Abdominal Pain: Crohn’s Disease

Inflammatory bowel disease, or IBD, is a common inflammatory condition that can affect the GI tract. IBD involves chronic (or long-term) inflammation of some or all of your digestive tract and can come with a number of painful symptoms.

IBD is typically distinguished into two separate diseases: Crohn’s disease and ulcerative colitis. Ulcerative colitis is inflammation of the inside lining of the colon, and Crohn’s disease is inflammation that can affect any part of the GI tract and involves the entire thickness of the affected area.

Crohn’s disease, the focus of this blog, is a lifelong ailment with no known cure. However, proper management, preventive measures, and diligent care can often allow people with Crohn’s disease to live normal, comfortable lives. Here’s a look at the basics of Crohn’s disease and how it’s treated and managed.

Causes and Risk Factors

Doctors have not been able to identify any direct causes of Crohn’s disease. However, at its simplest, Crohn’s disease is a disease in which our body’s immune system attacks our body—typically the GI tract—as if it’s a virus or bacteria. These types of problems, where our bodies’ immune systems attack our bodies, is called an autoimmune disease. The following are possible causes of Crohn’s disease.

1. Immune system: Some doctors and researchers believe that Crohn’s disease begins when a particular bacteria or virus triggers our immune systems but does so in a way that causes the immune system to attack not only the bacteria or virus but the healthy cells in the digestive system also. No specific bacteria or virus, despite extensive research, has been proven as a clear culprit.
2. Genetics: Genetics plays a role in Crohn’s disease. People with a family history of Crohn’s disease are at a higher risk of acquiring Crohn’s disease. However, Crohn’s disease is not totally genetic. Even with identical twins—who have the exact same genes—only 50 percent of the time will both twins have Crohn’s disease. The vast majority of current Crohn’s sufferers do not have a family history of Crohn’s disease.

Several other risk factors for Crohn’s disease have been identified as follows:

Ethnicity: Crohn’s disease can affect anyone, but people of Western European ancestry and anyone of Eastern European Jewish descent (also known as Ashkenazi Jews) have a higher risk of acquiring Crohn’s disease.
Age: Crohn’s disease usually occurs before the age of 30.
Anti-inflammatory medications: Although ibuprofen-like medications (Advil, Motrin, Aleve, etc.) don’t cause Crohn’s disease, they can exacerbate and even mimic the symptoms of Crohn’s disease.
Smoking
Location: Crohn’s disease is more common in industrialized nations and developed areas. Why this is true is a puzzle. Some doctors and researchers believe lifestyle and environmental factors (pollution, chemicals, etc.) may contribute to its development.

Symptoms and Complications

Because Crohn’s disease can affect so many different parts of the digestive tract, symptoms can vary between people with Crohn’s disease. Crohn’s also comes with long stretches of remission where no symptoms are present at all. During active periods, symptoms may include:

Diarrhea and loose stools
Bloody stools
Severe abdominal pain and cramping
Nausea and vomiting
Fever and fatigue
Inflamed skin and eyes
Weight loss and issues with appetite
Mouth sores
Sores and inflammation near the anus
For children who develop Crohn’s disease, growth and sexual development can be affected

The above symptoms are vague and can be symptoms of many diseases. However, bloody bowel movements and severe abdominal pain or cramping are symptoms that should always be evaluated by a doctor or healthcare professional. There are several advanced conditions that can be caused in part by Crohn’s disease, but getting ahead of your health can lower your risk for almost all of them.

Diagnosis

A careful history and physical exam is always the first step in diagnosing Crohn’s disease. Infections of the GI tract and several other diseases can mimic the symptoms of Crohn’s disease. If no obvious other reason for your symptoms is identified, your doctor may order a number of other tests to assess for Crohn’s disease. The following is a sample of tests that are commonly ordered:

Blood test for anemia or infection
Fecal occult blood test (a stool sample where the doctor checks for hidden blood in the stool)
• Colonoscopy: A special camera test performed by a gastroenterologist to view your whole colon and take tissue samples to be analyzed for findings of Crohn’s disease.
CT scan: Computerized tomography is a special, multi-X-ray image that gives more detail than a standard X-ray
Flexible sigmoidoscopy: A special camera test performed by a gastroenterologist similar to a colonoscopy that allows for a limited assessment of your colon.
Capsule endoscopy: A pill or capsule with a camera that is swallowed and takes pictures, as it passes through your GI tract, of everything it sees.
MRI: Magnetic resonance imaging is a special test that uses radio waves to create an image more detailed than a standard X-ray.

Management and Treatment

Although Crohn’s disease can’t be cured, medications, special diets and other management factors can help the symptoms of Crohn’s disease and often bring about remission. Medications need to be continued indefinitely; if they are stopped after achieving remission, the symptoms of Crohn’s disease will almost always return. Treatment of Crohn’s disease involves managing symptoms and making daily life as comfortable as possible. The following are options your doctor may discuss:

Anti-inflammatory medications: Corticosteroids and oral 5-aminosalicylates help relieve inflammation and improve symptoms.
Immune suppressors: Certain medications can safely target key areas of the immune system to prevent and heal inflammation.
Antibiotics: Antibiotics can be used to treat infection complications from Crohn’s disease and also play a role in killing the bacteria that may trigger the immune system to attack the digestive system.
Others: Anti-diarrheal medicines, painkillers and various iron and vitamin supplements might also be used depending on your symptoms.

In rare cases, supplemental nutrition through and IV or a feeding tube may be necessary to provide the nutrients our bodies need and to help lower stress on the bowels.

If you’re under 30 and have signs of Crohn’s disease, don’t wait. Speak to your doctor right away and learn what you can do to manage your symptoms and live a healthy life.

I grew up in Utah County and graduated from Brigham Young University. I received my medical degree from the University of Virginia, and I finished my residency in internal medicine at the University of Utah where I also served as chief medical resident. As a doctor, I recognize the tremendous trust my patients place in me, and I do my best to help them understand not only their medical issues but also the plan—the how and why—behind helping them feel better. I love the challenge posed by all gastrointestinal disorders but especially enjoy the challenges and intricacies of Crohn’s disease and Ulcerative Colitis.