- When Is Surgery Necessary for Crohn's disease?
- If You Have Surgery for Crohn's Disease, Will You Need and Wear a Colostomy Bag?
What Are Inflammatory Bowel and Crohn's Disease (IBD)?
Inflammatory bowel disease (IBD) is divided into two diseases 1) Crohn's disease, and 2) ulcerative colitis. Crohn's disease can affect the entire digestive tract, whereas ulcerative colitis is confined to the colon. Because these diseases have many similarities, doctors often refer to them together as IBD.
Crohn's disease (also spelled Crohn disease) is a chronic disease of the digestive tract that is characterized by inflammation. It can affect any part of the digestive tract from the mouth to the anus, but usually involves the small intestine (the duodenum, the jejunum, and especially the ileum) and/or the area around the anus. Although it is a potentially serious disease, many medications are now available to help patients' symptoms and reduce the development of complications.
What Is Inflammation?
Inflammation is a response of the immune system, which protects us from infections and other outside "invaders." When the digestive tract becomes inflamed, the tissue becomes red, swollen, and thickened. Painful ulcers develop and may bleed. This damage causes bothersome and embarrassing symptoms.
What Are the Symptoms and Signs of Crohn's Disease?
The symptoms depend on which part of the digestive tract is affected, but diarrhea and abdominal cramps are almost universal. Other typical symptoms include
Some people have
- pain with a bowel movement,
- blood in the stool, and/or
- rectal bleeding.
Are the Symptoms of Crohn's Disease Permanent?
While Crohn's disease is life long, the symptoms may not be continuous. Most people experience unpredictable episodes called "flares" in which symptoms appear or get worse. The symptoms eventually get better or go away completely ("remission") until the next flare. Most people feel pretty well when the disease is in remission.
How Serious is Crohn's Disease?
- In severe cases, the bowel can develop blockages, perforations, connections to other organs called fistulas, and/or pockets of infection called abscesses.
- People with Crohn's disease often suffer nutritional deficiencies because eating can make symptoms worse.
- Crohn's disease also can cause inflammation in other parts of the body, which can cause symptoms and serious problems.
- Deficiency occurs also when areas of the digestive tract are damaged from the diseased process, especially in areas of inflamed small intestine where absorption of nutrients takes place, such as the duodenum and ileum.
What Causes Crohn's Disease, Who Gets It?
- We do not know what causes the abnormal inflammation in the digestive tract.
- Experts believe that it is caused by an unknown triggering event in susceptible people.
- We do not know what makes a person susceptible, except that about 20% to 30% of people with Crohn's disease have relatives with the disease - in other words, Crohn's disease runs in the family.
- In the other 70% to 80% of cases, there is no family connection.
- There is no evidence that stress or diet causes Crohn's disease - although these factors can make the symptoms worse.
- Anyone can get Crohn's disease.
- Crohn's disease affects all ages and all social and ethnic groups.
- Crohn's disease most often strikes young adults aged 15 to 30 years, but it can also appear in young children, middle-aged, and elderly people.
What Procedures and Tests Diagnose Crohn's Disease?
Unfortunately, there is no laboratory test that can be used to diagnose Crohn's disease. To be certain that you have Crohn's disease, you will have to undergo diagnostic imaging studies.
- Barium contrast studies: This is a series of X-rays taken after introduction into your digestive tract of a contrast material containing barium. The barium allows the intestines to show up better than on a plain X-ray. Barium studies are very useful in defining the nature, distribution, and severity of the disease. The barium studies may include an "upper GI series" (X-rays of the upper part of the digestive system), a "small bowel follow-through" (X-rays of the small intestine), and a "lower GI series" (barium enema).
- CT enterography or MRI called MR enterography can evaluate the small intestine to determine the extent of Crohn's disease.
- Ultrasound scans can be helpful in evaluating complications outside of the intestine, such as fistulas, an abscess.
- Endoscopy/colonoscopy: This involves inserting a thin tube with a light and a tiny camera on the end into the digestive tract, either through the mouth or the anus. The camera transmits pictures of the inside of the intestine so that the doctor can see inflammation or bleeding or other problems. The doctor may use the instrument to take tiny samples of the inside of the intestinal wall. These samples, or biopsies, are examined under a microscope to see if you have Crohn's disease.
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What Is the Treatment for Crohn's Disease?
There are medical and surgical treatments for Crohn's disease, but there is no cure. The goals of treatment are to relieve symptoms, prevent complications, and maintain good nutrition.
- The medications used to control Crohn's disease work by reversing the inflammation.
- A number of different medications are used.
- Some block a chemical reaction that causes inflammation; others "turn down" the immune system so it does not react so strongly.
- Medications also may be given to relieve symptoms in the short term.
When Is Surgery Necessary for Crohn's disease?
Surgery is usually necessary only for people who have intestinal blockage or very severe symptoms that are not relieved by medication. It involves having a section of the intestine removed. This can improve Crohn's disease, but it does not cure it. Often, Crohn's disease comes back after surgery. Surgery also may be necessary for an abscess or certain types of fistula.
If You Have Surgery for Crohn's Disease, Will You Need and Wear a Colostomy Bag?
People who have part of their bowel removed rarely require an ostomy. In cases in which an ostomy is required, because the remaining bowel is so much shorter than the normal bowel, or because there is severe infection in the abdomen and the bowel cannot be reconnected right away, it is attached to an opening in the lower abdomen called a stoma. Feces are no longer passed from the body through the rectum and anus, but through this stoma. An "ostomy bag" is worn on the outside of the body to collect the waste. The ostomy often is called by which part of the bowel is attached, such as colostomy or ileostomy.
Usually, only a resection is performed, without a bag.
What Is the Life-Expectancy for Crohn's, and Is There a Cure?
- The outlook for Crohn's disease depend on how severe Crohn's disease is, and any complications.
- Although Crohn's disease is a serious and chronic disease, usually, it is not fatal.
- Appropriate therapies can help you have a reasonable quality of life.
- The longer you have disease that is not controlled by medications, the more likely you are to develop complications.
Can You Lead a Normal Life With Crohn's Disease?
- If you mean will your life go back to the way it was before you had Crohn's disease, probably not.
- You will have to see your health care professional regularly, you will take potent medications, and you will probably have days when you don’t feel well enough to do things you need or want to do.
- Adjusting to all of these changes can be difficult. Just remember that you are not alone.
- More than 1 million people in the United States alone have Crohn's disease.
- There is a well-established network of information, advocacy, and support out there for you to tap into.
- Most people with Crohn's disease can lead a useful and otherwise normal life.
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