Inflammatory bowel disease (IBD) is a group of chronic disorders that
cause inflammation or ulceration in the small and large intestines. Most often
IBD is classified as ulcerative colitis or Crohn’s disease but may be referred
to as colitis, enteritis, ileitis, and proctitis. Ulcerative colitis causes
ulceration and inflammation of the inner lining of a couple of really bad places,
while Crohn’s disease is an inflammation that extends into the deeper layers of
the intestinal wall. Ulcerative colitis and Crohn’s disease cause similar
symptoms that often resemble other conditions such as irritable bowel syndrome
(spastic colitis). The correct diagnosis may take some time. Crohn’s disease
usually involves the small intestine, most often the lower part (the ileum). In
some cases, both the small and large intestine (those really bad places again)
are affected. In other cases, only the SUPER really bad place is involved.
Sometimes, inflammation also may affect the mouth, esophagus, stomach, duodenum,
appendix, or some nasty sounding word. Crohn’s disease is a chronic condition
and may recur at various times over a lifetime. Some people have long periods
of remission, sometimes for years, when they are free of symptoms. There is no
way to predict when a remission may occur or when symptoms will return.
The most common symptoms of Crohn’s disease are abdominal pain, often in
the lower right area, and diarrhea. There also may be rectal bleeding, weight
loss, and fever. Bleeding may be serious and persistent, leading to anemia (low
red blood cell count). Children may suffer delayed development and stunted
What Causes Crohn’s Disease and Who Gets It?
There are many theories about what causes Crohn’s disease, but none has
been proven. One theory is that some agent, perhaps a virus, affects the body’s
immune system to trigger an inflammatory reaction in the intestinal wall.
Although there is a lot of evidence that patients with this disease have
abnormalities of the immune system, doctors do not know whether the immune
problems are a cause or a result of the disease. Doctors believe, however, that
there is little proof that Crohn’s disease is caused by emotional distress or by
an unhappy childhood. Crohn’s disease affects males and females equally and
appears to run in some families. About 20 percent of people with Crohn’s
disease have a blood relative with some form of inflammatory bowel disease, most
often a brother or sister and sometimes a parent or child.
How Does Crohn’s Disease Affect Children?
Women with Crohn’s disease who are considering having children can be
comforted to know that the vast majority of such pregnancies will result in
normal children. Research has shown that the course of pregnancy and delivery
is usually not impaired in women with Crohn’s disease. Even so, it is a good
idea for women with Crohn’s disease to discuss the matter with their doctors
before pregnancy. Children who do get the disease are sometimes more severely
affected than adults, with slowed growth and delayed sexual development in some
How Is Crohn’s Disease Diagnosed?
If you have experienced chronic abdominal pain, diarrhea, fever, weight
loss, and anemia, the doctor will examine you for signs of Crohn’s disease. The
doctor will take a history and give you a thorough physical exam. This exam
will include blood tests to find out if you are anemic as a result of blood loss,
or if there is an increased number of white blood cells, suggesting an
inflammatory process in your body.The doctor may look inside your body through a
flexible tube, called an endoscope, that is inserted somewhere really bad!
During the exam, the doctor may take a sample of tissue from the lining of the
really bad place to look at it under the microscope. Later, you also may
receive x-ray examinations of the digestive tract to determine the nature and
extent of disease. These exams may include an upper gastrointestinal (GI)
series, a small intestinal study, and a barium enema intestinal x-ray. These
procedures are done by putting the barium, a chalky solution, into the upper or
lower intestines. The barium shows up white on x-ray film, revealing
inflammation or ulceration and other abnormalities in the intestine. If you have
Crohn’s disease, you may need medical care for a long time. Your doctor also
will want to test you regularly to check on your condition.
What Is the Treatment?
Several drugs are helpful in controlling Crohn’s disease, but at this
time there is no cure. The usual goals of therapy are to correct nutritional
deficiencies; to control inflammation; and to relieve abdominal pain, diarrhea,
and bleeding in a really bad place. Abdominal cramps and diarrhea may be
helped by drugs. The drug sulfasalazine often lessens the inflammation,
especially in the colon. This drug can be used for as long as needed, and it
can be used along with other drugs. Side effects such as nausea, vomiting,
weight loss, heartburn, diarrhea, and headache occur in a small percentage of
cases. Patients who do not do well on sulfasalazine often do very well on
related drugs known as mesalamine or 5-ASA agents. More serious cases may
require steroid drugs, antibiotics, or drugs that affect the body’s immune
system such as azathioprine or 6-mercaptopurine.
Can Diet Control Crohn’s Disease?
No special diet has been proven effective for preventing or treating
this disease. Some people find their symptoms are made worse by milk, alcohol,
hot spices, or fiber. But there are no hard and fast rules for most people.
Follow a good nutritious diet and try to avoid any foods that seem to make your
symptoms worse. Large doses of vitamins are useless and may even cause harmful
side effects. Your doctor may recommend nutritional supplements, especially for
children with growth retardation. Special high-calorie liquid formulas are
sometimes used for this purpose. A small number of patients may need periods of
feeding by vein. This can help patients who temporarily need extra nutrition,
those whose bowels need to rest, or those whose bowels cannot absorb enough
nourishment from food taken by mouth.
