Crohn’s disease

Several factors can increase the likelihood of developing Crohn's disease:

Genetic Factors

Genetics may play a significant role in the development of Crohn’s disease. The condition often runs in families, and individuals with a close relative who has Crohn's disease have a higher risk of developing it themselves. Studies suggest that children of parents with inflammatory bowel disease (IBD) have a 7-9% lifetime risk of developing the condition, with a 10% chance of developing some form of IBD.

Age

Crohn's disease can occur at any age but is most commonly diagnosed before the age of 30.

Immune System

Crohn’s disease is classified as an autoimmune disorder, meaning the immune system mistakenly attacks healthy cells in the body. This leads to abnormal inflammation in the intestines, causing symptoms such as ulcers, thickened intestinal walls, and chronic swelling.

Stress

Stress is believed to play a role in the development and worsening of Crohn's disease. Stress may trigger or exacerbate gastrointestinal inflammation, leading to a flare-up of symptoms.

Environmental Factors

Several environmental factors can increase the risk of developing or exacerbating Crohn’s disease, including:

• Painkillers: Long-term use of pain medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, especially in women, has been linked to a higher risk of developing IBD.
• Smoking: Smoking cigarettes significantly raises the likelihood of developing Crohn's disease. Smokers are more than twice as likely to develop Crohn’s disease as non-smokers.
• Diet: A diet rich in sugars, omega-6 fatty acids, polyunsaturated fats, total fats, oils, and meats has been associated with an increased risk of Crohn’s disease. However, no single food has been proven to directly trigger IBD, though certain foods may worsen symptoms for some people.
• Appendicitis: Interestingly, children who have their appendix removed may have a lower risk of developing ulcerative colitis later in life, but they may have a slightly higher risk of Crohn’s disease.
• Oral Contraceptives and Hormone Replacement Therapy (HRT): Both oral contraceptives and HRT in women have been associated with an increased risk of IBD.
• Antibiotics: Early exposure to antibiotics, particularly in childhood, has been linked to an increased risk of developing Crohn’s disease or other forms of IBD later in life.

Diagnosing Crohn's disease typically involves a combination of different tests. It is important to inform your doctor about your medical history, including any medications you are taking and your family’s health history, prior to the examination.

Physical Examination

• The doctor will check your abdomen for signs of bloating.
• Using a stethoscope, the doctor will listen for sounds within your abdomen.
• The doctor may tap on your abdomen to identify areas of tenderness or pain and to check for any abnormalities in the liver or spleen.

Laboratory Tests

• Blood Test: This test looks for an elevated white blood cell count, which can indicate inflammation or infection. It also helps detect anemia, a condition where the red blood cell count is low.
• Stool Test: This test screens for the presence of bacteria or parasites, which helps rule out infections that may cause chronic diarrhea.

Imaging Tests

• Intestinal Endoscopy: This involves using a probe to examine the digestive tract. Depending on the type of procedure, the probe may be inserted through the mouth (endoscopy) or the rectum (colonoscopy) to observe the inner lining of the gastrointestinal tract in real-time.
• Biopsy: A small tissue sample is collected from the intestines during an endoscopy or colonoscopy for further examination. This is also done to test for cancer.
• Chromoendoscopy: A special blue dye is sprayed into the colon to highlight any subtle changes in the intestinal lining. This technique can also help detect and remove polyps.
• Capsule Endoscopy: A small capsule containing a camera is swallowed, allowing the doctor to visualize the inside of the digestive tract as it moves through.
• X-rays and Fluoroscopy: This procedure requires you to drink barium, which shows up on an x-ray. The radiologist observes the movement of the barium through the digestive tract using x-rays and fluoroscopy.
• CT Scan and Magnetic Resonance Enterography (MRE):
• A CT scan involves taking a series of x-rays to create detailed images of the digestive tract.
• MRE produces high-resolution images of the small intestine, offering detailed insights into the condition of the digestive system.

The “treat to target” or “tight control” strategy is becoming a common approach for managing chronic conditions like Crohn’s disease and other forms of inflammatory bowel disease (IBD).

There are several lifestyle changes that can help reduce the risk or prevent the onset of Crohn’s disease:

Follow Healthy Dietary Guidelines

This includes limiting the consumption of dairy products and focusing on a high-fiber diet with plenty of fruits, vegetables, legumes, and whole grains. Avoid processed and packaged foods, as well as meats and milk products that are low in fiber.

Stay Hydrated

Aim to drink at least 8 glasses of water a day. Limit alcohol and caffeine intake, as these can cause dehydration.

Quit Smoking

Smoking can trigger or worsen symptoms of Crohn’s disease, so it is essential to quit for better management of the condition.

