CROHN’S DISEASE
Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients, and getting rid of waste. Inflammation (red, swollen, and tender areas) always affects the innermost lining of the gastrointestinal tract, called the mucosa. However, the disease can affect the deeper layers of the gastrointestinal wall and even extend through the entire bowel wall.
CAUSES
The exact cause of Crohn’s disease is unknown. Current research is exploring the possible connection of the disease to immune system problems and bacterial infections.
Diagram showing Crohn’s disease causing stricture in terminal ileum and in sigmoid colon
SYMPTOMS
Crohn’s disease can present as abdominal disease, anorectal (anus and rectum) disease, or both. Patients with Symptoms vary widely among patients and often come and go over a long period of time. These include:
- Abdominal cramping
- Abdominal pain
- Ongoing diarrhea
- Chronic constipation
- Bleeding with bowel movements
- Fever
- Extreme tiredness
- Weight loss
- Abscesses (infections) around the anus that come back
- Anal fissures
DIAGNOSIS
Colonoscopy will provide information on the extent of disease and guide treatment.
MEDICAL TREATMENT
Medication is always the first option unless emergency surgery is required. Several treatment approaches are used at the onset and for the long term to help patients control the disease. The most common initial therapy includes anti-inflammatory medication. Diet and lifestyle changes can also help.
SURGICAL TREATMENT
Surgery may be needed when patients develop disease-related abdominal and anorectal complications. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. Both of these conditions can be life-threatening. Immediate surgery may also be required for an abscess near the anus.
Abdominal surgery: Surgery is typically performed when the patient’s symptoms are no longer being controlled with their medications. This usually means there is a section of bowel that is either too scarred or narrow to function properly. The surgery can usually be performed laparoscopically . Emergency abdominal surgery is usually performed as an open procedure due to the urgency of the situation.
The most common procedure is removal of the last portion of the small bowel and the start of the large bowel (ileo-colic resection) to relieve abnormal, narrowed sections (strictures). Following removal of part of the bowel, the remaining bowel is reconnected if possible.
Anorectal surgery: This is most commonly done to open and drain anorectal abscesses. A seton (small drain) may be left in place for a period of time until the infection clears up. Surgery is also used to treat anorectal fistulas.
HOW CAN I REDUCE RECURRENCE?
Recurrence is most common in patients who stop taking their medications, so it is vital to follow your physician’s orders. Smoking negatively impacts every organ in the body and presents health risks for everyone, so quitting is advised. For patients with Crohn’s disease, smoking has been linked to higher recurrence rates, so quitting can reduce this risk.
