Crohn’s Disease

Crohn's Disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients, and getting rid of waste. Inflammation (red, swollen, and tender areas) always affects the innermost lining of the gastrointestinal tract, called the mucosa. However, the disease can affect the deeper layers of the gastrointestinal wall and even extend through the entire bowel wall.

Causes

The exact cause of Crohn's Disease is unknown. Current research is exploring the possible connection of the disease to immune system problems and bacterial infections.

Risk Factors

Crohn's Disease can occur in people of all ages, but usually starts between ages 15 and 35. Men and women are equally affected. A family history of Crohn's Disease or Inflammatory Bowel Disease slightly increases one's risk. Crohn's Disease is not contagious.

Symptoms

Crohn's Disease can present as abdominal disease, anorectal (anus and rectum) disease, or both. Patients with Crohn's Disease are at greater risk of developing a fistula. A fistula is a small tunnel that tracks from one portion of bowel to another portion of bowel, another organ or the skin. Symptoms vary widely among patients and often come and go over a long period of time. These include:

  • Abdominal cramping

  • Abdominal pain

  • Ongoing diarrhea

  • Chronic constipation

  • Bleeding with bowel movements

  • Fever

  • Extreme tiredness

  • Weight loss

  • Drainage from the skin around the anus

  • Abscesses (infections) around the anus that come back

  • Anal fissures

Diagnosis

During the first visit, your colon and rectal surgeon will perform a thorough medical history and physical exam. They will also examine the inside of the bowel using flexible instruments with lighted cameras. X-ray studies and lab tests such as stool samples and blood tests will also be done. This evaluation will provide information on the extent of the disease and guide treatment.

Nonsurgical Treatment

Medication is always the first option, unless emergency surgery is required. Several treatment approaches are used at the onset and for the long-term to help patients control the disease. The most common initial therapy includes anti-­inflammatory medication. Diet and lifestyle changes can also help.

Surgical Treatment

Surgery may be needed when patients develop disease-related abdominal and anorectal complications. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. Both of these conditions can be life-threatening. Immediate surgery may also be required for an abscess near the anus.

Abdominal surgery: Surgery is typically performed when the patient's symptoms can no longer be controlled with their medications. This usually means there is a section of bowel that is either too scarred or narrow to function properly. The surgery can be performed either through a traditional open approach or a minimally invasive procedure. Emergency abdominal surgery is usually performed as an open procedure due to the urgency of the situation. Your surgeon will decide on the safest approach based on your individual case.

The most common procedure is removal of the last portion of the small bowel and the start of the large bowel to relieve abnormal, narrowed sections. Following removal of part of the bowel, the remaining bowel is reconnected, if possible. The end of the bowel can also be brought through a surgical opening in the skin of the abdominal wall. This procedure (called an ostomy) redirects waste (feces) from the bowels.

Anorectal surgery: This is most commonly done to open and drain anorectal abscesses. A seton (small drain) may be left in place for a period of time until the infection clears up. Surgery is also used to treat anorectal fistulas. In combination with this procedure, an ostomy may be created but usually only in severe cases.

Post-Treatment Prognosis

It is important to follow up with your doctors so they can devise an ongoing management plan to control your symptoms. When you have Crohn's Disease, you must stay on medication throughout your entire life. Crohn's Disease that impacts the colon (large intestine) increases your risk of colon cancer. This risk goes up after 8-10 years of ongoing colon involvement. For those patients, it is key to undergo regular follow-up colonoscopies (examination of the colon using a flexible instrument with a lighted camera).

How can I reduce recurrence?

Recurrence is most common in patients who stop taking their medications. So, it is vital to follow your doctor's orders. Smoking negatively impacts every organ in the body and presents health risks for everyone; so quitting is advised. For patients with Crohn's Disease, smoking has been linked to higher recurrence rates; so quitting can reduce this risk.

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