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Scientists do not know if the abnormality Blood tests may be done to check for ane
in the functioning of the immune system in mia, which could indicate bleeding in the
people with Crohn’s disease is a cause, or intestines. Blood tests may also uncover a
a result, of the disease. Research shows high white blood cell count, which is a sign
that the inflammation seen in the GI tract of inflammation somewhere in the body.
of people with Crohn’s disease involves By testing a stool sample, the doctor can
several factors: the genes the patient has tell if there is bleeding or infection in the
inherited, the immune system itself, and intestines.
the environment. Foreign substances,
The doctor may do an upper GI series to
also referred to as antigens, are found in
look at the small intestine. For this test,
the environment. One possible cause for
the person drinks barium, a chalky solution
inflammation may be the body’s reaction to
that coats the lining of the small intestine,
these antigens, or that the antigens them
before x rays are taken. The barium
selves are the cause for the inflammation.
shows up white on x-ray film, revealing
Some scientists think that a protein pro
inflammation or other abnormalities in
duced by the immune system, called
the intestine. If these tests show Crohn’s
anti-tumor necrosis factor (TNF), may disease, more x rays of both the upper and
be a possible cause for the inflammation lower digestive tract may be necessary to
associated with Crohn’s disease. see how much of the GI tract is affected
by the disease.
What are the symptoms? The doctor may also do a visual exam of
The most common symptoms of Crohn’s the colon by performing either a sigmoi
disease are abdominal pain, often in the doscopy or a colonoscopy. For both of
lower right area, and diarrhea. Rectal these tests, the doctor inserts a long,
bleeding, weight loss, arthritis, skin prob flexible, lighted tube linked to a computer
lems, and fever may also occur. Bleeding and TV monitor into the anus. A sigmoi
may be serious and persistent, leading to doscopy allows the doctor to examine the
anemia. Children with Crohn’s disease lining of the lower part of the large intes
may suffer delayed development and tine, while a colonoscopy allows the doctor
stunted growth. The range and severity to examine the lining of the entire large
of symptoms varies. intestine. The doctor will be able to see
any inflammation or bleeding during either
of these exams, although a colonoscopy is
usually a better test because the doctor can
2 Crohn’s Disease
see the entire large intestine. The doctor What is the treatment for
may also do a biopsy, which involves taking
a sample of tissue from the lining of the Crohn’s disease?
intestine to view with a microscope. Treatment may include drugs, nutrition
supplements, surgery, or a combination of
these options. The goals of treatment are
What are the complications to control inflammation, correct nutritional
of Crohn’s disease? deficiencies, and relieve symptoms like
The most common complication is block abdominal pain, diarrhea, and rectal
age of the intestine. Blockage occurs bleeding. At this time, treatment can help
because the disease tends to thicken the control the disease by lowering the number
intestinal wall with swelling and scar tissue, of times a person experiences a recurrence,
narrowing the passage. Crohn’s disease but there is no cure. Treatment for
may also cause sores, or ulcers, that tunnel Crohn’s disease depends on the location
through the affected area into surrounding and severity of disease, complications, and
tissues, such as the bladder, vagina, or skin. the person’s response to previous medical
The areas around the anus and rectum are treatments when treated for reoccurring
often involved. The tunnels, called fistulas, symptoms.
are a common complication and often
Some people have long periods of remis
become infected. Sometimes fistulas can
sion, sometimes years, when they are
be treated with medicine, but in some cases
free of symptoms. However, the disease
they may require surgery. In addition to
usually recurs at various times over a per
fistulas, small tears called fissures may
son’s lifetime. This changing pattern of the
develop in the lining of the mucus
disease means one cannot always tell when
membrane of the anus.
a treatment has helped. Predicting when a
Nutritional complications are common in remission may occur or when symptoms
Crohn’s disease. Deficiencies of proteins, will return is not possible.
calories, and vitamins are well documented.
