Crohn’s Disease

Bersano, Harris, Phillips, Prins

What is Crohn’s Disease?

A chronic inflammatory intestinal disease

that usually presents with abdominal pain,
fatigue, diarrhea, weight loss, and a
low-grade fever.

Image Source:
https://www.healthdirect.gov.au/surgery/abdominal-surgery-for-crohns-disease
Populations at Risk

● Most common in those ≤45 years of age

● Hispanic or non-Hispanic White
● With less than a high school level of education
● Not currently employed
● Born in the United States (compared with
adults born outside of the United States)
● Living in poverty
● Living in suburban areas
● Chronic inflammatory intestinal disease Image Source: https://www.healthcentral.com/condition/crohns-disease

● Genetic susceptibility
Signs and Symptoms

● Clinical presentation varies

○ Location
○ Severity
○ Disease behaviour
● Common presentation
○ Right lower quadrant Abdominal pain
○ Chronic diarrhea
○ Weight loss
● Can also have:
○ Fatigue
○ Anorexia
○ Rectal bleeding
○ Bloody diarrhea
○ Skin, joint, or eye extraintestinal manifestations
○ Erythema nodosum
○ Pauciarticular large joint arthritis
Image Source:
https://ecosh.com/crohns-disease-symptoms-causes-risk-factors-crohns-disease-diet-and-supplements-fo
r-crohns-disease-treatment/
Risk Factors

● Increased with cigarette smoking

● Nonsteroidal Anti-Inflammatory Medications
○ Won’t cause Crohn’s
○ Can make bowel symptoms worse
● High-fat or processed foods
● Mycobacterium avium paratuberculosis and
E.coli are connected with Crohn’s
● Infections can cause the onset of Crohn’s
● Stress
● Diets high in fat and sugar, low in fiber
● Age
● Race
Image Source: https://www.verywellhealth.com/crohns-disease-causes-and-risk-factors-4164358
Pathophysiology/Mechanism of Pathology

● Each patient has a unique pathogenic signature

● Complex and not completely understood
● Combination of genetic, epigenetic, immunological, and
microbiological mechanisms affected by exposure to triggering
factors.
● Chronic inflammation from T-cell activation leading to tissue
injury is implicated in the pathogenesis of Crohn disease.
● Environmental “triggers” that perturb the mucosal barrier, alter
the healthy balance of the gut microbiota, and abnormally
stimulate gut immune responses.
● Crohn’s disease pathogenesis is based on tissue inflammation,
caused by an unrestrainable immune response against luminal
bacterial antigens
○ CD4 T-Cells
○ CD8 T-Cells
○ B-Cells
○ CD14 monocytes
○ Natural killers
https://www.cghjournal.org/article/S1542-3565(20)31283-0/fulltext
Genetics

● Microbial gene products may influence

gene expression
○ Region of chromosome 16
■ Chromosome 16q12 activated nuclear
factor kappa B which is a component of the
innate immune response
● Muc2 gene reducing mucus production
● NOD2 is one of the most prominent genes
○ Defects in gene causes an increase microcellular
bacteria that damage the lumen of the gut
○ May also impact cytokine response which
disturbs gut homeostasis

https://commons.wikimedia.org/wiki/File:Human_chromosome_16_from_NCBI_Bookshelf.jpg
Transmission & Incidence

● Non-transmissible
● Genetic predisposition
○ Environmental factors
○ Immune system
○ Susceptibility genes and host microbiome
changes
○ Disruption of intestinal mucosa

Image Source: https://www.nationalheraldindia.com/health/novel-potential-therapy-for-crohns-disease-in-children

Mortality Rates

● Crohn’s Disease is not fatal on its

own. However it can lead to death
if left untreated and symptoms
become severe enough.
● Higher mortality rate

Image Source:
https://www.researchgate.net/figure/Colonoscopy-photographs-showing-extensive-and-deep-ulcers-together-with-nearly-t
otal-loss_fig2_265093225
Daily impacts of Crohn’s Disease

● Frequent bathroom visits

● Lack of energy
● Avoid certain foods & medications
● Increased stress/anxiety due to the disease

Image Source: https://www.medicinenet.com/crohns_disease/article.htm

Goal of Physical Therapy

● Manage stress
● Manage pain radiating into the hip, buttock, thigh, or knee
● Perhaps: decrease inflammation in the intestines

Image Source: https://www.everydayhealth.com/crohns-disease/living-with/can-yoga-help-relieve-crohns-symptoms/

 Considerations and Implications for Physical
Therapists
● Key sign is a granulomatous inflammatory
response
● May be confused with Ulcerative Colitis
(UC)
○ UC only affect the colon, where as Crohn's can
affect anywhere from the mouth to the anus
○ The whole colon is affected with UC
○ Crohn’s can still have healthy parts of the colon
followed by inflamed areas
● Presents differently with each patient
https://cdhf.ca/digestive-disorders/crohns-disease/ulcerative-colitis-vs-crohns-di
sease-whats-the-difference-infographic/
Prevention

● No prevention or cure
○ Antibiotics
○ Systemic
corticosteroids
○ Anti-inflammatory
drugs
○ Immunosuppressants
○ Anastomosis Surgery
○ Diet
○ Reducing stress https://www.healthcentral.com/condition/crohns-disease
Clinical Questions

1. True or False: Crohn’s Disease is curable through surgery.

2. As physical therapists, our management of Crohn’s Disease includes:

a. Perform a fecal transplant
b. Manage emotional stress through exercise
c. Prescribe medication
d. Recommend dietary changes to improve GI function
Resources

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