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Crohn’s Disease

Abby Greenleaf

ZO 116

Dr. Faith Hammer

12/08/2020

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Crohn’s disease is a type of inflammatory bowel disease that affects around 780,000

Americans, according to the Crohn’s and Colitis Foundation (2020). This digestive disease is an

abnormal immune system response that causes chronic inflammation in the digestive tract, which

leads to many discomforting symptoms. Crohn’s does not have an exact cause; scientists believe

that several factors including heredity, a malfunctioning immune system, poor diet, and stress

contribute to the cause. According to Healthline (2018), one of the causes of Crohn’s may be an

autoimmune reaction where the immune system attacks the healthy bacteria in the GI tract. This

inflammation causes thickening in the walls of the intestines and triggers the symptoms.

Heredity is a big factor in the cause of Crohn’s disease. When someone has a family

member with an Irritable Bowel Disease of any kind, especially Crohn’s then the odds increase

to about 35 percent(Healthline 2018). The end of the small bowel and the beginning of the colon

is where Crohn's is normally found, although it can affect any part of the GI tract. Crohn’s is

caused by a multitude of factors. Environmental factors, stress, diet, and an unhealthy lifestyle

may also contribute to the cause, however doctors and scientists still work to this day to find the

direct cause of the disease.

Crohn’s is an autoimmune disease that affects the entire GI tract; this fact means that

anywhere from the mouth to the anus can be affected. This disease is an inflammatory condition,

so it can also cause problems in other areas of the body as well. Crohn’s mainly affects the

digestive tract and the most common area of the disease involves the lower part of the

ileum(Healthline 2018). The inflammation that comes with Crohn’s disease can also affect other

parts of the intestines. A few other issues that patients with this disease may develop include

fistulas which can increase the risk of infection, ulcers, and sores in the mouth.

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The cardiovascular system is also affected from Crohn’s. Have an irritable bowel disease

can triple the risk of developing a blood clot in a (deep vein thrombosis) or a clot that blocks a

lung artery, known as a pulmonary embolism(Healthline 2020). Another potential threat to the

cardiovascular system for Crohn’s patients are the increased risk of lymphoma. Doctors may

treat Crohn’s with biologics, which repress the immune system and may increase the risk of

blood cancer. Another treatment for this diagnosis would be corticosteroids that may result in

high blood pressure.

There are a multitude of signs and symptoms that arise from this complex digestive

disease. When the disease is active or “flared” they include diarrhea, cramping, fever, fatigue,

abdominal pain, blood in the stool, mouth sores, reduced appetite, weight loss, and fistulas.

However, people with severe Crohn’s may also experience inflammation of the skin, eyes, joints,

liver or bile ducts, kidney stones, and iron deficiency anemia(Mayo Clinic 2020). Symptoms

may vary from person to person but most people do undergo flare ups that consist of a plethora

of unpleasant symptoms.

The physicians that diagnose and treat Crohn’s disease are Gastroenterologists.

Gastroenterology is the study of the normal function and diseases of the esophagus, stomach,

small intestine, colon, rectum, pancreas, bile ducts and liver(ACG 2019). A GI doctor must first

complete a 3-year residency in Internal Medicine, then goes through an additional fellowship in

Gastroenterology, which lasts about 3 years. These providers also receive training in endoscopy,

colonoscopy, and sigmoidoscopy. This is a specialized training that includes a detailed and

intensive study of how and when to perform endoscopy, optimal methods to complete the tests

safely, and the use of sedating medications to ensure comfort and safety of patients(ACG 2019).

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There are a few diagnostic tests that are utilized to detect Crohn’s disease in patients. The

first step in diagnosing Crohn’s is a Gastroenterologist going through a physical exam; asking a

series of questions about the patient's diet, exercise, and family history. Initial testing that the

doctor may order include a set labs consisting of the patient’s blood and stool. Further

examination may include X rays, CT scans or MRI’s of the abdomen and pelvis to get a detailed

picture of the GI tract. In order to get a more in depth look at the inside of the colon to confirm

Crohn’s as a diagnosis, the Gastroenterologist may suggest an upper endoscopy and a

colonoscopy. A colonoscopy is used to examine a lower part of the large intestine and the colon,

this test is preformed with a small flexible tube with a bright light on the end. An upper

endoscopy also known as an EGD is used to examine the upper parts of the GI tract. The lighted

tube is inserted through the mouth, maneuvered down the esophagus and ends up in the stomach

as far down as the duodenum. During these procedures biopsies of tissue inside the body are

often obtained for additional testing. The last way to test for Crohn’s disease would be to

preform a capsule endoscopy. This procedure is when a small pill sized camera is swallowed and

while it travels down the GI tract it takes pictures. All of these methods are used daily to help

patients that have gastrointestinal problems.

Treatment of Crohn’s disease varies from patient to patient; what works for one person

may flare up someone else. While there is no cure, for Crohn’s it can be managed and placed into

remission. One of the more common treatments that are used by Gastroenterologists is the use of

immune suppressants that help control the bodies inflammatory responses. Anti-inflammatory

drugs, corticosteroids, and antibiotics may also be used to treat an individuals

symptoms(HealthLine 2020). Biologics as well as medication is also a common treatment for

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Crohn’s patients, infusions such as Remicade are used to create antibodies that stop certain

proteins in the body from flaring.

Diet and nutrition also play a big role in helping put a patient Crohn’s in remission. Many

people have to pay special attention to specific foods in order to reduce the symptoms that they

are undergoing. Many people find that bland and softer foods cause less discomfort to them than

foods high in fiber or spicy. If all else fails and a patient ends up flaring, a surgical intervention

may be needed. About 70% of people with Crohn’s end up requiring surgery at some point along

their journey with this disease(CrohnsColitisFoundation 2020). Surgery becomes a necessary

intervention when medications, and a healthy lifestyle can no longer control the disease.

Development of a fissure, fistula, or intestinal obstruction may require surgery where the surgeon

removes the segment of diseased bowel and joins the two healthy bowles together. This

procedure may put the patients Crohn’s into remission for many years, although it does not

always last forever.

Crohn’s Disease is very complex and requires maintenance from the time of diagnosis.

Working in a Gastroenterology office I see Crohn’s patients daily; while some are in great

condition living in remission, others come in and are in such pain and discomfort with no hope or

relief. The providers I work with often say that they are intrigued by this disease, but it can be

very intimidating as the disease is constantly changing and it can vary so much from patient to

patient. While the road ahead for patients with Crohn’s disease is a long one, new information on

testing and treatments is always changing for the better.

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References:

Crohn's disease. (2020, October 13). Retrieved December 11, 2020, from https://
www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/
syc-20353304

Crohn's Disease Treatment Options. (2020). Retrieved December 11, 2020, from https://
www.crohnscolitisfoundation.org/What-is-crohns-disease/treatment

Thomas, J. (2018, September 24). Crohn’s Disease: Facts, Statistics, and You. Retrieved
December 10, 2020, from https://www.healthline.com/health/crohns-disease/facts-
statistics-infographic

Pietrangelo, A. (2020, August 17). The Effects of Crohn's Disease on the Body. Retrieved
December 10, 2020, from https://www.healthline.com/health/crohns-disease/effects-of

What is a Gastroenterologist? (2019, September 09). Retrieved December 11, 2020, from https://
gi.org/patients/gi-health-and-disease/what-is-a-gastroenterologist/




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