Someone with Crohn’s disease may need
These deficiencies may be caused by inad
medical care for a long time, with regular
equate dietary intake, intestinal loss of
doctor visits to monitor the condition.
protein, or poor absorption, also referred
to as malabsorption. Drug Therapy
Other complications associated with Anti-Inflammation Drugs. Most people
Crohn’s disease include arthritis, skin prob are first treated with drugs containing
lems, inflammation in the eyes or mouth, mesalamine, a substance that helps
kidney stones, gallstones, or other diseases control inflammation. Sulfasalazine is
of the liver and biliary system. Some of the most commonly used of these drugs.
these problems resolve during treatment Patients who do not benefit from it or who
for disease in the digestive system, but cannot tolerate it may be put on other
some must be treated separately. mesalamine-containing drugs, generally
known as 5-ASA agents, such as Asacol,
3 Crohn’s Disease
Dipentum, or Pentasa. Possible side effects Infliximab, the first treatment approved
of mesalamine-containing drugs include specifically for Crohn’s disease is a TNF
nausea, vomiting, heartburn, diarrhea, substance. Additional research will need
and headache. to be done in order to fully understand the
range of treatments Remicade may offer to
Cortisone or Steroids. Cortisone drugs help people with Crohn’s disease.
and steroids—called corticosteriods—
provide very effective results. Prednisone Antibiotics. Antibiotics are used to treat
is a common generic name of one of the bacterial overgrowth in the small intestine
drugs in this group of medications. In the caused by stricture, fistulas, or prior sur
beginning, when the disease it at its worst, gery. For this common problem, the
prednisone is usually prescribed in a large doctor may prescribe one or more of the
dose. The dosage is then lowered once following antibiotics: ampicillin, sulfon
symptoms have been controlled. These amide, cephalosporin, tetracycline, or
drugs can cause serious side effects, includ metronidazole.
ing greater susceptibility to infection.
Anti-Diarrheal and Fluid Replacements.
Immune System Suppressors. Drugs that Diarrhea and crampy abdominal pain are
suppress the immune system are also used often relieved when the inflammation sub
to treat Crohn’s disease. Most commonly sides, but additional medication may also
prescribed are 6-mercaptopurine or a be necessary. Several antidiarrheal agents
related drug, azathioprine. Immunosup could be used, including diphenoxylate,
pressive agents work by blocking the loperamide, and codeine. Patients who are
immune reaction that contributes to dehydrated because of diarrhea will be
inflammation. These drugs may cause treated with fluids and electrolytes.
side effects like nausea, vomiting, and
diarrhea and may lower a person’s resist Nutrition Supplementation
ance to infection. When patients are treat The doctor may recommend nutritional
ed with a combination of corticosteroids supplements, especially for children whose
and immunosuppressive drugs, the dose of growth has been slowed. Special high-
corticosteroids may eventually be lowered. calorie liquid formulas are sometimes
Some studies suggest that immunosuppres used for this purpose. A small number of
sive drugs may enhance the effectiveness of patients may need to be fed intravenously
corticosteroids. for a brief time through a small tube insert
ed into the vein of the arm. This procedure
Infliximab (Remicade). This drug is the
can help patients who need extra nutrition
first of a group of medications that blocks
temporarily, those whose intestines need
the body’s inflammation response. The
to rest, or those whose intestines cannot
U.S. Food and Drug Administration
absorb enough nutrition from food.
approved the drug for the treatment of
There are no known foods that cause
moderate to severe Crohn’s disease that
Crohn’s disease. However, when people
does not respond to standard therapies
are suffering a flare in disease, foods such
(mesalamine substances, corticosteroids,
as bulky grains, hot spices, alcohol, and
immunosuppressive agents) and for the
milk products may increase diarrhea
treatment of open, draining fistulas.
and cramping.
