The incidence of Crohn’s disease has been increasing in America, now up to 13 cases in 100,000 compared with 6 per 100,000 in Asia. Nobody knows what triggers the body to recognize it’s lining as foreign. There are thought to be genetic factors as well as exposure to an inciting stimulus that “turn on” the immune system. Both UC and Crohn’s are less prevalent in countries where food sources are less processed. Industrialized diet, smoking, antibiotics, and stress all may play some role. About 15-30% of patient have other family members afflicted.
Unlike ulcerative colitis that always involves the rectum, Crohn’s Disease will frequently involve the last part of the small bowel, called the “terminal ileum”, before it empties into the large bowel. Functionally, this results in pain in the right lower abdomen. It can be confusing as this is where appendicitis pain appears—but a CT scan rule out appendicitis in most cases. As mentioned above, Crohn’s disease can involve large bowel, small bowel and even the upper GI tract. The inflammation is “transmural” which means it can extend all the way through the bowel wall. These tunnels or “fistula” can extend to other organs like bladder or vagina, or even up to the skin. The fistula are very common around the rectum in this disease.
Treatments will vary depending on the amount of tissue involved and level of damage. Because of the chronic nature of this condition, the disease rarely “goes away”, although with age it can “burn itself out”, becoming less prominent over time.
Most often patients come in with vague abdominal pain and diarrhea. Unlike ulcerative colitis, this diarrhea is not usually blood tinged.
Your primary care provider or gastroenterologist may order stool studies to rule out infection and look for parasites and white blood cells.
X-rays , barium studies or CT scans can be helpful and appraising the level of involvement. Findings can include narrowed areas (stricture or stenosis) or fistula formation from organ or organ, or skin.
A colonoscopy will be required to check the appearance of the inflammation in the colon and obtain confirmatory biopsies.
There may be blood markers and measure of inflammation that can be checked. For example a C-reactive protein is a blood marker that corresponds to the overall inflammation in the body (also increases with COVID), and fecal calprotectin levels use the stool to answer the same question. These can be used to monitor for treatment too.
Your gastroenterologist will want to check your colon periodically after a period of years to look for cancer and other lesions. The risk is about 8% after 20 years and 18% after 30 years.
There are several non-pharmacologic treatments:
See your local gastroenterologist to help make the diagnosis and get started on a therapy that is right for you. Our goal is give you therapy to result in long-lasting remissions, maintenance of your independence, and a better quality of life while minimizing medication side effects.
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