Crohn's disease is a type of inflammatory bowel disease. It is a progressive condition, which means that it tends to worsen gradually. But symptoms can sometimes disappear for weeks or even years.
In this article, we look at what Crohn's disease is and its stages and progression. We also cover symptoms, complications, and treatment.
What is Crohn's disease?
Crohn's disease requires long-term management.
Crohn's disease affects the gastrointestinal (GI) tract, which runs from the mouth to the anus and includes the stomach and intestines. The role of the GI tract is to break down the food a person eats and absorb the nutrients into the bloodstream. What remains at the end of this process is waste product, and the body passes it out as stool.
Crohn's disease causes the GI tract to become inflamed. There are five different forms of Crohn's disease, each affecting a different part of the GI tract:
- Gastroduodenal Crohn's disease affects the stomach and the beginning of the small intestine.
- Jejunoileitis affects the upper half of the small intestine, usually in patches.
- Ileitis affects the end of the small intestine.
- Ileocolitis affects the end of the small intestine and the large intestine.
- Crohn's colitis, or granulomatous colitis, affects the large intestine.
Stages and progression
Crohn's disease is chronic, which means that it is a long-term and often lifelong condition. It can also be progressive, which means that a person's symptoms may become worse over time, but this is not always the case.
Crohn's disease may get worse over time because long-term inflammation can damage the GI tract.
Doctors can treat and manage a person's disease to stop or reduce inflammation. Early diagnosis and treatment of Crohn's are vital to help slow progression and prevent more damage.
Crohn's disease does not usually follow a set pattern. Typically, there are no recognizable stages that the condition moves through, and it is not always possible to predict how it will progress.
A person with Crohn's disease will usually have flare-ups and periods of remission. A flare-up is when someone has a sudden increase or worsening of their symptoms. Remission is when they have few or no symptoms.
A doctor will help a person monitor their symptoms and offer advice on treatment and management, as needed.
A high temperature may be a symptom of Crohn's disease.
Symptoms of Crohn's diseases vary from person-to-person and can range from mild to severe. Symptoms also change over time and depend on the severity and location of the inflammation.
Common symptoms of Crohn's disease include:
- abdominal pain and cramping
- unintentional weight loss
- bloody stools
Other possible symptoms may include:
A person may not have all of these symptoms, but symptoms may increase or worsen, especially if left untreated. Crohn's disease can also lead to complications.
Crohn's disease can damage the GI tract over time, which can lead to:
- fistulas when two parts of the intestine connect to form a tunnel
- intestinal abscesses
- intestinal blockages
- internal bleeding from tears or holes in the bowel wall
In some cases, a person may need surgery to repair or remove a damaged section of the GI tract. According to a 2012 study, nearly 60 percent of people with Crohn's disease needed surgery after 20 years of having the condition. Some people required surgery more than once.
Crohn's disease can also affect how well a person's body absorbs nutrients from the foods they eat, which may lead to a vitamin or mineral deficiency. Common deficiencies in people with Crohn's disease include vitamin B-12, vitamin D, and iron. Taking supplements can help replace these nutrients.
Inflammation from Crohn's disease can sometimes spread to other areas of the body, leading to:
- painful joints
- redness or pain in the eyes
- mouth ulcers
- blisters, ulcers, or swelling on the skin, often on the legs
- liver inflammation
Early symptoms of colon cancer can be similar to Crohn's and may include:
- blood in the stool
- a change in bowel habits that persists for more than a few days
- a lasting feeling of needing to have a bowel movement
- abdominal pain and cramping
- weight loss
For people who have had Crohn's for more than 8 years, a doctor may recommend yearly screening for colon cancer.
A doctor may prescribe drugs to treat the symptoms of Crohn's disease.
Treatment of Crohn's disease is different for everyone and aims to:
- reduce inflammation in the intestines
- relieve symptoms
- prevent flare-ups
- achieve and maintain remission
Treatment may change over time, and it is essential to seek medical advice for flare-ups.
Different medications are available to treat people with Crohn's disease. A doctor will prescribe drugs based on how severe a person's symptoms are and what type of Crohn's disease they have.
Drug treatments include:
- Aminosalicylates, which doctors use to treat people with mild to moderate symptoms. These drugs help reduce inflammation in the intestines.
- Corticosteroids reduce inflammation by suppressing the immune system. Doctors prescribe these drugs for moderate to severe symptoms.
- Antibiotics can treat infections or complications that arise from Crohn's disease.
- Immunomodulators reduce inflammation by suppressing the immune system but can take several weeks or longer to start working. A doctor may prescribe these if a person's symptoms do not respond to other medications.
- Biologics are drugs that target and suppress the immune system. Doctors usually only prescribe these drugs if other treatments have not been effective.
A person may require surgery to treat complications of Crohn's disease. Types of surgery may include:
- Small bowel resection. This is where a surgeon removes part of the small intestine and then reconnect the two ends.
- Large bowel resection. Also known as a subtotal colectomy, this is where a surgeon removes part of the large intestine and then reconnect the two ends.
- Proctocolectomy. In this surgery, a surgeon removes the entire colon and rectum. Afterward, a person will need to use an ostomy pouch to collect stools through a small opening in the abdomen.
Over-the-counter medications, such as pain relievers and vitamin supplements, can also help with symptoms. A person should take these in addition to prescription medication.
Diet is an important way to manage Crohn's disease symptoms. A person is often less able to absorb nutrients from their food and drink. A healthful diet has a good balance of protein, vitamins, minerals, fats, and fiber. This can help a person to get the nutrients they need and maintain good energy levels.
Some people may find that certain foods or drinks trigger or worsen their symptoms. Common examples include spicy foods or dairy products. Keeping a food diary may help a person to identify possible triggers.
People with Crohn's disease should seek medical advice before making major changes to their diet.
Symptoms of Crohn's disease are likely to change over time, and a person may experience both flare-ups and periods of remission. Agreeing on a treatment plan with a doctor and making changes to this, as needed, is key to managing Crohn's disease.
Finding the right treatment can help reduce inflammation, minimize long-term damage, and lower the risk of complications. Many people are likely to need surgery if they have lived with Crohn's disease for a long time. Surgery can often give a person a period of remission that may last for several years.