Many a time people have to suffer some really peculiar ailments where diagnosis and treatment get complicated. Though science and technology have moved forward in a purposeful way beyond the imaginations, there are still some maladies where the diagnosis is intricate or cumbersome. Crohn’s disease is one such disease where the diagnosis is kind of complicated. Crohn’s disease tests are done to detect and monitor the ailment. But there are lots of issues even after getting the disease diagnosed.
In this post, we will talk all about Crohn’s disease, its symptoms, causes, and treatments. The article will also try to throw some light on the diagnosis process of the ailment. At the end of the article, we will also be providing 10 important questions that you might like to ask your physician while you visit him. Keeping reading till the end to know all about the ailment and also about an advanced Crohn’s disease test which we have covered at the last of the post.
It should be noted that the author of the article has himself experienced, though not exactly Crohn’s disease but a different form of inflammatory bowel disease(IBD) and so feels that it would be appropriate to talk from his experience which will benefit the victims of this malady.
What is Crohn’s Disease?
Crohn is a type of inflammatory disease which occurs in the digestive tract of our body. Inflammatory disorders are caused by the immune system attacking the own body cells. Inflammation is actually in one way a kind of defense mechanism of our body where the immune system recognizes the damaged cells and tries to heal them.
Crohn’s disease is a type of inflammatory bowel disease (IBD). IBD is an umbrella term for inflammatory disorders that occur in the digestive tract.
IBD is of two types:-
a) Ulcerative colitis.
b) Crohn’s disease.
Ulcerative colitis is that kind of inflammatory disease caused by ulcers of the colon and rectum. Though it is different from Crohn’s disease, both fall in the same category of inflammatory bowel diseases(IBD). Crohn’s disease is named after Dr. Burill B Crohn who first described the disease along with Dr.Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer in the year 1932.
Symptoms of Crohn’s disease:
The symptoms of Crohn’s disease vary from patients to patients. While in some cases only the ileum (last section of small intestine) is affected, in other cases the colon is affected. The disease is often seen to be evolving slowly and gradually, but sometimes it may even occur suddenly without any signs of warning. There may be even times when the ailment shows no sign of occurrence but may recur again. We are however trying to list down few common symptoms of the disease. If you observe any of these signs of the ailment, you need to visit the physician and undergo crohn’s disease test to properly diagnose the disease.
When the disease is active, you may experience any of the following symptoms:
- Diarrhea, which occurs frequently and recurrently.
- Fever can be another sign of both mild and severe Crohn’s disease. The occurrence of fever can be also attributed to inflammation disorder or even due to the medications used to cure the disease itself. Night sweats are also often seen to be reported by people suffering from Crohn’s disease.
- Abdominal Pains and Cramping are also some of the common symptoms of Crohn’s disease. While inflammation in the small intestine causes cramping, its due to inflammation in the digestive tract which causes abdominal pains that normally occur 1-2 hours after eating.
- Blood in stool is another common symptom of this ailment. Continuous loss of blood may give rise to anemia, a disease caused by the decrease of hemoglobin in red blood cells.
- Fatigue is another common symptom of Crohn’s disease. Nearly 60% of the people suffering from the disease complain about fatigue. Fatigue is a kind of physical and mental weariness or exhaustion which creates problems in our ability to do normal physical and mental activities.
- Mouth Sores, another symptom of Crohn’s disease is often detected more among children than adults. Studies say that mouth sores may be caused due to medications of the disease itself or due to serious deficiency of Vitamin B.
- Weight loss is also seen among people suffering this ailment. Weight loss can also be due to the medications used to cure this disease. Moreover, it is often seen that people diagnosed with Crohn’s disease also experience nausea which often results in weight loss.
These common symptoms can be helpful in detecting the ailment, however, to properly diagnose the disease physicians are most likely to advise you a Crohn’s disease test. It should be noted that Crohn’s is a chronic disease and so there may be times when the disease may show no signs but symptoms typically return at some point. The disease-free period is known as remission and can span for months or even years.
