As defined by the U.S. National Library of Medicine, Crohn’s disease is a complex chronic disorder that affects the digestive system. The disease is an autoimmune response that causes excess inflammation in the intestinal walls, most notably in the lower regions of the small intestine, as well as some areas of the colon or large intestine. The inflammation can manifest itself in any part of the digestive system, ranging from the mouth to the anus.
Crohn’s disease is just one of several diseases falling under inflammatory bowel disease (IBD), as well as one of the most common of its forms. For many years, there wasn’t a lot of research or information about Crohn’s disease. Inflammatory bowel diseases were lumped together in a group.
Back in 1875 ulcerative colitis (UC) was first defined by two English physicians named Wilks and Moxon. Ulcerative colitis can also cause chronic inflammation of the intestinal lining. However, unlike Crohn’s disease, which spreads out and can affect other parts of the digestive system, ulcerative colitis tends to localize its inflammation around the colon.
Then, an autopsy performed in a 42-year-old woman who died after many months of suffering diarrhea and fever showed a “transmural ulcerative inflammation of the colon and terminal ileum.” Though Wilks and Moxon first described this as simple ulcerative colitis, it would be renamed roughly a century later into what is now known as Crohn’s disease.
Crohn’s disease was first adequately described in 1932 by Drs. Burril Crohn, Leon Ginzberg, and Gordon D. Oppenheimer. The three doctors had collected data from 14 patients who were supposedly suffering from a disease in the small intestine that they previously only called intestinal tuberculosis. Upon studying the significant symptoms that all 14 patients displayed, they realized that these were not hallmarks of tuberculosis nor that of any other known disease. The group of doctors then described the illness as something new and named it Crohn’s disease. While treatments have improved in the subsequent 90 days, there still isn’t a known cure for the disease.
The inflammation caused by Crohn’s disease compels tissues to become thick and swollen, to the point that some surface areas in the digestive system will develop open sores. The inflammation itself leads to abdominal pain, weight loss, fatigue, and severe diarrhea, along with malnutrition. As the inflammation itself spreads deep into the affected bowel tissue, the patient can experience debilitating pain, and in turn, lead to complications that can threaten their lives. These complications can include intestinal blockages and ulcers. The disease, though it begins gradually, can worsen over time, especially when its symptoms aren’t adequately addressed. In some cases, Crohn’s disease can even lead to chronic bleeding, anemia, and eye and skin issues.
Patients who have Crohn’s disease experience a cycle of flare-ups wherein the disease’s symptoms worsen before going into remission once again. The cycle itself can happen multiple times throughout a person’s life. This cycle is especially evident with individuals who have gastrointestinal tract inflammation, who suffer greatly during a flare-up of the disease. Patients may feel more at ease or even normal during times of remission.
Roughly three million Americans are affected by some form of inflammatory bowel disorder. And more than 700,000 of those are diagnosed with Crohn’s disease. According to the Crohn’s and Colitis Foundation of America, this number grows steadily as new people are diagnosed. The disease affects both adults and children, and symptoms and complications for each of these people may differ.
As Crohn’s disease’s symptoms manifest differently in different people, there are also different types of the disease.
To correctly assess which type of Crohn’s disease a patient may have, a thorough examination and diagnosis by a medical professional are necessary.
As mentioned, the signs and symptoms of Crohn’s disease may vary between patients. The experience of having Crohn’s disease will depend upon which part of the gastrointestinal tract is affected by the illness.
Crohn’s can affect both children and adults, and signs of the disease may start at any age. Research has shown that the symptoms often begin to show among adolescents or young adults who are 15-35 years old.
Because Crohn’s is considered a chronic disease, people experience cycles wherein there will be active symptoms called flares followed by periods of remission. During flares, symptoms manifest, but the most notable one remains gastrointestinal tract inflammation, the hallmark of Crohn’s disease. The disease can affect virtually any area of the G.I. tract, from the mouth, all the way to the anus. Issues that Chron’s can cause in the G.I. tract include:
These are some of the most common symptoms of Crohn’s. However, the disease also has several secondary signs or complications that aren’t restricted to areas in or around the G.I. tract. Other symptoms that may be evident in the patient’s overall health and affect a patient’s quality of life include:
In severe cases, some complications of Crohn’s disease may lead to:
For some researchers, the stress involved in living with Crohn’s disease and its symptoms may exacerbate symptoms. Some studies suggest a connection between smoking and Crohn’s, as some frequent smokers develop worse or more frequent flare-ups than non-smokers.
There is also the possibility that having Crohn’s disease may increase the likelihood of the patient developing G.I. cancer. Colorectal cancer risks are increased in people with Crohn’s and may increase further as time goes by.
