Pediatric Gastroenterology

Crohn's Disease and How to Manage its Symptoms

Inflammatory bowel diseases, which include ulcerative colitis and Crohn's disease, affect millions of people worldwide. More than one and a half million Americans have been diagnosed with these conditions over the past decades. Crohn's disease usually occurs between 10 and 20 years of age. It is more common in women and smokers, causing inflammatory-type symptoms. Although there is no cure for this condition, its symptoms can be managed through diet and medications. Surgery may be required in severe cases.

How Does Crohn's Disease Affect Your Health?

This chronic disorder causes inflammation in the gastrointestinal tract. It usually affects the ileum, which is the end of the small intestine. Compared to ulcerative colitis, it can occur in any part of the GI tract, from the mouth to the rectum. The pain and swelling can be debilitating.

Crohn's disease affects people of all ages, especially young adults between the ages of 15 and 30. Incidence rates are higher in urban areas, developed countries, and northern climates. Patients may experience weight loss, fever, severe abdominal pain, diarrhea, anemia, and nutrient deficiencies. Over time, their risk of developing scleritis, inflammatory arthropathies, and osteoporosis increases.

About 30 percent of all patients diagnosed with Crohn's disease are younger than 20 years. More than 90 percent have symptoms before the age of 40. This condition is common among children and adolescents. In addition to abdominal pain, rectal bleeding, and other common GI symptoms, children may experience a pubertal delay, growth delay, low bone density, and malnutrition. Growth deceleration and anorexia may occur too.

In general, Crohn's disease causes malabsorption, which affects children's growth and development. Boys are more likely to develop this condition than girls. Crohn's typically affects young people at a time in life when they are still in school or starting work, and it can have a dramatic impact on quality of life. Diagnosis is based on radiographic, endoscopic, and pathological findings that could indicate high white blood cell count or bleeding in the intestines.

What Causes Crohn's Disease?

The exact cause of Crohn's disease is unknown. Health experts believe that this condition could be triggered by an abnormal pro-inflammatory response to gut bacteria. Some claim that Crohn's disease is caused by a combination of genetics, poor immune response, and environmental factors.

According to researchers, the immune system reacts abnormally in patients with Crohn's, mistaking foods, and bacteria for being foreign. As a result, white blood cells accumulate in the lining of the digestive tract, producing inflammation, bowel injury, and ulceration. Recent studies indicate that anti-tumor necrosis factor (TNF), a protein produced by the body's immune system, may be responsible for the inflammation associated with this condition.

Family history plays a major role in the development of Crohn's disease. People who have a first-degree relative with this condition are 10 times more likely to develop it. Researchers have also found that smoking increases progression to more advanced stages of the disease. Quitting tobacco is associated with a reduced need for surgery. Atypical mycobacterial infections, childhood infections, birth control pills, antibiotics, non-steroidal anti-inflammatory drugs, and diet have been considered but not proven, to trigger inflammatory bowel disorders.

Signs and Symptoms

Crohn's disease symptoms depend on where the inflammation is located. Most patients experience diarrhea, stomach pain, fatigue, unexplained weight loss, skin disorders, rectal bleeding, stunted growth, and arthritis. Severe bleeding can lead to anemia.

People with Crohn's disease may also develop non-specific symptoms, such as kidney stones, gallstones, venous thromboembolic disease, episcleritis, large joint arthropathy, and malignant melanoma. Over time, fistulas and strictures may occur. Other common symptoms of Crohn's disease include:

• Stomach distention, Bloating, Vomiting
• Delayed puberty
• Skin lesions
• Joint pain
• Night sweats
• Constipation
• Amenorrhea
• Tiredness
• An urgency to have a bowel movement
• Perirectal pain or discharge
• Painful defecation
• Cramping abdominal pain
• Bloody diarrhea
• Anterior uveitis
• Chronic intermittent fever
• Perianal disease

More than 45 percent of patients have abscesses, fissures, and skin tags in the perianal region. Symptoms vary from mild to severe, and may change over time. Most people suffering from this condition go through remission periods, alternating with times when the symptoms show up (flares).

If left untreated, Crohn's disease may cause nutritional deficiencies, malabsorption, perforated bowel, intestinal blockage, fistula, hepatitis, cirrhosis, painful ulcerations, and osteoporosis. Patients diagnosed with Crohn's disease have a higher overall mortality rate compared to the general population.

Treatment Options for Crohn's Disease

Treatment depends on the severity of symptoms. For patients with mildly to moderately active disease, the doctor may recommend a special diet and medications, such as budesonide and oral proton pump inhibitors. Oral steroids and prednisone are usually prescribed in more severe cases. Those who are steroid-resistant may require methotrexate, azathioprine, or 6-MP.

About 70 percent to 90 percent of patients undergo surgery during their lifetime. In general, surgical therapy is recommended to those with complex perianal disease, enterocutaneous fistulas, intra-abdominal abscess, and bowel obstruction. The aim of treatment is to relieve symptoms and preserve the bowel. Surgery does not cure the disease, but may improve the quality of life.

Mild symptoms can be controlled with medication and dietary changes. Regular exercise, smoking cessation, and reduction of stress can prevent relapse. The latest research shows that a diet high in fiber and monounsaturated fats can ease the pain and discomfort associated with this disease. Some patients find relief in eliminating gluten, casein, and lactose from their diets. Adequate hydration is essential. Eating small, frequent meals can help prevent bloating, stomach distention, and abdominal pain.