Besides the common symptoms, there are some other signs which may occur in some patients. These signs include strictures, narrowing of intestines, fissures, tears in the lining of anus etc.
Want to know more? Read on.
Classifications of Crohn’s disease:
Based on the severity of the disease, it is classified in following types:
- Mild to moderate level: During this stage, patients usually complain about abdominal pain, bowel obstruction. During this stage, the patient is able to take oral diet without dehydration.
- Moderate to severe level: During this stage the patients experience weight loss, anemia, abdominal pain, and vomiting.
- Severe to fulminant level: During this stage, the patients have high fever, persistent vomiting, severe abdominal pain and bowel obstructions.
Causes of Crohn’s disease:
The cause of Crohn’s disease is an uncertain etiology, which means there is no single factor which can be treated as the root cause of the ailment. Though researches are still undergoing to determine the cause of the disease, it can, however, be well perceived that the disease is not caused due to someone’s eating habits or lifestyle. Most experts are of the opinion that Crohn’s disease occurs due to the combination of multiple factors. The three leading factors that are suspected to be contributing to one suffering from the disease may include:
- Environmental factors: Though still not identified, there may be some triggers in the environment that prompts the immune system to launch an attack on the GI tract which results in inflammation.
- Genetic factor: It is likely that a person may inherit one or more genes which make him vulnerable to Crohn’s disease.
- An inappropriate reaction of body’s immune system: Inflammation is a kind of weapon of our body’s immune system to tackle invading bacteria s and viruses. Crohn’s disease may be attributed to this fact that our body’s own immune system causes inflammation as a weapon against these foreign invaders.
Contrary to people’s beliefs, researches have also opined that Crohn’s disease is not contagious that means you cannot catch it from anyone. Appropriate diagnosis and proper Crohn’s disease test can help detect the ailment in early stages.
Who is prone to Crohn’s disease?
Crohn’s disease is more common in urban areas than in rural areas. The disease is seen more often in northern climates. People of age group 15-35 have the maximum risk of getting this disease. Studies say that in a single year almost 33000 new cases of Crohn’s disease is detected in the USA itself. Both males and females are equally affected by the disease. The disease is, however, is seen to be spreading to developing parts of the world like India, China, South America etc.
Patterns of the disease:
This disease may occur in three different patterns. These patterns are described briefly as below:
- Luminal Crohn’s Disease: When inflammation is caused in the lumen or tube of the intestine, its called the luminal crohn’s disease.
- Luminal fibrostenosing Crohn’s disease: This pattern of Crohn’s disease is observed among patients when the disease is active for a time span and disappears though recurs again at any time. This pattern is characterized by narrowing of the intestine.
- Fistulizing Crohn’s disease: This is another pattern of Crohn’s disease which shows occurence of fistulas. Fistulas are an abnormal connection between two hollow spaces such as blood vessels, intestines. They are most likely caused by inflammation.
Types of Crohn’s disease:
There are 5 different types of Crohn’s disease depending upon the location of the inflammation. These 5 types are as follows:
- Crohn’s colitis: When only the colon is affected by the disease, it is called crohn’s colitis.
- Gastroduodenal Crohn’s disease: When the stomach and first part of the small intestine gets affected, its called gastroduodenal Crohn’s disease.
- Ileitis: This is the type of Crohn’s disease when the ileum gets affected. The ileum is the last section of the small intestine.
- Ileocolitis: This is the most common type of the disease. Its when the colon and the ileum get affected.
- Jejunoileitis: This is the form of Crohn’s disease which creates inflammation in the jejunum. The upper half of the small intestine is called jejunum.
Crohn’s disease test:
Since Crohn’s disease is not caused by a single factor, it cannot be diagnosed properly just by one test. Doctors may advise multiple tests to find out the potential cause of the ailment. Some of the medical tests that are performed to detect Crohn’s disease are mentioned as below:
- Stool Test: Stool test is done to detect any kind of infection that may occur as a result of prolonged Crohn’s disease.
- Blood Test: Blood Test is done to detect inflammation, antibodies or anemia.
