I have chosen to discuss Crohn’s disease this semester because diseases of the digestive system can be viewed as taboo or embarrassing to discuss for patients and others, even though digestive issues in general are very common. My hope with this topic is to help the taboo at least a bit for someone in regards to diseases like this. I myself suffer from a bladder disease, and I understand how hard it can be to discuss something very intimate to oneself with others and even healthcare providers.
Crohn’s disease is a chronic inflammatory disease of a person’s digestive tract. Crohn’s can affect all parts of the digestive system from the mouth to the rectum and anus, so two patients with the same diagnosis can have extremely different symptoms. Some common and more well-known symptoms of Crohn’s disease include abdominal pain, diarrhea which can sometimes be bloody, and weight loss.
Crohn’s disease has unknown causes. It has been generally accepted to be an autoimmune disease, but recent research has shown that the inflammation seen in the disease could be caused by the body attacking normal microbes living in the digestive system, rather than the tissues themselves. This swelling can be viewed in many other parts of the body, such as the joints and eyes.
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Crohn’s disease is shown to often be inherited. Approximately 20 percent of all Crohn’s patients have at least one close relative with the disease, and it is shown to be more common in people of European-Jewish descent. It is a disease that can affect people of all ages, but most patients are diagnosed before they turn 30 years old. This disease can be extremely debilitating in its victims, and it should be more understood by the public. (WebMD LLC, 2018)
A more in-depth look at the symptoms of Crohn’s disease shows that along with cramping, frequent diarrhea, and weight loss, fever, low energy and fatigue, rectal bleeding, a sudden urge to defecate, feeling as though defecation is not complete, and reduced appetite are also symptoms of the disease. These symptoms can range in severity. Mild symptoms can include frequent diarrhea, abdominal pain that does not affect walking or the ability to eat, and lacks other signs such as weight loss, dehydration, tenderness, or severe weight loss and obstruction.
Very severe symptoms can be drastically different, and can include persistent vomiting, high fever and severe weight loss, and evidence of obstruction of abscesses filled with pus, and anal fissures. Anemia can also be seen is cases ranging towards severe. These symptoms can vary from person to person and be located on any part of the GI tract, but, as stated earlier, can take place outside of the GI tract. (AbbVie Inc, 2016)
Crohn’s disease is a form of Inflammatory Bowel Disease, or IBD. It is most prevalent in adolescents and young adults ranging from ages 15 to 35 years old. Men and women have the same chances of being affected by this disease. The causes of Crohn’s and IBD disease are unknown, but research has shown possible links to genetics, environmental factors, and hereditary traits. The disease is also said to be aggravated by stress and diet. With Inflammatory bowel disease, the normal healthy bacteria in our GI tract is thought to be a foreign invader by our immune system, so it is attacked.
This causes our immune cells in the blood to travel to our digestive system and produce an inflammatory response that does not go away. This response can cause the wall of the intestines to thicken, ulcers to develop, and chronic inflammation, and then disease symptoms occur shortly afterwards. While every part of the GI tract is susceptible to Crohn’s disease, the ileum, or the beginning of the small intestine, is usually affected. Crohn’s is not to be mistaken for Ulcerative Colitis, as Colitis can only take place in the bowel, or large intestine. (Crohn’s & Colitis Foundation, 2018)
It is not an easy task to diagnose Crohn’s disease. Often times, a practitioner will rule out other causes for symptoms such as stomach flu, gallbladder disease, pancreatitis, and irritable bowel syndrome (IBS) first before moving to a possible IBD or Crohn’s diagnoses. After other causes are ruled out, a practitioner will usually first review the medical history of the patient and perform a physical examination. A review of the medical history will give information showing how long the symptoms have been going on, their severity, and what has and hasn’t helped symptoms.