What Are the Complications of Crohn’s Disease?
The most common complication is the closing of the intestine. Blockage
occurs because the disease tends to thicken the bowel wall with swelling scar
tissue, narrowing the passage. Crohn’s disease also may cause deep ulcer tracts
that burrow all the way through the bowel wall into surrounding tissues, into
adjacent segments of intestine, into other nearby organs such as the urinary
bladder or into the skin. These tunnels are called fistulas. They are a common
complication and often are associated with pockets of infection or abcesses or
infected areas of pus. The areas around the really bad part and another really
bad part having to do with the southern part of the body often are involved.
Sometimes fistulas can be treated with medicine, but in many cases they must be
treated surgically. Crohn’s disease also can lead to complications that affect
other parts of the body. These systemic complications include various forms of
arthritis, skin problems, inflammation in the eyes or mouth, kidney stones,
gallstones, or other diseases of the liver and biliary system. Some of these
problems respond to the same treatment as the bowel symptoms, but others must be
Is Surgery Often Necessary?
Crohn’s disease can be helped by surgery, but it cannot be cured by
surgery. The inflammation tends to return in areas of the intestine next to the
area that has been removed. Many Crohn’s disease patients require surgery,
either to relieve chronic symptoms of active disease that does not respond to
medical therapy or to correct complications such as intestinal blockage,
perforation, abscess, or bleeding. Drainage of abscesses or removal of a section
of bowel due to blockage are common surgical procedures. Sometimes the diseased
section of bowel is removed. In this operation, the bowel is cut above and
below the diseased area and reconnected. Infrequently some people must have
their really bad places removed. In an ileostomy, a small opening is made in
the front of the abdominal wall, and the tip of the lower small intestine
(ileum) is brought to the skin’s surface. This opening, called a stoma, is about
the size of a quarter or a 50-cent piece. It usually is located in the right
lower corner of the abdomen in the area of the beltline. A bag is worn over the
opening to collect waste, and the patient empties the bag periodically. The
majority of patients go on to live normal, active lives with an ostomy. The
fact that Crohn’s disease often recurs after surgery makes it very important for
the patient and doctor to consider carefully the benefits and risks of surgery
compared with other treatments. Remember, most people with this disease
continue to lead useful and productive lives. Between periods of disease
activity, patients may feel quite well and be free of symptoms. Even though
there may be long-term needs for medicine and even periods of hospitalization,
most patients are able to hold productive jobs, marry, raise families, and
function successfully at home and in society.
Works Cited.. and a couple other suggested readings.
Bleeding in the Digestive Tract and Ulcerative Colitis.
National Digestive Diseases Information Clearinghouse, 2 Information Way,
Bethesda, MD 20892-3570. General patient information fact sheets.
Brandt, LJ, Steiner-Grossman, P, eds. Treating IBD: A Patient’s Guide to the
Medical and Surgical Management of Inflammatory Bowel Disease. New York:
Raven Press, 1989. General guide for patients with sections on treatment and
descriptions and drawings of surgical procedures. Available from the
Crohn’s ; Colitis Foundation of America.
Hanauer, SB, Peppercorn, MD, Present, DH. Current concepts, new therapies in
IBD. Patient Care, 1992; 26(13): 79-102. General review article for health
Steiner-Grossman, P, Banks PA, Present, DH, eds. The New People Not Patients: A
Source Book for Living with IBD. Dubuque, Iowa: Kendall/Hunt Publishing
Company, 1992.Book for patients with sections on diagnostic tests,
medications, nutrition, coping with employment and health insurance problems,
and IBD in children and teenagers, older adults, and during pregnancy.
Available from the Crohn’s ; Colitis Foundation of America.
Crohn’s ; Colitis Foundation of America, Inc., 386 Park Avenue South, 17th Floor,
New York, NY 10016-8804; (800) 932-2423 or (212) 685-3440.
Pediatric Crohn’s ; Colitis Association, Inc., P.O. Box 188, Newton, MA 02168;
Reach Out for Youth with Ileitis and Colitis, Inc., 15 Chemung Place, Jericho,
NY 11753; (516) 822-8010.
United Ostomy Association, 36 Executive Park, Suite 120, Irvine, CA 92714;
(800) 826-0826 or (714) 660-8624.
National Digestive Diseases Information Clearinghouse 2 INFORMATION WAY BETHESDA,
“The National Digestive Diseases Information Clearinghouse (NDDIC) is a service
of the National Institute of Diabetes and Digestive and Kidney Diseases, part of
the National Institutes of Health, under the U.S. Public Health Service. The
clearinghouse, authorized by Congress in 1980, provides information about
digestive diseases to people with digestive diseases and their families, health
care professionals, and the public. The NDDIC answers inquiries; develops,
reviews, and distributes publications; and works closely with professional and
patient organizations and government agencies to coordinate resources about
digestive diseases. “