Crohn’s disease (1)

It is a type of inflammatory bowel disease IBD, characterized by the chronic inflammation of the digestive tract leading to severe diarrhea, abdominal pain, weight loss, fatigue, and malnutrition. The location of inflammation varies from person to person. It can runs from the oral cavity to the anus and sometimes this inflammation goes deep down the bowel layers. It is painful and weakens the person.

Onset of disease

The symptoms of Crohn’s disease appear in the early 20s. However, another late peak can appear at the age of 50 to 70 years.

  • Elderly-onset Crohn’s disease EOCD; in which symptoms appear in people above 60 years. Typically such people exhibit conditions of constipation, malaise, fever, and gastrointestinal hemorrhage.

Signs and Symptoms

In Crohn’s disease, any portion of large or small testing can be involved. In some people, it is localized to colon only.

Sign and symptoms of Crohn’s disease can be mild, or severe. Symptoms may appear gradually or abruptly. Some people suffer from this disease without showing any symptoms. It happens when the disease is in an inactive state.

Inactive state, signs, and symptoms are:

  • Fatigue
  • Fever
  • Diarrhea
  • Mouth sores
  • Loss of appetite
  • Loss of weight
  • Blood in stool
  • Abdominal cramping

People suffering from severe Crohn’s disease experience

  • Inflammation of eyes, skin, and joints
  • Kidney stones
  • inflammation of bile ducts or live
  • Iron deficiency (anemia)
  • Delayed growth in children

Causes

The exact cause to spot Crohn’s disease is still mysterious. Formerly, stress and diet were thought to be the cause, but later on, doctors said that these two factors can just elevate the syndrome. Several factors such as a compromised immune system and heredity play a role in the onset of this syndrome.

  • Immune system

Any bacterium and virus can trigger Crohn’s disease. However, exact viral and bacterial agents are yet to identify. When any foreign agent attacks the body, then the abnormal immune system starts to produce antibodies against both the foreign agent and body as well. These antibodies invade the body’s digestive tract cells as well.

  • Heredity

People with a family history of Crohn’s disease are most likely to develop this syndrome. It means genes enhance their susceptibility to the syndrome.

Risk factors

Factors that increase the risk of Crohn’s disease are:

  • Age: Crohn’s disease can begin at any age but it mostly targets the young ones. Most of the people, who are a victim of Crohn’s disease, are around their 30’s.
  • Smoking: carcinogenic substances in cigarette wear off the tissues of the digestive tract. This makes a person more prone to disease.
  • Family history: a person is at a higher risk of getting this disease if his first-degree relatives are found having it.
  • Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) breach the cell layer of the digestive tract and causes inflammation in the bowel. This leads to the onset of Crohn’s disease.
  • Although this syndrome can target people of any ethnicity, white people of Eastern Europe have a higher risk. This syndrome is spreading also in black people living in the United Kingdom and North America.

Diagnosis

There is no particular test to diagnose Crohn’s disease. The doctor rules out other factors possibly causing this syndrome. A combination of several tests is performed to confirm Crohn’s disease in a person.

Lab tests

  • Stool test

The stool of a patient is examined to check any parasite and blood in it.

  • Blood test

A blood test is carried to check anemia (a condition in which the body does not produce enough red blood cells).

Procedures

  • Colonoscopy

The doctor uses a flexible and lighted-tube with a camera on end to examine the entire colon and terminal ileum. The doctor may also take a part of it (biopsy) for lab analysis. The presence of granulomas confirms Crohn’s disease.

  • Computerized tomography CT

CT scan of a person shows the inside as well outside tissues of the bowel. CT enterography is a type of CT scan in which clear images of the bowel can be seen.

  • Magnetic resonance imaging MRI

MRI scanner uses radio waves and a magnetic field to give detailed images of tissues and organs.

  • Pelvic MRL; evaluates anal fistula
  • MR enterography; evaluates fistula in the small intestine
  • Capsule endoscopy

In this procedure, the patient takes in a capsule with having a camera inside. This camera takes the images of the small intestine and transfers them to a recorder attached to the belt. These images are then displayed on the monitor and examined for any signs and symptoms of the syndrome.

  • Balloon-assisted enteroscopy

In this, A scope with a device known as “overtube” is used. This helps the doctor to examine those parts of the small bowel, which are not otherwise accessible by using standard endoscopes.

Treatment (2)

  1. Anti-inflammatory drug

It is the first-line treatment of Crohn’s disease.

  • Corticosteroids

They reduce inflammation. But they are only used when the patient does not respond to other treatments. Examples are Budesonide and prednisone.

  • Oral 5-aminosalicyclates

These agents are also used to treat Crohn’s disease. Examples are sulfasalazine and mesalamine.

  1. Immune system suppressors

Immune cells that cause inflammation are suppressed by immune suppressors. These include azathioprine, mercaptopurine, and methotrexate.

  1. Biologics

This therapeutic class hits the proteins produced by the immune system. This includes:

  • Natalizumab; stops protein binding of integrins to other cells in the bowel lining, thus reducing the symptoms of Crohn’s disease.
  • Infliximab; also known as a “tumour necrosis factor TNF” inhibitor. It neutralizes the immune system.
  • Ustekinumab

It blocks the action of interleukin (a protein that causes inflammation)

  1. Antibiotics

They reduce the fistula drainage and heal it in the affected person. Frequently used antibiotics are ciprofloxacin and metronidazole.

  1. Other medications

Over-the-counter medications can be given to the patient. Such as

  • Anti-diarrheal (Loperamide, methylcellulose)
  • Pain relievers (acetaminophen, ibuprofen)
  1. Lifestyle changes

Some lifestyle modifications can help one to deal with Crohn’s disease. Such as

  • Less alcohol consumption
  • No caffeine
  • Less spices

References

  1. https://en.wikipedia.org/wiki/Crohn%27s_disease
  2. https://www.webmd.com/ibd-crohns-disease/crohns-disease/crohns-disease-treatment-common-medications-for-treating-crohns