- CT scan: Computerized Tomography or MRI scans are normally done either to check the thickness of the bowel wall or to evaluate fistulas. It is also done to evaluate the collection of infected fluids in the abdomen.
- Colonoscopy: Colonoscopy is a procedure to enable the examiner to look at the lining of the gastrointestinal tract with a tube that has a camera at the end.
- CT Colonography: This is a new technology of imaging which uses X-rays and computers to produces 2D and 3D images of the colon from rectum to the small intestine. This test is also called the virtual colonoscopy. Though being an advanced method of detecting diseases like crohn’s disease, many researchers do not recommend this test for its inability to take tissue samples(biopsy) during the test.
Besides these common tests, there may be some more Crohn’s disease test which is recommended by a physician to monitor the disease. Some other tests that a patient may undergo are as below:
- Leukocyte scintigraphy (White Blood Cell Scan).
- Endoscopic ultrasound (EUS).
- Antibody Blood test (Biomarkers).
But Wait. The list for crohn’s disease test has not ended yet, though. There is one advanced and latest diagnosis test for crohn’s disease which we will discuss at the end. You ought to read till the end of this information filled article to know about this latest test. But before that let’s discuss some other important points that are required to be mentioned about the disease.
Before any crohn’s disease test:
Before undergoing any of the tests you may like to ask the physician the following questions:
- How should I prepare for the test?
- Will I feel any discomfort?
- How safe is the test?
- How should I prepare for the test?
- What kind of information will test result provide?
Treatment of Crohn’s disease:
The diagnosis of crohn’s disease starts with a thorough study of the patient’s symptoms, medical history of the patient as well as patients. A doctor may rely on a number of physical crohn’s disease test to correctly determine the root cause of the ailment. He may advise any of the above-mentioned tests to be conducted on the patient.
It should be remembered that the treatment procedures may vary from patient to patient. There is no single treatment for the disease that will work for every patient.
Important points to know about the treatment of Crohn’s disease:
- Almost 60% of the patients diagnosed with Crohn’s disease will eventually require a surgery.
- Different type of treatment procedures will be performed on the patient depending on the severity and location of the disease.
The basic goal of Crohn’s disease treatment is to bring the patient’s condition to a state of remission. And once it is achieved, the goal is to sustain the state of remission. If the state of remission cannot be achieved, physicians try to reduce the severity of the ailment in order to improve the patient’s quality of life.
Medicines for Crohn’s disease:
Medicines prescribed by physicians may bring the state of remission for the disease. However, it is not certain that the disease will not recur at times. Flares of Crohn’s disease may indicate that change in medications or frequency is required.
Doctors across the world have been using medications for Crohn’s disease for a long time. Prescribed medicines normally fall under 5 basic categories which are described as below.
- Aminosalicylates: This is class of drug that is specially used to treat inflammatory bowel diseases like ulcerative colitis and Crohn’s disease. These drugs contain 5-aminosalicylic acid and are effective when the patient’s condition is mild to moderate. It is most effective when the inflammation is in the colon only. They are given either orally or rectally.
Examples of Aminosalicylates are balsalazide, mesalamine, olsalazine and sulfasalazine
- Corticosteroids: These classes of drug is effective for short term control of Crohn’s disease and not recommended for long-term use. Corticosteroids are analogs of cortisol, one of our body’s natural anti-inflammatories. These drugs reduce the activity of our immune system resulting in prevention of inflammation. These drugs do have side-effects and hence should be taken under strict supervision and advice of the physician. It is also should be noted that these medicines are not meant to be stopped abruptly. Physicians may also prescribe other drugs along with corticosteroids. These drugs are given as injections, rectally or intravenously.
- Immunomodulators: For those patients on whom aminosalicylates and corticosteroids show no results or show partial results, immunomodulators are generally used. This class of medicines has the same impact on our immune system as a result of which the inflammation ceases to occur. Immunomodulators, however, take several months to get effective. They are given orally or injected.
- Biological therapies: These are the latest type of medications used to prevent Crohn’s disease. These involve preparation of antibodies in the laboratory. The antibodies perform the task of preventing certain proteins in the body from causing inflammation.