After those are done, diagnostic testing of the blood and stool usually take place. Patients may receive an endoscopy after this point, which is a procedure that is used to look at a person’s digestive system with a small camera. Diagnostic scans and images may also be taken to give a proper diagnoses for Crohn’s disease. The disease is determined to be Crohn’s disease based on the location of the inflammation and how deeply the inflammation penetrates the intestinal wall. In Crohn’s, the entire wall is able to be affected and the disease is not limited to just the large intestine. (Health Union, LLC., 2018)
There are several different treatment options for people suffering from Crohn’s. The goal of treatment is to achieve a state of remission, in which or no symptoms are occurring. Treatments usually focus on minimizing inflammation, eliminating any nutritional deficiencies, and alleviating pain, diarrhea, and bleeding. Prescriptions drugs, supplements, and surgeries may be used alone or in combinations to provide treatment. Often times, anti-inflammatories are prescribed to eliminate inflammation. A common anti-inflammatory used is called sulfasalazine (Azulfidine).
If this initial treatment is ineffective, a practitioner may then decide to prescribe a Corticosteroid. Corticosteroids also work to reduce inflammation, but it usually prescribed in larger dose when the disease is in an active state and weened down over time. Corticosteroids carry their own risks, such as infection or ulcers. Immunomodulators and immunosuppressants may also be used to either alter the way the immune system response or to decrease immune response. If these treatments are still yielding no results, a biologic drug, such as Humira, may be prescribed. Other treatments are more focused on eliminating symptoms such as fluid replacements, anti-diarrheals. (WebMD LLC, 2018)
Surgical procedures may be used to treat Crohn’s disease, although it is usually used as a last resort in the event that other treatments are unsuccessful. While these procedures are not a go-to treatment for the disease, it is stated that 75 percent of all Crohn’s patients will need a surgical procedure at some point to alleviate symptoms. One of the most common procedures used for treating Crohn’s disease is an ostomy. An ostomy is when a surgical opening is made in a patient’s abdomen for them to pass stool through. Before an ostomy takes place, a section of either the small or large intestine is usually removed.
With an ostomy, either the small or large intestine can be connected to the ostomy site. The small intestine is used when a patient receives an ileostomy, and the large intestine is used during a colostomy. Other procedures include bowel resections to remove damaged portions of the intestine, colectomy’s to remove diseased portions of the colon, proctocolectomys to remove the colon and rectum and usually an create an ostomy, and strictureplasty’s to make the intestines shorter and wider to reduce scarring. (Rachel Nall, 2016)
The prognosis of Crohn’s disease varies. It is dependent on treatment and the patient themselves. Many patients experience periods of remission and relapse. When in a period of remission, patients may feel well with no symptoms of their disease, but it is impossible to know when remission will occur, end, or how long it will last. Despite the uncertain nature of the disease, hospitalizations, and lifelong treatments, most patients are able to live normal lives and hold down a job. They can maintain relationships, starts families, and continue to live a happy life with proper treatment. (Health Grades Inc., 2015)
References
- AbbVie Inc. (2016). Crohn’s and Colitis- Crohn’s Disease Symptoms. Retrieved from crohnsandcolitis.com: https://www.crohnsandcolitis.com/crohns/disease-symptoms
- Crohn’s & Colitis Foundation. (2018). Crohn’s & Colitis Foundation. Retrieved from crohnscolitisfoundation.org: http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/
- Health Grades Inc. (2015, August 13). Crohn’s Disease: RightDiagnoses. Retrieved from rightdiagnoses.com: http://www.rightdiagnosis.com/c/crohns_disease/prognosis.htm
- Health Union, LLC. (2018). Inflamatory Bowel Disease Website. Retrieved from inflamatoryboweldisease.net: https://inflammatoryboweldisease.net/diagnosis/
- Rachel Nall, R. B. (2016, March 31). Crohn’s Disease: Healthline . Retrieved from Healthline Web site: https://www.healthline.com/health/crohns-disease/surgery#types
- WebMD LLC. (2018). Inflamatory Bowel Disease: WebMD. Retrieved from WebMD.com: https://www.webmd.com/ibd-crohns-disease/crohns-disease/digestive-diseases-crohns-disease#1