Get Regular Screenings

Discuss with your doctor about early screening for colorectal cancer, as people with IBD may need to start screenings before 50. If you are a woman with IBD, cervical cancer screenings are also recommended, as the condition can increase the risk of cervical cancer.

Ensure Proper Immunization

Vaccinations against preventable diseases like influenza, pneumonia, and shingles are crucial for IBD patients, as they are more susceptible to these illnesses. Following vaccination guidelines for inactivated vaccines is key to minimizing infectious complications.

Exercise Regularly

Engage in regular physical activity to improve digestion. After heavy meals, light exercises like walking can aid in the digestion process.

Manage Stress

Stress and anxiety can exacerbate symptoms of Crohn’s disease and even trigger flare-ups, so it is important to find ways to manage and reduce stress.

Doctors to Consult

To properly diagnose and manage Crohn’s disease, it is important to consult the right healthcare professionals:

• General Physician: Your first point of contact for any health concerns.
• Infectious Disease Specialist: These specialists treat infections caused by bacteria, viruses, fungi, and other pathogens, and can help rule out any infections that may be complicating your symptoms.
• Gastroenterologist: A doctor specializing in disorders of the gastrointestinal tract and related organs, essential for diagnosing and treating conditions like Crohn’s disease.

When to See a Doctor?

You should seek medical attention if you experience chronic Crohn’s disease symptoms or if you develop any of the following signs:

• Persistent diarrhea
• Vomiting
• Blood or mucus in stools
• Fever
• Unexplained weight loss
• Severe abdominal pain
• Fatigue
• Night sweats

These symptoms may indicate a flare-up or worsening of the condition, and timely medical intervention is crucial.

The treatment for Crohn's disease can be grouped into five main categories:

I. Aminosalicylates

These medications help reduce inflammation in the intestines and are typically prescribed to individuals newly diagnosed with mild symptoms of Crohn's disease. Common drugs in this category include:

• Balsalazide
• Mesalamine
• Olsalazine
• Sulfasalazine

II. Corticosteroids

Corticosteroids are used to suppress the immune system and decrease inflammation. These are generally prescribed to individuals with moderate to severe symptoms and are effective in controlling flare-ups in the short term. However, due to potential side effects, they are not suitable for long-term or maintenance therapy. Common corticosteroids include:

• Budesonide
• Hydrocortisone
• Methylprednisolone
• Prednisone

III. Immunomodulators

Immunomodulators work by suppressing the immune system to reduce inflammation in the digestive tract. They are often used for maintaining remission in patients who have not responded well to other medications or who have had limited response to steroids. These medications include:

• 6-mercaptopurine (6-MP)
• Azathioprine
• Cyclosporine
• Methotrexate

IV. Biologic Therapies

Biologic drugs are used for patients with moderate to severe active Crohn's disease who have not responded to standard treatments. These biologics include:

• Adalimumab
• Certolizumab
• Infliximab
• Natalizumab
• Vedolizumab
• Ustekinumab

V. Other Medications

• Acetaminophen: Used for mild pain relief.
• Antibiotics: These are used to treat or prevent infections, such as abscesses and fistulas. Common antibiotics include ciprofloxacin and metronidazole.
• Loperamide: Helps manage severe diarrhea by slowing bowel movements.

VI. Surgery

For many patients, surgery is required even when medications are used. Surgical options for treating Crohn's disease include:

Small Bowel Resection

• This procedure involves removing the diseased part of the small intestine. The healthy ends of the intestine are then joined together (anastomosis). There are two types:
• Laparoscopic: Minimally invasive surgery where a small camera is inserted into the abdomen to remove the diseased section.
• Open Surgery: A larger incision is made to remove the affected part of the small intestine and reconnect the intestines.

Subtotal Colectomy or Large Bowel Resection

This surgery involves the removal of part of the large intestine. It can be performed as:

• Laparoscopic Colectomy: The diseased section of the large intestine is removed through small incisions.
• Open Surgery: A larger incision is made to remove the diseased section and reconnect the intestine.

Proctocolectomy and Ileostomy

This surgery removes the entire colon and rectum. An ileostomy is created by making an opening in the abdomen through which waste is collected in a pouch.

Some individuals with Crohn’s disease may develop serious complications requiring immediate medical intervention. These include:

Fistulas

Fistulas are abnormal passages that form between different parts of the intestine or between the intestine and other organs or the skin.

Strictures

Strictures are narrowings of the intestine caused by scarring, which can lead to a blockage in the bowel.

Abscesses

Abscesses are pockets of pus that may form in the abdomen, pelvis, or around the anus. These may require drainage via a needle or surgery.