They are given intravenously or injected.
- Antibiotics: Due to infection during Crohn’s disease, a collection of pus may form in the abdomen, pelvis or anal area. Antibiotics are used to drain the abscesses (collection of pus) and treat crohn’s disease.
The below image will give you an idea about the various classes of medications used to treat crohn’s disease
Surgery for Crohn’s disease:
Though a majority of the patients with Crohn’s disease respond quite well to medical treatment, yet 66 to 75 percent of patients will still require surgery at some point in their lives. Surgery may be required for the sake of following reasons:
- Medications have refused to impact on the ailment.
- To perform a repair of the fistula.
- To remove an intestinal obstruction from the narrowed segment of bowel.
- To remove other infections or complications such as the abdominal abscess.
Usually, during surgery, the infected part of the bowel or any other associated abscess are removed. This removal is called resection, at the end of which the healthy parts of the bowel are joined together in a process called anastomosis.
It should be however kept in mind that surgery is not the complete cure for the disease. It can lead to a few symptom-free years, but there will still be a risk of recurring of the disease at the site of repair. The goal of surgery in crohn’s disease is to prevent the bowel from getting infected or inflamed. However, it should be remembered that no surgery can ever cure Crohn’s disease or prevent it from flaring up again.
Diet and nutrition for crohn’s disease:
Since the site of occurrence of Crohn’s disease varies from person to person and even changes within the same person over time, there is no fixed diet that will work for every person. Like medicines, the diet and nutrition also vary from patient to patient. Some of the diets that may be recommended by the physician are:
- Low salt diet: If the patient is prescribed with corticosteroids, he may be advised to take low salt diet in order to reduce the water retention.
- Low fiber diet: If the patient has strictures, then low fiber diet is advised by the physicians to avoid blockages.
- Low-fat diet: Normally when the ailment is active, absorption of fats by the body becomes an issue. During this time, patients are advised with a low-fat diet.
- High-calorie diet: One side effect of Crohn’s disease that is seen in most patients is the loss of weight. Patients experiencing this issue are often advised a high-calorie diet.
- Lactose free diet: Patients who are intolerant to dairy products are recommended to have lactose free diet.
Most of the physicians will advise Crohn’s disease patients to follow a diet keeping in mind the following points:
- The quantity of meal should be small but can be taken frequently.
- Carbonated beverages should be avoided as they may give rise to problems of gas.
- Caffeine should also be restricted as they may act as a laxative.
- Fried and greasy foods, as well as spicy foods, should be avoided to the most as they may cause diarrhea.
Maintaining a proper diet and nutrition is very much necessary for curing of Crohn’s disease. The effects of Crohn’s disease such as diarrhea and rectal bleeding can rob the body fluids, electrolytes, and minerals. Proper nutrition is therefore mandatory to maintain a balance and keep the keep the body functioning properly.
Crohn’s disease and cancer:
In the United States, more than ⅓ cases of cancer are colorectal cancer and are the third leading cause of cancer-related deaths. Though less than 1% of these cases are related to IBD (inflammatory bowel disease), the risk of colorectal cancer increases if one experiences IBD at any point in time.
Who are at risk of colorectal cancer?
Patients diagnosed with Crohn’s disease before the age of 30 are more prone to colorectal cancer. Moreover, patients having Crohn’s colitis and ileocolitis are at a greater risk of getting colorectal cancer. While Crohn’s colitis is the type of crohn’s disease that affects the colon, ileocolitis is that type of crohn’s disease which affects both the colon and the small intestine.A person whose small intestine is the only part affected by Crohn’s disease is not at the risk of colon cancer. But the more the digestive tract is infected by crohn’s disease, the more is the risk of getting colon cancer.
Symptoms of colon cancer
Colon cancer has similar symptoms as inflammatory bowel disease(IBD). In both the cases, the patient experiences either some or all of the following difficulties:
- diarrhea or constipation.
- abdominal pain and cramping.
- weight loss.
