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Crohn’s Disease Causes, Symptoms and Treatment

An increasing number of people suffer from indigestion due to unhealthy lifestyles nowadays. Specialists no longer regard abdominal discomfort as a normal consequence of poor diets but a dangerous sign of gastrointestinal disease. In spite of sounding similar, the irritable bowel syndrome(IBS) and the inflammatory bowel disease(IBD) are two distinct stomach disorders characterized by symptoms that differ both in manifestation and intensity.

The former, a rather common one, is characterized by abdominal pain, nausea, diarrhea or constipation.

Statistics show that twenty-five percent of Americans experience two or more symptoms, of which fifteen percent allegedly suffer from it. While it might be damaging to one’s personal comfort and social life, IBS does not necessarily constitute a preliminary phase to either IBD or colon cancer. It seldom requires hospitalization, so patients rely on medical treatment in most cases.

IBD, on the other hand, is more severe. Deemed as an autoimmune one, the inflammatory bowel disease affects the body in the long term and can deteriorate the entire gastrointestinal tract. IBD comes in the form of Crohn’s disease or ulcerative colitis; no less than 1.4 million Americans suffered from either one as of 2012.

What is Crohn’s Disease?

Crohn’s disease is an inflammatory bowel disease that mainly affects the colon, but can cause harm to any portion of the digestive system, from the mouth to the anus. Doctor Burrill B. Crohn was the first to offer a description of it, but it was not until 2001 when the first gene related to Crohn’s disease was discovered that the scientific world started to pay more attention to it. The medical condition is regarded as an autoimmune disease due to the body’s immune system attacking healthy cells. Regardless of this theory, current research shows the inflammation might actually be caused by the immune system fighting against gut bacteria, thus leading to bowel damage. Crohn’s disease’s symptoms are more severe than those of other gastrointestinal disorders and include abdominal pain, weight loss, anemia, skin rashes or tiredness. Some people have reported internal bleeding due to bowel obstruction or even perforation which might represent the onset of colon cancer.

There is no established cause for the disease. Rather than that, the illness is influenced by a sum of elements such as genetics, weak immune system or environmental factors. Likewise, no traditional treatment can cure it, but only medication through which the patient can alleviate certain symptoms and maintain remission for as long as possible. Both women and men are prone to suffering from it. Crohn’s disease mainly affects people from Europe or North America, and is less common in Asia, Africa or South America. Individuals with a family history of Crohn’s disease as well as Jewish people of European descent are more likely to present symptoms. The illness targets people between the ages of fifteen and thirty-five, but all individuals are susceptible to developing it to a greater or lesser extent.

Causes

The cause of Crohn’s disease is unknown at the present moment. Scientific evidence shows that the combination of genetics and environmental conditions is to blame for its development, while stress and unwise food choices contribute to its aggravation. Even so, specialists state none of them causes the disease, but they merely trigger and support its development. Clinic evidence suggests that patients suffering from Crohn’s disease have a genetic predisposition to it.

Furthermore, their immune systems present disturbances in that the immune cells show little resistance to harmful bacteria and attack the real ones instead.

The following are some of the possible causes of Crohn’s disease:

  1. Genetics

Not once have genetics been considered the main culprit in Crohn’s disease’s occurrence. Present data on the subject are plentiful and detailed as to safely assume heredity plays a significant role in the illness’ developing. Crohn’s disease is believed to run in families. People who have parents, brothers or sisters suffering from it have higher chances of being affected. Studies show that twelve to fifteen percent of the patients have a close relative with this condition. Moreover, they are more likely to show early symptoms than the general population. Crohn’s disease is related to genetic mutations which lead to inflammation. Scientific research indicates the presence of more than two hundred genes that are common in people with Crohn’s disease of which thirty are directly connected with it. When affected, certain genes are linked to a weaker immune system and infection, whereas others are believed to cause eye and skin problems. Gene mutation in Crohn’s disease patients stimulates the production of chemokines, which attract inflammatory cells and amplify their number as to increase infection.

Moreover, the medical condition seems to favor certain world populations such as the Europeans or North Americans which is yet another argument for the genetics’ theory. Historically speaking, people from the more economically developed countries were more prone to its impact. After conducting several regional studies, American researchers have reached the following conclusions:

  • Ten to seventy people in one hundred thousand suffered from Crohn’s disease on the United States territory
  • Up to two hundred Canadians in one hundred thousand were likely to develop it
  • Participants aged over twenty represented the majority of patients
  • More than 1.100.000 United States citizens had inflammatory bowel disease in 2009, of which more than half presented Crohn’s disease’s symptoms

Still, ever since globalization became less of a concept and more of everyday reality, countries in Asia and Africa have started to register an increasing number of cases as well.

