Understanding Crohn’s Disease?

Crohn’s disease, also known as ileitis or enteritis, is an inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting, or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.

Crohn’s disease is caused by interactions between environmental, immunological, and bacterial factors in genetically susceptible people. It results in a chronic inflammatory disorder, in which the body’s immune system attacks bacteria within the digestive system; this leads to ulceration and inflammation of the lining of the digestive tract.

The exact cause is unknown, but Crohn’s disease may be related to a combination of factors and there is evidence that it can run in families.

Both “Crohn’s” and “Crohn’s disease” are used to refer to the condition, but the U.S. National Library of Medicine uses only “Crohn’s” in clinical documents. It is named after Burrill Bernard Crohn, who described it with colleagues in 1932.

Symptoms:

The most common symptoms occurring at onset and during exacerbations include abdominal pain (may be relieved by sitting or defecating), diarrhea (which often contains blood and mucus) nausea, vomiting, fever, arthralgia (joint pain), abdominal tenderness, possible weight loss and in some cases lesions on the ileum.

The most common symptom is diarrhea, with studies showing that it occurs in up to 72% of patients. Other symptoms may include rectal bleeding or stenosis (constipation). Many people with ileocolonic Crohn’s will experience mild or no gastrointestinal symptoms at all.

Extraintestinal manifestations are also common in Crohn’s disease; the most common manifestation is arthritis (affecting around 30% of individuals with CD). It can affect any joint but it commonly affects the knees, ankles, feet, and toes. Other less frequent extraintestinal effects are inflammation of the eye, skin rashes, tiredness or poor stamina, and decreased fertility.

Crohn’s disease may have a greater effect on women than men. One area that is under research is the role of hormones (especially progesterone) in women who suffer from CD. Estrogen has been shown to increase the risk for CD; this risk becomes greater after age 35.

Rectal bleeding is often one of the first signs of Crohn’s disease. Blood may be seen in the stool, in the toilet water, or on toilet paper. Bright red blood is typically due to inflammation inside the anus or rectum from hard stools; dark blood likely comes from further up in the colon (colitis). Melena indicates bleeding higher up in the gastrointestinal tract.

Crohn’s disease, like all forms of IBD, can affect any part of the GI tract, from mouth to anus. The most common signs and symptoms are abdominal pain, diarrhea, rectal bleeding, or fistulizing perineum.

Symptoms may be acute or involve only the lining of the GI tract (the mucosa) without actual inflammation—this is known as “silent” Crohn’s.[citation needed] In other parts of the bowel are involved there may be nausea, vomiting, weight loss, or malabsorption due to an inability to absorb nutrients despite normal or even high levels of digestive secretions; this results in malnutrition. severe cases it may result in short stature, delayed puberty, and osteoporosis.

Risk factors:

Crohn’s disease is most commonly diagnosed in people in their teens and 20s, although the disease is typically present much earlier. The greatest increase of Crohn’s occurs during early adolescence with a second smaller peak occurring at 50–60 years of age. Females are most often affected in those aged between 20 and 29 years old.

There appears to be a protective effect of marriage, regular smoking, higher alcohol consumption, and higher levels of education. Indications from twin studies suggest a strong hereditary element to developing this disorder. People who have a first-degree relative (parent or sibling) with the disease have about a fourfold greater risk of developing Crohn’s disease.

Other risk factors include smoking, appendectomy, some other surgical procedures, and the presence of any type of infection in the GI tract including endocarditis; it is more common after gastroenteritis or following a case of food poisoning (post-infectious IBD). It may also be triggered by: certain vaccinations, long-term use of proton pump inhibitors, antibiotics that do not directly target the causative bacteria. People with ileal-pouch anal anastomosis are at increased risk for developing the disease.

How to diagnose Crohn’s disease:

Blood test-

Diagnosis of Crohn’s disease can be done by a blood test. Blood tests can reveal certain antibodies which are found in the blood of people with Crohn’s disease.

A blood test is important to judge how your intestines are working and if they are not, what caused it.

It also gives information on whether any medicines you may be taking are working or not. You will find out if you have an infection that causes diarrhea.

There are several ways that you need to go for this testing like tissue transglutaminase antibody (TGA), perinuclear antibodies (pANCA), and fecal calprotectin (FC). TGA is a blood test that should be done annually to see if a person’s Crohn’s is worsening.

pANCA is a special type of antibody that can show inflammation in the small intestine but not elsewhere in the body.

fecal calprotectin – It is a simple non-invasive stool test, which can detect an increase of a protein called calprotectin in your feces. Calprotectin levels rise when there is any intestinal damage or inflammation, including from IBD. This makes it very useful for making an early diagnosis of inflammatory bowel disease.

 X-ray –

X-rays may also be used to get images of the inside of your intestines and colon, showing how inflamed they are and where there are blockages.

 Colonoscopy-

A colonoscopy is the most accurate method of diagnosis. It involves the insertion of a long thin flexible tube called a colonoscope through your rectum into your large intestine, which allows the doctor to examine the entirety of your bowel for any abnormalities.

If Crohn’s disease causes inflammation only in the inner lining of your intestine, it could be difficult to diagnose with just an endoscopy. Instead, you may have to have surgery known as a bowel resection to see if any unusual tissues appear different during surgery or whether specific areas are inflamed.

This further strengthens the diagnosis by treating affected parts at surgery and seeing how they heal after treatment. A biopsy, which is the removal of a small piece of tissue that can be viewed under a microscope to see whether there are any abnormal cells present, may also be performed on the bowel tissue. For example, you will have this test if your doctor suspects Crohn’s disease affecting your anus.

 Capsule endoscopy-

This uses a tiny wireless video camera attached to some string-like plastic that you swallow so it can travel through your digestive tract. The camera transmits images wirelessly to a receiver worn like a backpack by the person taking part in the test.

This allows direct examination of your small intestine and colon (the large bowel) without requiring an invasive procedure such as inserting an endoscope into your rectum or mouth. A capsule endoscopy test is usually offered if you have symptoms of Crohn’s disease, such as abdominal pain and bleeding from the rectum.

 Flexible sigmoidoscopy-

In this procedure, a doctor uses a thin, flexible tube with a light and tiny video camera at the end to examine your anus and rectum for signs of inflammation or any other abnormalities.

The doctor will look at the lining of your lower intestine (called the sigmoid) by inserting either an ordinary sigmoidoscope or a more advanced version called a high-resolution scope. This type of endoscopy may be used in people who are known to have Crohn’s disease but who do not yet need surgery. It can also be useful for ruling out other conditions in cases where there is uncertainty about the nature of symptoms.

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