, polyunsaturated fatty acids, total fat, oil, and meat have been associated with an increased risk of developing Crohn's disease. IBD is not triggered by any one particular food, but certain foods can aggravate symptoms for some individuals.
   • Appendicitis: Children who have their appendix removed are less likely to develop ulcerative colitis later in life, but they may be more likely to develop Crohn's disease.
   • Oral contraceptives or hormone replacement therapy: Both hormone replacement therapy and oral contraception may increase the risk of IBD in women.
   • Antibiotics: Antibiotic exposure during childhood may increase the risk of IBD or Crohn’s disease.

To diagnose Crohn's disease, doctors typically use a combination of tests. Before undergoing a physical examination, you must inform your doctor about your medical history, including any medications you are taking and your family history.

1. Physical Examination

• Examines your abdomen for bloating.
• Uses a stethoscope to listen for sounds within your abdomen.
• Taps on your abdomen to detect tenderness and pain, as well as to determine whether your liver or spleen is abnormal or enlarged.

2. Lab Tests

• Blood Test: This test checks for high levels of white blood cells, which are indicative of inflammation or infection. The test also looks for anemia, or a low red blood cell count.
• Stool Test: This test checks for bacteria or parasites and is useful in ruling out infections that cause chronic diarrhea.

3. Imaging Tests

• Intestinal Endoscopy: This includes the following:
• Endoscopy and Colonoscopy: These are invasive tests in which a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time.
• Biopsy: During the biopsy, a small piece of tissue is removed from the inside of the intestine for further testing and analysis. A biopsy sample is also taken in the case of cancer.
• Chromoendoscopy: A blue liquid dye is sprayed into the colon to highlight and detect minor changes in the lining of the intestine. Polyps can also be removed and/or biopsied.
• Capsule Endoscopy: In this procedure, a capsule containing a tiny camera is swallowed, allowing the doctor to visualize the inside of the digestive tract.
• X-rays and Fluoroscopy: For this procedure, you will be asked to stand or sit in front of an x-ray machine and drink barium. The barium will make your upper GI tract more visible on the x-ray, and the radiologist will observe the barium moving through your upper GI tract on x-ray and fluoroscopy.
• CT Scan and Magnetic Resonance Enterography (MRE): A CT scan (computed tomography) takes a series of x-rays to create a picture of the digestive tract. MRE is an imaging test that produces detailed pictures of your small intestine.

The "treat to target" or "tight control" approach is quickly becoming the standard in the treatment and management of many chronic conditions, including IBD and Crohn's disease. Certain lifestyle modifications can help prevent the condition as follows:

• Follow a few dietary rules: Limit dairy products and adopt a fibrous diet rich in fruits, vegetables, legumes, and whole grains. Restrict foods low in fiber, such as processed and packaged foods, milk, and meat products. Want to know how a healthy diet can help you? Read This Now
• Drink plenty of water: Aim for a minimum of 8 glasses of water daily. Limit alcohol and caffeine intake, as they can lead to dehydration.
• Quit smoking: Cigarette smoking can exacerbate Crohn's symptoms. Looking to quit smoking but finding it difficult? Read about some practical ways to help you get rid of this unhealthy habit.
• Get screened for colorectal and cervical cancer: Consult your doctor about colorectal cancer screening, which may need to begin before age 50 for patients with IBD. Women with IBD should discuss cervical cancer prevention with their doctor, as it is more common in this population.
• Immunize yourself: Immunizations against infectious diseases are essential for primary prevention. IBD patients are at higher risk for vaccine-preventable illnesses such as influenza, pneumococcal pneumonia, and shingles. Following vaccination guidelines for inactivated vaccines can help reduce these complications. Note: Immunization is key to disease prevention. Want to Know More About Immunization? Read Here
• Exercise regularly: Stay active by exercising regularly. Light exercises, such as walking after heavy meals, can aid digestion.
• Manage stress: Stress and anxiety can aggravate Crohn's disease symptoms and trigger flare-ups. Is stress affecting your overall well-being? Try some relaxation techniques to manage stress.

The medical treatment is broadly classified into five groups:

I. Aminosalicylates

Aminosalicylates help control swelling in the intestinal wall. They are usually prescribed for individuals who are newly diagnosed with Crohn’s disease and have mild symptoms. These drugs include:

• Balsalazide
• Mesalamine
• Olsalazine
• Sulfasalazine

II. Corticosteroids

Corticosteroids, also known as steroids, suppress the immune system and reduce swelling. They are typically given to individuals with moderate to severe symptoms and are effective for controlling flare-ups in the short term. Due to side effects, they are not recommended for long-term or maintenance use. Drugs include:

• Budesonide
• Hydrocortisone
• Methylprednisolone
• Prednisone

III. Immunomodulators

Immunomodulators suppress the immune system, leading to reduced swelling in the digestive tract. These medications are used to maintain remission in individuals who have not responded to other treatments or have only responded to steroids. The drugs include:

• 6-mercaptopurine
• Azathioprine (6-MP)
• Cyclosporine
• Methotrexate

IV. Biologic Therapies

Biologic therapies are indicated for individuals with moderate to severe active disease who have not responded well to conventional therapy. The drugs used include:

• Adalimumab
• Certolizumab
• Infliximab
• Natalizumab
• Vedolizumab
• Ustekinumab

V. Other Medicines

• Acetaminophen: Used for mild pain.
• Antibiotics: Used to prevent or treat complications involving infection, such as abscesses and fistulas, including ciprofloxacin and metronidazole.
• Loperamide: Helps to slow or stop severe diarrhea.

