How Is Crohn's Disease Diagnosed?
A thorough physical exam and a series of tests may be required to
diagnose Crohn's disease.
Blood tests may be done to check for anemia, which could indicate
bleeding in the intestines. Blood tests may also uncover a high white
blood cell count, which is a sign of inflammation somewhere in the body.
By testing a stool sample, the doctor can tell if there is bleeding or
infection in the intestines.
The doctor may do an upper gastrointestinal (GI) series to look at the
small intestine. For this test, the patient drinks barium, a chalky
solution that coats the lining of the small intestine, before x-rays are
taken. The barium shows up white on x-ray film, revealing inflammation or
other abnormalities in the intestine.
The doctor may also do a colonoscopy. For this test, the doctor inserts
an endoscope--a long, flexible, lighted tube linked to a computer and TV
monitor--into the anus to see the inside of the large intestine. The
doctor will be able to see any inflammation or bleeding. During the exam,
the doctor may do a biopsy, which involves taking a sample of tissue from
the lining of the intestine to view with a microscope.
If these tests show Crohn's disease, more x-rays of both the upper and
lower digestive tract may be necessary to see how much is affected by the
disease.
|
What Are the Complications of Crohn's Disease?
The most common complication is blockage of the intestine. Blockage
occurs because the disease tends to thicken the intestinal wall with
swelling and scar tissue, narrowing the passage. Crohn's disease may also
cause sores, or ulcers, that tunnel through the affected area into
surrounding tissues such as the bladder, vagina, or skin. The areas around
the anus and rectum are often involved. The tunnels, called fistulas, are
a common complication and often become infected. Sometimes fistulas can be
treated with medicine, but in some cases they may require surgery.
Nutritional complications are common in Crohn's disease. Deficiencies
of proteins, calories, and vitamins are well documented in Crohn's
disease. These deficiencies may be caused by inadequate dietary intake,
intestinal loss of protein, or poor absorption (malabsorption).
Other complications associated with Crohn's disease include arthritis,
skin problems, inflammation in the eyes or mouth, kidney stones,
gallstones, or other diseases of the liver and biliary system. Some of
these problems resolve during treatment for disease in the digestive
system, but some must be treated separately.
|
What Is the Treatment for Crohn's Disease?
Treatment for Crohn's disease depends on the location and severity of
disease, complications, and response to previous treatment. The goals of
treatment are to control inflammation, correct nutritional deficiencies,
and relieve Crohn's disease symptoms like abdominal pain, diarrhea, and rectal bleeding.
Treatment may include drugs, nutrition supplements, surgery, or a
combination of these options. At this time, treatment can help control the
disease, but there is no cure.
Some people have long periods of remission, sometimes years, when they
are free of Crohn's disease symptoms. However, the disease usually recurs at various times
over a person's lifetime. This changing pattern of the disease means one
cannot always tell when a treatment has helped. Predicting when a
remission may occur or when symptoms of Crohn's disease will return is not possible.
Someone with Crohn's disease may need medical care for a long time,
with regular doctor visits to monitor the condition.
Drug Therapy
Most people are first treated with drugs
containing mesalamine, a substance that helps control inflammation.
Sulfasalazine is the most commonly used of these drugs. Patients who do
not benefit from it or who cannot tolerate it may be put on other
mesalamine-containing drugs, generally known as 5-ASA agents, such as
Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine
preparations include nausea, vomiting, heartburn, diarrhea, and
headache.
Some patients take corticosteroids to control inflammation. These drugs
are the most effective for active Crohn's disease, but they can cause
serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to treat Crohn's
disease. Most commonly prescribed are 6-mercaptopurine and a related drug,
azathioprine. Immunosuppressive agents work by blocking the immune
reaction that contributes to inflammation. These drugs may cause side
effects like nausea, vomiting, and diarrhea and may lower a person's
resistance to infection. When patients are treated with a combination of
corticosteroids and immunosuppressive drugs, the dose of corticosteriods
can eventually be lowered. Some studies suggest that immunosuppressive
drugs may enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the drug infliximab
(brand name, Remicade) for the treatment of moderate to severe Crohn's
disease that does not respond to standard therapies (mesalamine
substances, corticosteroids, immunosuppressive agents) and for the
treatment of open, draining fistulas. Infliximab, the first treatment
approved specifically for Crohn's disease, is an anti-tumor necrosis
factor (TNF) substance. TNF is a protein produced by the immune system
that may cause the inflammation associated with Crohn's disease. Anti-TNF
removes TNF from the bloodstream before it reaches the intestines, thereby
preventing inflammation. Investigators will continue to study patients
taking infliximab to determine its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small
intestine caused by stricture, fistulas, or prior surgery. For this common
problem, the doctor may prescribe one or more of the following
antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or
metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the
inflammation subsides, but additional medication may also be necessary.
Several antidiarrheal agents could be used, including diphenoxylate,
loperamide, and codeine. Patients who are dehydrated because of diarrhea
will be treated with fluids and electrolytes.
|
The U.S. Government does not endorse or favor any specific
commercial product or company. Brand names appearing in this
publication are used only because they are considered essential in
the context of the information reported
herein. |
Nutrition Supplementation
The doctor may recommend
nutritional supplements, especially for children whose growth has been
slowed. Special high-calorie liquid formulas are sometimes used for this
purpose. A small number of patients may need periods of feeding by vein.
This can help patients who need extra nutrition temporarily, those whose
intestines need to rest, or those whose intestines cannot absorb enough
nutrition from food.
Surgery
Surgery to remove part of the intestine can help
Crohn's disease but cannot cure it. The inflammation tends to return next
to the area of intestine that has been removed. Many patients require
surgery, either to relieve Crohn's disease symptoms that do not respond
to medical therapy or to correct complications such as blockage,
perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need to
have their entire colon removed in an operation called colectomy. A small
opening is made in the front of the abdominal wall, and the tip of the
ileum is brought to the skin's surface. This opening, called a stoma, is
where waste exits the body. The stoma is about the size of a quarter and
is usually located in the right lower part of the abdomen near the
beltline. A pouch is worn over the opening to collect waste, and the
patient empties the pouch as needed. The majority of colectomy patients go
on to live normal, active lives.
Sometimes only the diseased section of intestine is removed and no
stoma is needed. In this operation, the intestine is cut above and below
the diseased area and reconnected.
Because Crohn's disease often recurs after surgery, people considering
it should carefully weigh its benefits and risks compared with other
treatments. Surgery may not be appropriate for everyone. People faced with
this decision should get as much information as possible from doctors,
nurses who work with colon surgery patients (enterostomal therapists), and
other patients. Patient advocacy organizations can suggest support groups
and other information resources. (See More Information on Crohns Disease
for the names of such organizations.)
People with the disease may feel well and be free of Crohn's disease symptoms for
substantial spans of time when their disease is not active. Despite the
need to take medication for long periods of time and occasional
hospitalizations, most people with Crohn's disease are able to hold jobs,
raise families, and function successfully at home and in society.
|
