Crohn’s disease is a type of inflammatory bowel disease (IBD) in which an abnormal immune system response causes chronic inflammation in the digestive tract. Crohn’s is often confused with ulcerative colitis, a similar IBD that only affects the large intestine.
According to the Crohn's & Colitis Foundation of America, about 1.4 million Americans have Crohn’s disease or ulcerative colitis. Of those, about 700,000 have Crohn’s. In the years between 1992 and 2004, there was a 74 percent increase in doctor’s office visits due to Crohn’s disease. In 2004, Crohn’s disease was the cause of 57,000 hospitalizations.
Who Gets Crohn’s Disease
Anyone can develop Crohn’s disease or ulcerative colitis. However, IBDs are usually diagnosed in young adults between the ages of 15 and 30. Children are twice as likely to be diagnosed with Crohn’s as ulcerative colitis. Boys develop IBDs at a slightly higher rate than girls.
In the United States, males and females get Crohn’s at about the same rate. Caucasians and Ashkenazi Jews develop Crohn’s at a higher rate than other ethnicities. The highest rates occur in Canada. In general, people who live in higher latitudes are more likely to develop Crohn’s than those in lower latitudes. When relocating from a low-latitude to a high-latitude region, the risk of developing Crohn’s matches that of the high-latitude region within a single generation.
In Crohn’s disease, the immune system mistakenly attacks healthy bacteria in the GI tract. Chronic inflammation causes thickening of the intestinal wall, which triggers the symptoms. The exact reason this occurs is not clear, but there is a hereditary factor. According to the Crohn's & Colitis Foundation of America, between 5 and 20 percent of people who have an IBD have a first-degree relative with one. The risk is higher in Crohn’s than ulcerative colitis, and higher when both parents are affected.
There may also be an environmental element. Rates of Crohn’s are higher in developed countries, urban areas, and northern climates. Stress and diet may worsen Crohn’s, but neither is thought to cause the disease. It’s likely that Crohn’s is caused by a combination of factors.
Symptoms of the disease vary from person to person, depending on the type of Crohn’s. The most widespread form is called ileocolitis, which affects the end of the small intestine (ileum) and the large intestine. Symptoms include pain in the lower or middle part of the abdomen. Diarrhea and weight loss are common. Ileitis affects only the ileum, but causes the same symptoms.
Gastroduodenal Crohn’s disease manifests in the beginning of the small intestine (duodenum) and the stomach. The main symptoms are loss of appetite, nausea, and vomiting, which can result in loss of weight. Jejunoileitis causes areas of inflammation in the upper part of the small intestine (jejunum). It can cause severe abdominal pain and cramping, especially after eating. Another symptom is diarrhea.
When Crohn’s affects only the colon, it is called Crohn’s granulomatous colitis. This type of Crohn’s causes diarrhea and rectal bleeding. Patients may develop abscesses and ulcers in the area of the anus. Other symptoms include joint pain and skin lesions.
Other general symptoms of Crohn’s include fatigue, fever, and night sweats. Some patients experience an urgent need to move their bowels. Constipation can also be a problem. Women may have an interruption in their menstrual cycle. Young children may have delayed development.
Most Crohn’s patients have episodes of disease activity followed by remissions. The stress of a flare-up can lead to anxiety and social withdrawal.
Diagnosis and Treatment
There’s no single test that can positively diagnose Crohn’s disease. If you have symptoms, your doctor will probably run a series of tests to rule out other conditions. Diagnostic testing may include:
- blood tests to look for infection or anemia (not enough red blood cells)
- fecal tests to see if there is blood in your stool
- capsule endoscopy or double-balloon endoscopy, two procedures that allow a better view of the small bowel
- flexible sigmoidoscopy, a procedure that helps your doctor view the last section of colon
- colonoscopy to enable doctors to get a good look at the entire length of your colon and to remove samples for analysis (biopsy). The presence of inflammatory cells can help diagnose Crohn’s.
- imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) to get detailed pictures of the abdominal area and intestinal tract
There’s no cure for Crohn’s. Treatment usually involves a combination approach. Immune suppressants can help control your immune system’s inflammatory response. Various medications can be used to treat individual symptoms. The Crohn's & Colitis Foundation of America estimates that about 70 percent of Crohn’s patients eventually need surgery to repair damage or remove an obstruction. Sometimes, a portion of the bowel must be removed. About 30 percent of surgical patients will have a flare-up within three years, and 60 percent will have one within 10 years.
Good nutritional decisions are crucial for people with Crohn’s. A well-chosen diet can help reduce symptoms and help you heal. You may find that certain foods trigger symptoms, but it may take some trial and error to isolate which ones. Loss of appetite and diarrhea can make it hard to absorb the nutrients you need. Ask your doctor or nutritionist to advise you about dietary supplements.
Crohn’s can lead to fissures, or tears, in the lining of the anus. This can cause bleeding and pain. A common and serious complication is when inflammation and scar tissue block the intestines. Crohn’s can cause ulcers within the intestines. Another serious complication is the formation of fistulas, abnormal spaces that connect organs within the body. Crohn’s disease may also increase the risk of colorectal cancer.
Living with Crohn’s disease also takes an emotional toll. Embarrassment over bathroom issues can interfere with your social life and your career. You may find it helpful to seek counseling or join a support group for people with IBD.
Crohn’s is an expensive disease. In a 2008 study, direct medical costs were $18,022 to $18,932 per patient per year in the United States. About 53 to 67 percent of those costs were from hospitalizations. Costs were higher for patients with more severe disease activity. Patients in the top 25 percent averaged $60,582 per year. Those in the top two percent averaged more than $300,000 per year.
In 2004, the United States spent $1.84 billion on Crohn’s and ulcerative colitis.