CROHN’S DISEASE

Crohn’ disease  is an inflammatory condition of the digestive tract.

Approximately 80 percent of patients have small bowel involvement, usually in the distal ileum.
Approximately 20 percent have disease limited to the colon.
Approximately 50 percent of patients involvement of both the ileum and colon.
A small percentage have predominant involvement of the mouth or gastroduodenal area.
Approximately one-third of patients have perianal disease.

CAUSES -GENETICS+ ENVIRONMENTAL FACTORS

The current belief is that, in a genetically susceptible person, a trigger leads the body’s immune system to inappropriately cause inflammation in the digestive tract.

SYMPTOMS

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems
Perianal disease

DIAGNOSIS

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests, X rays  and  colonoscopy are helpful in making a diagnosis.

COMPLICATIONS 

Stricture  A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Perforation and fistulae
Bleeding
Toxic Megacolon
Blood Clots
Severe malnutrition
Gallstones
As with ulcerative colitis there appears to be an increased risk of colon cancer in patients with longstanding Crohn’s colitis.

MEDICATIONS

Many different drugs are used to treat Crohn’s disease. The choice of medications will depend upon the area of the digestive tract affected by the disease and the symptoms.
Steroids (such as prednisone and budesonide) can induce remission in patients with active, moderate to severe Crohn’s disease. However, steroids do not prolong remission and there are many serious side effects of long-term steroid use.

Sulfasalazine was one of the first drugs used to treat Crohn’s disease restricted to the colon. Sulfasalazine usually begins to reduce symptoms within a few days, but its full effect may require up to four weeks of treatment.
5-aminosalicylates – The 5-aminosalicylate (5-ASA) drugs (such as Asacol, Lialda  and Pentasa) are similar to sulfasalazine, but are less likely to cause headaches and allergic reactions.
Antibiotics – Antibiotics can reduce the number of bacteria in the intestines, which can in turn reduce inflammation. The antibiotics most frequently used are metronidazole and ciprofloxacin.
Immunomodulator drugs – Immunomodulator drugs decrease the inflammation associated with Crohn’s disease. The most commonly used drugs include azathioprine, 6-mercaptopurine.
Biologic response modifiers (Infliximab (Remicade) , Adalimumab (Humira), Natalizumab (Tysabri), Certolizumab pegol (Cimzia)) are   medications that  used as treatment options in moderate to severe Crohn’s disease who have not responded to other therapies.

SURGERY 
About 80 percent of patients with Crohn’s disease will require an operation at some time, usually to stop bleeding, to close fistulas and bypass obstructions, and often to remove the affected areas of the intestine However, surgery does not cure Crohn’s disease, and recurrence is likely.

COMMONLY USED DRUGS
Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information, please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.ccfa.org