Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Crohn's Disease

(CD; Regional Enteritis)
by Rosalyn Carson-DeWitt, MD
Definition

Crohn's is a severe, chronic inflammatory bowel disease. It causes inflammation, ulcers , and bleeding in the digestive tract. It usually affects the end portion of the small intestine called the ileum. However, any part of the digestive tract can be affected, from the mouth to the anus.

Causes

The cause of Crohn's disease is not known. Inflammatory bowel diseases ( ulcerative colitis and Crohn's disease) seem to run in some families. Some researchers think that it is due to a reaction to a virus or bacteria. The immune system overreacts and causes damage to the intestines.

Risk Factors

Factors increase your chance of getting Crohn's include:

  • Diet high in fat, sugar, and meat
  • Family members with inflammatory bowel disease
  • Jewish heritage
Symptoms

Symptoms include:

  • Abdominal cramps and pain
  • Anemia
  • Diarrhea
  • Fatigue, weakness
  • Fever
  • Mouth sores
  • Nausea
  • Rectal bleeding
  • Sores, abscesses in the anal area
  • Weight loss
Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • Barium enema x-ray —insertion of fluid into the rectum that makes your colon show up on an x-ray
  • Barium swallow —a series of x-rays of structures inside the throat that are taken after drinking a barium-containing liquid
  • Biopsy —removal of a sample of colon tissue for testing (may be performed as part of a flexible sigmoidoscopy or colonoscopy)
  • Blood tests
  • Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
  • Flexible sigmoidoscopy —a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon
  • Stool examination

If you are diagnosed with Crohn's disease, follow your doctor's instructions .

Treatment

Treatment may include:

Dietary Changes

Your doctor may recommend that you avoid foods that provoke symptoms. These foods are different for each person. They may include:

  • Dairy foods (due to lactose intolerance)
  • High-fiber foods
  • Highly seasoned foods
Medications

There are many types of medicines that are used to treat Crohn's disease. Examples of these medicines include:

  • Aminosalicylate medicines—such as sulfasalazine , mesalamine , olsalazine
  • Anti-inflammatory medicines—such as prednisone , methylprednisolone , budesonide
  • Antibiotic medicines—such as metronidazole , ampicillin , ciprofloxacin
  • Immune modifiers—such as azathioprine , 6-mercaptopurine, methotrexate
  • TNF-inhibitors—such as infliximab , adalimumab , etanercept , certolizumab , golimumab
Surgery

Very severe Crohn's may not improve with medicines. You may be advised to have the severely diseased section of your intestine removed. The two remaining healthier ends of the intestine are then joined together. You are still at high risk for recurrence of the disease elsewhere.

Surgery may also be done if you have an obstruction or fistulas.

Untreated Crohn's disease may lead to:

  • Arthritis
  • Eye inflammation
  • Fistulas—abnormal connections between the intestine and other organs or tissues, such as the bladder, vagina, or skin
  • Gallstones
  • Intestinal obstruction
  • Kidney stones
  • Liver disease
  • Osteoporosis
  • Skin rashes
Prevention

There are no guidelines for preventing Crohn's disease because the cause is unknown.

Last reviewed: September 2011 by Daus Mahnke, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Crohn's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ . Accessed July 20, 2008.
  • Disease information. Crohn's and Colitis Foundation of America website. Available at: http://www.ccfa.org/info/?LMI=4 . Accessed July 20, 2008.
  • DynaMed Editorial Team. Crohn's disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated June 16, 2011. Accessed June 17, 2011.
  • Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis, MO: Mosby; 2005.
  • Ferri F, ed. Ferri’s Clinical Advisor 2010. Philadelphia, PA: Mosby Elsevier; 2009.
  • Goroll AH, Mulley AG. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.
  • Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106(4):563-573.
  • Inflammatory bowel disease. American Gastroenterological Society website. Available at: http://www.gastro.org/wmspage.cfm?parm1=851 . Accessed July 20, 2008.
  • 10/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDA approves new drug to treat psoriasis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183851.htm . Published September 25, 2009. Accessed October 2, 2009.