Crohn's disease

Crohn's disease is an inflammatory condition of the digestive tract that affects children and adults. Common features of Crohn's disease include mouth sores, diarrhea, abdominal pain, weight loss, and fever. Patients can also have problems outside of the digestive tract, including a skin rash, joint pain, eye redness, and, less commonly, liver problems. Although Crohn's disease is usually chronic, medical and surgical treatment can help control the course of the disease, allowing many patients to experience long periods of symptom-free remission.

CAUSES

The exact cause of Crohn's disease is unknown. What is known is that the disease tends to run in families and affects certain groups more than others, suggesting that genetic factors are important.

The current belief is that, in a genetically susceptible person, a trigger leads the body's immune system to inappropriately cause inflammation in the digestive tract. Bacteria and food in the digestive tract probably also have a role. Once the inflammation begins, it causes damage to the intestines; this damage is mainly responsible for the symptoms of the disease.

COURSE OF CROHN'S DISEASE

Crohn's disease usually follows a pattern of flares (when the condition worsens) and remissions (when it improves). About 10 to 20 % of patients will enter remission after their first flare of Crohn's disease. The pattern in other patients can be quite variable, ranging from recurrent periods (weeks to months) of symptoms such as mild diarrhea and cramping to, less commonly, severe and disabling symptoms (such as severe abdominal pain and bowel obstruction).

Most cases of Crohn's disease primarily affect the terminal ileum (a region of the small intestine) and the colon, producing ileitis (inflammation of the ileum) and colitis (inflammation of the colon) . Inflammation in these areas can lead to the formation of abnormal passages (fistulas), perforation of the intestinal wall, or narrowing of the digestive tract (stricture) and obstruction. Crohn's disease can also affect the perianal area, producing fissures, ulcers, pockets of pus (abscesses), and fistulas.

TREATMENT

Many different drugs are used to treat Crohn's disease. The choice of medications will depend upon the area of the digestive tract affected by the disease and the symptoms. The following is commonly used medications:

Sulfasalazine (for treating Crohn's disease that is restricted to the colon)

5-aminosalicylates (they are formulated to be released in the terminal ileum -with Asacol- and throughout the small intestine -with Pentasa-)

Antibiotics (they can reduce the number of bacteria in the intestines, which can in turn reduce inflammation)

Steroids (such as prednisone and budesonide can induce remission in patients with active, moderate to severe Crohn's disease)

Immunomodulator drugs ( for patients who have not responded to "first line" therapy with drugs such as antibiotics, sulfasalazine, and 5-aminosalicylates)

 Infliximab (reserved for patients who do not respond adequately to first line therapy with antibiotics and 5-ASA drugs)

Surgery

Medical treatment can help control the symptoms and complications of Crohn's disease and may delay the need for surgery. Surgery is usually used as a last resort since it does not cure the disease, although in some patients it may be the fastest way to restore health. About 80 % of patients with Crohn's disease will require an operation at some time, usually to stop bleeding, to close fistulas and bypass obstructions, and often to remove the affected areas of the intestine.

It is important to have realistic expectations of surgery. Surgery can improve a patient's medical condition and can even be lifesaving. However, surgery does not cure Crohn's disease, and recurrence is likely.

 COMPLICATIONS

Over time, the intestinal problems of Crohn's disease and the ongoing inflammation can lead to secondary health problems. Fortunately, many of these problems can be anticipated and prevented; if they do occur, most can be successfully treated.

Inflammation of the stomach and upper small intestine

Ileitis

Ileocolitis and colitis

Malnutrition

Bone complications

Liver and gallbladder complications

Colorectal cancer

Skin conditions

Eye inflammation

Mouth sores

Perianal complications