What is Inflammatory bowel disease - Crohn’s disease: Causes, Symptoms and Treatment

INFLAMMATORY BOWEL DISEASE:

Inflammatory bowel disease (IBD) encompasses chronic inflammation of all or part of the digestive tract. IBD primarily includes Crohn's disease and ulcerative colitis. 

CROHN’S DISEASE:

Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.  The disease is characterized by flare-ups and remissions.

CAUSES:

One possible cause is an immune system malfunction.  When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the normal cells in the digestive tract, too. Heredity factor seems to play a role in that IBD is more common in people who have family members with the disease. However, IBDs are usually diagnosed in young adults between the ages of 15 and 30. Children are twice as likely to be diagnosed with Crohn’s as with ulcerative colitis. Positive family history, cigarette smoking, use of pain killers, urbanization, and industrialization predispose to the disease. Caucasians and Ashkenazi Jews develop Crohn’s at a higher rate than other ethnicities. Stress and diet may worsen Crohn’s. Smoking increases your risk of developing Crohn's disease, and once you have it, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need repeated medications.

SYMPTOMS:

Symptoms related to inflammation of the GI tract:

  1. Abdominal cramps and pain.
  2. Persistent diarrhea.
  3. Rectal bleeding.
  4. Urgent need to move bowels.
  5. Sensation of incomplete evacuation.
  6. Constipation.

General symptoms: 

  1. Fever.
  2. Loss of appetite (anorexia).
  3. Weight loss.
  4. Fatigue.
  5. Night sweats.
  6. Loss of normal menstrual cycle.
  7. Joint pain, eye problems, a skin rash, or liver disease due to immune system involvement.
  8. Delayed development in children.

COMPLICATIONS:

  1. Abnormal communication of the intestine to the skin or another organ (fistula).
  2. Bowel obstruction.
  3. Narrowing of the intestine (stenosis).
  4. Ulcers of the mouth, anus, and genital area.
  5. Anal fissure (a track near the anus).
  6. Malnutrition.
  7. Colon cancer.
  8. Other problems like anemia (lack of rbc’s due to vitamin B12 and folic acid deficiencies) and bone loss (osteoporosis).

DIAGNOSES:

  1. Blood tests to look for infection or anemia.
  2. Fecal tests to see if there is hidden blood in your stool (occult)
  3. Capsule endoscopy or double-balloon endoscopy  -  two procedures that allow a better view of the small bowel.
  4. Flexible sigmoidoscopy, a procedure that helps your doctor view the last section of colon.
  5. Colonoscopy to enable doctors to get a good look at the entire length of your large intestine and to remove samples for analysis (biopsy).  The presence of clusters of inflammatory cells can help diagnose Crohn’s.
  6. Imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) to get detailed pictures of the abdominal area and intestinal tract.

TREATMENT:

The following are used to treat Crohn’s:

Immune system suppressors  -  Many of them like ustekinumab (Stelara); vedolizumab; natalizumab (Tysabri); vedolizumab (Entyvio); methotrexate (Rheumatrex); infliximab (Remicade), adalimumab (Humira); golimumab (Simponi) reduce inflammation and target your immune system.

Antibiotics  -  Thecommonly used metronidazole, ciprofloxacin, etc., reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn's disease.

Anti-diarrheal medications  -  A fiber supplement — such as psyllium powder (Metamucil) or methylcellulose (Citrucel) can help relieve mild-to-moderate diarrhea by adding bulk to your stool.  For more severe diarrhea, loperamide (Imodium) may be effective.

Anti-anxiety medications:  Help in psychological distress.

Vitamin B-12 shots  -  Crohn's disease can cause vitamin B-12 deficiency. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function.

Acetaminophen  -  For mild pain, your doctor may recommend acetaminophen.  NOT RECOMMENDED are ibuprofen, diclofenac sodium, naproxen sodium, etc., since they worsen the disease.

Iron supplements  -  If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.

Calcium and vitamin D supplements  -  These are taken to reduce osteoporosis.

Nutrition  -  A special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) is recommended to treat Crohn's disease.  This can improve overall nutrition and allow the bowel to rest.

Surgery  -  Surgical treatment is not recommended for Crohn’s disease.

Tags: Inflammatory bowel disease , chronic inflammation , crohn’s , persistent diarrhea , Rectal bleeding , constipation

 

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