Screening for Colon cancer
If Crohn’s disease affects more than ⅓ rd of the colon, a patient is recommended undergo a screening of colon cancer where colonoscopy with multiple biopsies is done. The screening should start about 8-10 years from the first occurrence of crohn’s disease. It should be followed by a surveillance colonoscopy within 2-3 years of the screening colonoscopy.
Is colon cancer curable?
As a result infection and inflammation due to Crohn’s disease, polyps grow in the colon. Polyps are the abnormal tissue growth on the mucous membrane of the colon lining. These polyps have the risk of growing into cancer. However, it takes nearly 8-10 years for a polyp to become cancerous. If the screening is done before this period and the polyp is removed, then cancer can be prevented. Moreover, besides this, there are some medications for treatment of Crohn’s disease which reduces the risk of colorectal cancer. It is therefore recommended that patients once diagnosed with Crohn’s disease should undergo periodic and regular screening for cancer.
Lifestyle with crohn’s disease
So that we have covered almost all about Crohn’s disease, let’s throw some light on some other aspects that are linked with the ailment. Also as a bonus, we are providing information about a latest and advanced crohn’s disease test. To know about that, you need to read until the end of this post.
Stress and emotional factors associated with crohn’s disease
Mental stress and depression are often associated with Crohn’s disease. Though these are not the cause of the disease, patients sometimes feel mental stress as a reaction of crohn’s disease. For this kind of stress, formal psychotherapy is not normally required, yet speaking to a therapist having knowledge of IBD helps considerably.
Living your life with crohn’s disease
We would like to quote a few points that a patient may want to incorporate in order to augment the quality of living even while suffering from Crohn’s disease. He can plan some practical tactics to deal with the disease and be stressless even while the disease is active. Some points are discussed below.
- Visiting public places like restaurants, parks, shopping areas or theatres may seem awkward, but not necessarily. Most public places have restrooms which you can use in case of emergency.
- While traveling you may carry extra underclothing, toilet papers or moist wipes.
- If you are traveling for a longer period of time, consult with the doctor before leaving and plan out accordingly. Also get to know the generic names of medicines prescribed by the doctor. It will be helpful if you run out of stock during the time period.
The bottom line is to keep your daily activities as normal as possible. You should rather pursue all the activities you were performing before the diagnosis.
So, while we hope and pray for your speedy recovery, in case if you are diagnosed with Crohn’s disease, we would like to wrap the article with two bonus pieces of information. Here they go.
[Bonus Info 1] 10 important questions you would like to ask your doctor.
People diagnosed with crohn’s disease often wonder what they should ask their physician about the ailment. More often they embarrassed to ask anything to the doctors they visit. To make that easy for them, we have come with a list of 10 questions every patient diagnosed with Crohn’s disease may ask the physician. Here goes the list.
- What can be the reason for my symptoms? Can there be any reason other than the disease which is causing my symptoms?
- What Crohn’s disease test should I need to undergo?
- Should I have these Crohn’s disease test when the disease is active or on regular basis?
- Which part of my gastrointestinal tract is affected?
- How long should I take medications to see some results?
- Should I consult you if I miss a dose of medicine?
- What if the symptoms return again? And which symptoms are considered an emergency?
- Is there any side effect of the medicines?
- What dietary restrictions should be followed?
- When should I come back for a follow-up appointment?
[Bonus info 2] Prometheus test
We have already mentioned that the detection and diagnosis of Crohn’s disease are typically complicated due to unavailability of diagnostics tools. Only colonoscopy and endoscopy are the two tools that are widely used for diagnosis of the ailment.
However as technology has advanced, new Crohn’s disease test has evolved, one of which is the Prometheus test.
Prometheus test is a new serum test that measures and monitors mucosal healing status in Crohn’s disease patients. The test was introduced by Prometheus Laboratories Inc, a pharmaceutical and diagnostic company in 2010. The test enables physicians to use both serologic and genetic mutation markers to get a personalized profile of the patient which further helps in detecting the cause of the disease.
To conclude, this novel Crohn’s disease test is definitely a breakthrough in Crohn’s treatment and diagnosis.