To this day, doctors aren’t sure what specifically causes Crohn’s disease. Numerous risk factors may be associated with getting the disease. Initially it was thought that stress and diet might contribute to the onset of Crohn’s, but doctors have since discovered that those are aggravating factors rather than causes. Research so far suggests that the compound causes may be a combination of genetic, environmental, and lifestyle factors.
Over 700,000 people in America are believed to have Crohn’s disease. The Centers for Disease Control and Prevention indicates that it affects anywhere between 26 to 199 people for every 100,000. Both men and women are likely to be affected, and it can occur at any age. However, Crohn’s is seen as more prevalent among adolescents and adults, mainly between ages 15 and 35. Heredity and the immune system are seen as significant factors in the development of Crohn’s disease. Environmental triggers such as medication, pollution, and excessive usage of antibiotics get also considered as possible causes.
Some studies speculate that a virus or bacterium may be responsible for the disease by triggering an autoimmune response in the body. Instead of the normal immune response of fighting off the invading microbes, the immune system begins attacking the digestive tract and causing inflammation. White blood cells build up in the gut’s lining, leading to ulcers and bowel injury.
Crohn’s appears more common among people who have family members that also have the disease, so genetics may play a role in increasing the risk of getting Crohn’s disease. Even having a family history of irritable bowel disorders could increase the risk of developing Crohn’s. At least 15% of affected individuals also have a parent or a sibling who also has Crohn’s disease.
According to the U.S. National Library of Medicine’s Genetics Home Reference, many genes that are related to Crohn’s disease (including NOD2, ATG16L1, IL23R, and IRGM) produce proteins that are involved in immune system function. Variations in the genes can disrupt autophagy, changing the way the immune system responds to digestive system bacteria. When triggered by or combined with environmental factors, inflammation occurs and results in the symptoms that are characteristic of Crohn’s.
Crohn’s can affect virtually any ethnic group, but white people, including those of Eastern European Jewish descent, have the highest risk. There is also an increasing incidence of black people living in North America and the United Kingdom getting the disease.
Living in urban or industrialized areas may not necessarily cause Crohn’s disease, but there are more occurrences of the disease in these areas than other places. In terms of geographic distribution, most IBDs can be found in developed countries and northern climates. However, some studies suggest that the patterns may be changing, mostly due to the environment. Ethnic groups that immigrated to the U.S. after coming from countries with low incidences showed that they now adopt higher rates of developing the disease.
Most people that develop Crohn’s disease are typically diagnosed before they’re 30 years old. The condition can be diagnosed at a younger age, but it’s rare to have occurrences of the disease among children younger than eight years old. One-third of children with Crohn’s disease also grow to a shorter final adult height because of the condition.
To truly diagnose whether or not an individual has Crohn’s disease, doctors have to perform numerous exams and tests to seek out signs of bleeding and to rule out underlying causes. Because of the genetic and environmental factors, physicians must consider family and patient history as well. They need to study a patient’s background, where they’re from, and whether or not their families had any incidences of IBD or Crohn’s disease in particular.
Specific tests can be performed to aid healthcare providers in diagnosing or eliminating the possibility of Crohn’s disease.
Capsule endoscopy – The patient swallows a capsule that contains a tiny camera. The camera travels down the G.I. tract and can take photographs of the small intestine, which a doctor can then study for signs of the disease.
As mentioned previously, there is currently no cure available for Crohn’s disease. However, there are available treatments and medication that can help control its symptoms, especially during the cycle of flare-ups and remissions. Procedures will depend on where the inflammation is, how far along the disease has developed, any complications present, and the patient’s previous responses to prior treatments.
Diet & Lifestyle:
Changing one’s diet can help reduce symptoms. Doctors recommend:
Depending on the type of Crohn’s, a doctor might also recommend a diet that’s high calorie, lactose-free, low fat, low fiber, and low salt. It’s important to talk with one’s doctor about the right diet for your symptoms.
Therapy and Procedures:
There is still much to be learned about Crohn’s disease. Researchers are still conducting studies and clinical trials to test new treatments, interventions, and tests to detect and manage the disease.
Understanding where the disease comes from is also vital, as there is no specific cause, just numerous risk factors. Therefore it’s critical for patients to also keep a close eye on their patient records and their diaries during treatment. It can give doctors a valuable glimpse into what could cause the disease.
Through the digitalization of patient and medical records, it’s now easier for doctors to keep track of their patients’ progress. They can look into their medical histories, and find new answers to what causes Crohn’s disease, and how they might potentially be able to treat it better.
People with Crohn’s who want to contribute to research can sign up for a PicnicHealth account to contribute their anonymized medical data to Crohn’s research.