4 Crohn’s Disease
Surgery Sometimes only the diseased section of
intestine is removed and no stoma is need
Two-thirds to three-quarters of patients
ed. In this operation, the intestine is cut
with Crohn’s disease will require surgery at
above and below the diseased area and
some point in their lives. Surgery becomes
reconnected.
necessary when medications can no longer
control symptoms. Surgery is used either to Because Crohn’s disease often recurs after
relieve symptoms that do not respond to surgery, people considering it should care
medical therapy or to correct complications fully weigh its benefits and risks compared
such as blockage, perforation, abscess, or with other treatments. Surgery may not be
bleeding in the intestine. Surgery to appropriate for everyone. People faced
remove part of the intestine can help with this decision should get as much infor
people with Crohn’s disease, but it is not mation as possible from doctors, nurses
a cure. Surgery does not eliminate the dis who work with colon surgery patients
ease, and it is not uncommon for people (enterostomal therapists), and other
with Crohn’s Disease to have more than patients. Patient advocacy organizations
one operation, as inflammation tends to can suggest support groups and other
return to the area next to where the information resources. (See For More
diseased intestine was removed. Information on page 7 for the names of
such organizations.)
Some people who have Crohn’s disease in
the large intestine need to have their entire People with Crohn’s disease may feel well
colon removed in an operation called a and be free of symptoms for substantial
colectomy. A small opening is made in the spans of time when their disease is not
front of the abdominal wall, and the tip of active. Despite the need to take medica
the ileum, which is located at the end of tion for long periods of time and occasional
the small intestine, is brought to the skin’s hospitalizations, most people with Crohn’s
surface. This opening, called a stoma, is disease are able to hold jobs, raise families,
where waste exits the body. The stoma is and function successfully at home and in
about the size of a quarter and is usually society.
located in the right lower part of the
abdomen near the beltline. A pouch is
worn over the opening to collect waste,
and the patient empties the pouch as
needed. The majority of colectomy
patients go on to live normal, active lives.
5 Crohn’s Disease
Can diet control Crohn’s Can stress make Crohn’s
disease? disease worse?
People with Crohn’s disease often experi There is no evidence showing that stress
ence a decrease in appetite, which can causes Crohn’s disease. However, people
affect their ability to receive the daily nutri with Crohn’s disease sometimes feel
tion needed for good health and healing. increased stress in their lives from having
In addition, Crohn’s disease is associated to live with a chronic illness. Some people
with diarrhea and poor absorption of nec with Crohn’s disease also report that they
essary nutrients. No special diet has been experience a flare in disease when they are
proven effective for preventing or treating experiencing a stressful event or situation.
Crohn’s disease, but it is very important There is no type of person that is more
that people who have Crohn’s disease fol likely to experience a flare in disease than
low a nutritious diet and avoid any foods another when under stress. For people who
that seem to worsen symptoms. There are find there is a connection between their
no consistent dietary rules to follow that stress level and a worsening of their symp
will improve a person’s symptoms. toms, using relaxation techniques, such as
slow breathing, and taking special care to
People should take vitamin supplements eat well and get enough sleep, may help
only on their doctor’s advice. them feel better.
6 Crohn’s Disease
Hope Through Research For More Information
The National Institute of Diabetes and Crohn’s & Colitis Foundation of America
Digestive and Kidney Diseases (NIDDK) 386 Park Avenue South, 17th Floor
conducts and supports research into many New York, NY 10016–8804
kinds of digestive disorders, including Phone: 1–800–932–2423 or 212–685–3440
Crohn’s disease. Several clinical trials Email: info@ccfa.org
are currently evaluating the efficacy and Internet: www.ccfa.org
safety of different therapies for the treat
ment of Crohn’s disease. For a complete Reach Out for Youth with Ileitis and
listing of trials being conducted, visit Colitis, Inc.
www.clinicaltrials.gov. 84 Northgate Circle
Melville, NY 11747
Phone: 631–293–3102
Email: reachoutforyouth@
The U.S. Government does not endorse or favor
reachoutforyouth.org
any specific commercial product or company.
Trade, proprietary, or company names appearing Internet: www.reachoutforyouth.org
in this document are used only because they are
considered necessary in the context of the United Ostomy Association, Inc.
information provided. If a product is not 19772 MacArthur Blvd #200
mentioned, the omission does not mean or Irvine, CA 92612–2405
imply that the product is unsatisfactory. Phone: 1–800–826–0826 or 949–660–8624
Fax: 949–660–9262
Email: uoa@deltanet.com
Internet: www.uoa.org
7 Crohn’s Disease
National Digestive Diseases
Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov