Read more about this disease, some with Classification – Types – Signs and symptoms – Genetics – Pathophysiology – Diagnosis – Screening – Prevention – Treatment and management – Cures and much more, some including pictures and video when available.
Crohn’s disease (also known as granulomatous colitis and regional enteritis) is an inflammatory disease of the digestive system which may affect any part of the gastrointestinal tract from mouth to anus. As a result, the symptoms of Crohn’s disease can vary significantly among afflicted individuals. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be visibly bloody), vomiting, or weight loss. [1][2][3] Crohn’s disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.[1]
The precise cause of Crohn’s disease is not known. The disease occurs when the immune system attacks the gastrointestinal tract and for this reason, Crohn’s disease is considered an autoimmune disease. This autoimmune activity produces inflammation in the gastrointestinal tract, and therefore Crohn’s disease is classified as an inflammatory bowel disease. Research in 2007 has suggested that intestinal bacteria are theorized to drive immune activation. [4][5][6]
Like many other autoimmune diseases, Crohn’s disease is believed to be genetically linked. The highest risk occurs in individuals with siblings who have the disease. Males and females are equally affected. Smokers are three times more likely to develop Crohn’s disease.[7] Crohn’s disease affects between 400,000 and 600,000 people in North America.[8] Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000.[9] Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age.[1][10] Unlike the other major types of inflammatory bowel disease, there is no known drug based or surgical cure for Crohn’s disease.[11] Treatment options are restricted to controlling symptoms, putting and keeping the disease in remission and preventing relapse.
The disease was independently described in 1904 by Polish surgeon Antoni Lesniowski and in 1932 by American gastroenterologist Burrill Bernard Crohn, for whom the disease was named. Crohn, along with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness.[12] For this reason, the disease has also been called regional ileitis[12] or regional enteritis.
Crohn’s disease is generally classified as an autoimmune disease. It invariably affects the gastrointestinal tract, and most gastroenterologists categorize the presenting disease by the affected areas. Ileocolic Crohn’s disease, which affects both the ileum (the last part of the small intestine that connects to the large intestine) and the large intestine, accounts for fifty percent of cases. Crohn’s ileitis, affecting the ileum only, accounts for thirty percent of cases, and Crohn’s colitis, affecting the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis. The disease can attack any part of the digestive tract, from mouth to anus. However, individuals affected by the disease rarely fall outside these three classifications, being affected in other parts of the gastrointestinal tract such as the stomach and esophagus.[1] Crohn’s disease may also be categorized by the behavior of disease as it progresses. This was formalized in the Vienna classification of Crohn’s disease.[13] There are three categories of disease presentation in Crohn’s disease: stricturing, penetrating, and inflammatory. Stricturing disease causes narrowing of the bowel which may lead to bowel obstruction or changes in the caliber of the feces. Penetrating disease creates abnormal passageways (fistulae) between the bowel and other structures such as the skin. Inflammatory disease (or non-stricturing, non-penetrating disease) causes inflammation without causing strictures or fistulae.[13][14]
Many people with Crohn’s disease have symptoms for years prior to the diagnosis.[15] The usual onset is between 15 and 30 years of age but can occur at any age.[16] Because of the ‘patchy’ nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more vague than with ulcerative colitis. People with Crohn’s disease will go through periods of flare-ups and remission.
Abdominal pain may be the initial symptom of Crohn’s disease. The pain is commonly cramp-like and is not relieved by defecation.[citation needed] It is often accompanied by diarrhea, which may or may not be bloody, though diarrhea is not uncommon especially in those who have had surgery. People who have had surgery or multiple surgeries often end up with short bowel syndrome of the gastrointestinal tract. The nature of the diarrhea in Crohn’s disease depends on the part of the small intestine or colon that is involved. Ileitis typically results in large-volume watery feces. Colitis may result in a smaller volume of feces of higher frequency. Fecal consistency may range from solid to watery. In severe cases, an individual may have more than 20 bowel movements per day and may need to awaken at night to defecate.[1][10][17][18] Visible bleeding in the feces is less common in Crohn’s disease than in ulcerative colitis, but may be seen in the setting of Crohn’s colitis.[1] Bloody bowel movements are typically intermittent, and may be bright or dark red in colour. In the setting of severe Crohn’s colitis, bleeding may be copious.[10] Flatulence and bloating may also add to the intestinal discomfort.[10]
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