Perforated Bowel

Long-term inflammation can weaken the intestinal wall, causing it to rupture, leading to a life-threatening condition.

Anal Fissures

Small tears in the skin around the anus can cause pain, bleeding, and discomfort. These usually heal with treatment such as ointments and dietary changes.

Intestinal Obstruction

A blockage in the intestines can occur, requiring surgical intervention in severe cases.

Ulcers

Open sores may develop in the mouth, intestines, anus, or perineum.

Malabsorption and Malnutrition

Crohn’s disease can affect the body’s ability to absorb essential nutrients, leading to deficiencies in vitamins and minerals. Some patients may require intravenous fluids or feeding tubes to address malnutrition.

Systemic Swelling

Inflammation may spread to other areas of the body, such as the joints, eyes, and skin.

Extra-intestinal Complications

Crohn’s disease can also cause problems outside the digestive system, including:

• Eyes: Redness, pain, and irritation.
• Mouth: Mouth sores or ulcers.
• Joints: Pain, swelling, and stiffness.
• Skin: Tender bumps, painful sores, or rashes.
• Bones: Osteoporosis or thinning of the bones.
• Kidneys: Formation of kidney stones.
• Anemia: A reduction in red blood cells, leading to fatigue.
• Liver: Rarely, Crohn's disease may cause liver complications like hepatitis and cirrhosis.
• Cancer: Patients with Crohn’s affecting the colon are at an increased risk of developing colorectal cancer.
• Blood Clots: There is a higher risk of blood clot formation, especially in veins and lungs.
• Primary Sclerosing Cholangitis (PSC): A condition that causes severe inflammation and scarring in the bile ducts.

It is crucial for patients with Crohn's disease to work closely with their healthcare team to manage these potential complications effectively.

In addition to the medications prescribed by your doctor, you may wish to explore "complementary" treatments to help manage Crohn's symptoms, enhance your immune function, or simply feel better on a daily basis. Here are some alternative therapies to consider:

1. Dietary Adjustments

Changing your diet can help alleviate symptoms. Some key dietary changes include:

• Avoiding Carbonated Beverages: These can cause bloating and discomfort.
• During flare-ups: Limit high-fiber foods, dairy, sugar, fatty foods, and spicy items.
• Hydration: Drink plenty of fluids throughout the day.
• Smaller, more frequent meals: Opt for boiling or steaming food rather than frying.
• Food Diary: Keep track of what you eat to identify foods that may trigger flare-ups.

2. Probiotics

Probiotics help restore balance in your gut by introducing beneficial bacteria. These can improve digestion, and certain strains have been shown to reduce Crohn’s symptoms.

Sources of probiotics include yogurt, tofu, and other fermented foods.

3. Prebiotics

Prebiotics act as food for the beneficial bacteria in your digestive system. They promote the growth of these good bacteria, contributing to better gut health.

Sources of prebiotics include asparagus, bananas, and legumes.

4. Anti-Inflammatory Foods

Including anti-inflammatory foods in your diet can help reduce swelling and combat free radical damage. These foods may support overall health and reduce inflammation.

Examples of anti-inflammatory foods include:

• Virgin Olive Oil
• Leafy Greens like spinach and kale
• Fatty Fish such as salmon and tuna
• Fruits like strawberries, cherries, and oranges

5. Herbs

Certain herbs have natural properties that may help manage symptoms of Crohn’s disease:

• Aloe Vera Juice: Known for its soothing effects, it may help with digestion and immune support.
• Glutamine: An amino acid that supports intestinal function.
• Turmeric (Haldi): Contains anti-inflammatory compounds that may reduce swelling and irritation.

Note: Always consult with your doctor or dietitian before making any significant changes to your diet or starting new supplements, as self-modifying your treatment plan can have unintended effects.

6. Exercise and Yoga

Regular physical activity, including yoga, is beneficial for reducing stress, which is known to exacerbate Crohn’s symptoms. Gentle exercise helps improve gut function and reduces flare-ups triggered by stress.

7. Adequate Rest

During flare-ups, resting your digestive system with a liquid diet can help it recover. Along with bowel rest, ensure you are getting extra sleep, taking naps, and avoiding intense physical activity. Giving your body the chance to heal is vital during these periods

8. Moxibustion

Moxibustion is a traditional Chinese therapy often used alongside acupuncture. It involves burning dried herbs near specific acupuncture points on the skin, which is thought to complement acupuncture's effects. This heat therapy may help alleviate Crohn’s symptoms by promoting relaxation and reducing inflammation.

As with any alternative treatment, always discuss with your healthcare provider before trying new therapies to ensure they are safe and appropriate for your condition.