VI. Surgery

Even with medications, many individuals will require surgery to treat their Crohn’s disease. Various types of operations include:

1. Small Bowel Resection: This surgery often involves the removal of the diseased segment of the bowel (resection), with the two ends of healthy bowel joined together (anastomosis). There are two types:
• Laparoscopic: A minimally invasive technique where a laparoscope is inserted for a close-up view of the small intestine.
• Open Surgery: Involves making a 6-inch incision in the abdomen to remove the diseased or blocked section of the small intestine and reconnect the intestines.
2. Subtotal Colectomy or Large Bowel Resection: This procedure removes part of the large intestine and is also of two types:
• Laparoscopic Colectomy: The surgeon removes the diseased or blocked section of the large intestine and reconnects the ends.
• Open Surgery: Involves a 6-inch incision in the abdomen to remove the diseased or blocked section of the large intestine and reconnect the intestines.
3. Proctocolectomy and Ileostomy: This surgical procedure removes the entire colon and rectum. An ileostomy creates a stoma or opening in the abdomen from a section of the ileum.

Some people develop complications that may require urgent medical care, which includes:

• Fistulas: Fistulas are ulcers on the intestine's wall that spread and form a tunnel (fistula) to another part of the intestine, the skin, or another organ.
• Stricture: A narrowing of an intestine section caused by scarring, which can result in an intestinal blockage.
• Abscess: A collection of pus that can form in the abdomen, pelvis, or around the anal area. A doctor may drain an abscess with a needle inserted through your skin or through surgery.
• Perforated bowel: Chronic intestine swelling can weaken the wall to the point where a hole forms.
• Anal fissures: Small tears in the anus that can cause itching, pain, and bleeding. The majority of anal fissures heal with medical treatment, such as ointments, warm baths, and dietary changes.
• Intestinal obstruction: A blockage in the intestine.
• Ulcers: Open sores in your mouth, intestines, anus, or perineum.
• Malabsorption and malnutrition: Including deficiency of vitamins and minerals. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
• Swelling: In other parts of the body such as your joints, eyes, and skin.

Complications outside the GI tract: Some patients develop symptoms that are related to the disease but affect other parts of the body. The extraintestinal complications include:

• Eyes: Redness, pain, and itchiness.
• Mouth: Sores.
• Joints: Swelling and pain.
• Skin: Tender bumps, painful ulcerations, and other sores or rashes.
• Bones: Osteoporosis.
• Kidney: Stones.
• Anemia: A condition in which you have fewer red blood cells than normal.
• Liver: Hepatitis and cirrhosis - occurs rarely.
• Cancer: People with Crohn’s disease of the colon or ulcerative colitis have a higher risk for colorectal cancer than the general population.
• Blood clots: People with IBD have about a three times greater risk than the general population for developing blood clots that form in veins and lung arteries.
• Primary Sclerosing Cholangitis (PSC): PSC is a form of severe swelling and scarring that develops in the bile ducts.

Along with the medicine your doctor prescribes, you may want to add “complementary” treatments to help with Crohn’s symptoms, boost your immune system, or just feel better every day.

1. Pay attention to diet: Changing your diet can help reduce symptoms. Consider the following diet modifications:
   • Avoid carbonated drinks.
   • During a flare-up, avoid high-fiber foods, dairy, sugar, high-fat foods, and spicy foods.
   • Drink more liquids.
   • Eat small meals; boil or steam food instead of frying it.
   • Keep a food diary to help identify foods that cause problems.
2. Probiotics: Probiotics aim to restore balance by adding good bacteria in the gut. They can help improve digestion, and certain strains have shown to reduce symptoms of Crohn’s. Food sources of probiotics include yogurt and tofu. Here’s more about the health benefits of probiotics.
3. Prebiotics: Prebiotics provide fuel for the good bacteria growing in your digestive tract. Some prebiotic sources include asparagus, legumes, and bananas. Probiotics and prebiotics may prove effective in keeping our gut healthy. Check out our prebiotics and probiotics supplement range.
4. Anti-inflammatory food: This includes virgin olive oil, green leafy vegetables (spinach, kale), fatty fish (tuna, salmon), and fruits (strawberries, cherries, oranges). These foods help combat free radical damage and encourage less overall inflammation. Read more about an anti-inflammatory diet for a healthy body.
5. Herbs:
   • Aloe vera juice: Has calming effects that may help digestion and improve immunity.
   • Glutamine: An amino acid that aids in intestine functioning.
   • Turmeric (Haldi): It has anti-inflammatory properties and reduces swelling.
   Read more about 5 other benefits of turmeric for a healthy body.
6. Note: Talk to your doctor or dietician if you have any concerns about diet or food. Do not start any supplements or dietary modifications on your own without consulting your doctor or dietician.
7. Exercise and yoga: Any form of exercise or yoga can ease stress and is a great way to relax, helping your intestines function more normally. This can be key for Crohn’s, as stress can trigger flare-ups and worsen symptoms. Know more about yoga benefits.
8. Take proper rest: During flare-ups, consider consuming a liquid diet to allow your system to rest and reset. Aside from bowel rest, aim for extra sleep, proceed slowly, avoid stress and intense exercise, and take naps as needed. Allow your body to heal.
9. Moxibustion: This is a type of traditional Chinese medicine typically administered alongside acupuncture. The two approaches are thought to complement each other effectively. Moxibustion involves burning dry herbs close to your skin, often near acupuncture points. This combined treatment may help alleviate Crohn's symptoms.