In brief, there are some people more predisposed to it than others, due to genetically influenced aspects. Even so, the majority of individuals who suffer from it do not have a family history of the illness. The hereditary factor leads to a higher risk of occurrence, but its mechanism of action is still unclear. Researchers will probably conduct more studies in the near future in order to reach a definite conclusion in regards to the importance of genes in the Crohn’s disease’s development.[1]

  1. Immune System

Specialists regard Crohn’s disease as an autoimmune medical condition. Generally speaking, autoimmune disorders are caused by an abnormal action of the immune cells which mistake the healthy tissues with the damaging ones and eventually fight against them. No exact cause leads to such condition. However, specialists suggest this might be the result of antigen-containing substances confusing the immune system to the point in which it is no longer able to distinguish between toxins and healthy tissues. Currently, there are more than fifty million American suffering from no less than eighty autoimmune disorders.

Crohn’s disease is part of this category. What makes it more damaging than other autoimmune conditions is the fact that it affects the colon, which is home to the largest number of beneficial bacteria. These microorganisms are the main responsible for the body’s immunity. They sustain its natural function and support its health in normal conditions. However, Crohn’s disease patients register gene mutations that lead to weaker defense mechanisms which in turn cause harmful cell proliferation. Experts believe this action increases the quantity of cell signaling proteins, namely the Tumor Necrosis Factor Alpha(TNF), whose primary role is to regulate the immune cells. Yet, in Crohn’s disease, a dysregulation of TNF takes place. All bacteria are killed as a consequence, regardless of their function. The chronic inflammatory activity triggers are

extra- intestinal manifestations which include eye, mouth and skin problems. The liver, bile and kidneys are equally affected. In addition, the musculoskeletal system seems to be prone to the autoimmune disease’s symptoms with patients showing signs of peripheral arthritis or even osteoporosis. Recent research links a weak immune system with higher risks of developing Crohn’s disease in patients already genetically predisposed to it. Even so, more studies are required as it remains unclear if the disorder is the one that triggers the inappropriate immune response or if the weakened immunity influences its occurrence.

  1. Environmental Factors

Crohn’s disease has the highest occurrence rate in developed countries that benefit from stable economic conditions and enjoy a larger service sector. Considered a rich man’s disease, the medical condition affects people from westernized countries such as the United States or the United Kingdom, so is less likely for individuals from developing countries to suffer from it. However, the number of cases has drastically increased ever since the 1970s, so today people from Asia or Africa are more prone to damage caused by the illness as well. There is one theory, known as the “hygiene hypotheses”, that suggests the positive impact of microbes in the healthy development of a child’s immune system. Its supporters claim that childhood infections are a vital aspect of the individual’s future health status, so children should be exposed to germs in normal, everyday life conditions. However, most of them are raised in germ-free environments which might not be beneficial in the long term for the future adult. There is little clinic evidence to support this theory. Even so, one cannot argue with the statistics which show that people living in third-world countries face a considerably diminished risk of developing Crohn’s disease.

Other factors that influence the illness’ occurrence and worsen it are:

Excessive Consumption of Animal-based Protein and Omega-6 Fatty Acids

Data show that patients suffering from Crohn’s disease have experienced more severe symptoms due to high animal-based proteins and fats. Red meat and processed meat in particular have been associated with inflammatory bowel diseases and their aggravation. Studies suggest meat acidify the body and slow down digestion due to an increase in hydrogen sulfide levels. This toxin is generally tolerated by a well-functioning gut, but it can cause severe damage when in higher amounts than usual in Crohn’s disease patients.

Moreover, it impedes the healing process and stops the body from naturally detoxifying itself. Individuals with IBD are often times lactose intolerants; some evidence suggests people suffering from Crohn’s disease might present allergies to cow’s milk because of its property to increase pro-inflammatory cytokines levels.

Smoking or Exposure to Cigarette Smoke for Extended Periods

Smoking causes many damages to the human body, and the gastrointestinal system is no exception. Numerous studies have shown that certain toxic compounds found both in cigarettes and their smoke are related to Crohn’s disease. Smokers experience more intense abdominal pain and also a higher risk for inflammation than non-smokers. However, the relationship between smoking and IBD is a rather complicated one. Whereas it can worsen the state of a patient suffering from Crohn’s disease, some studies suggest it might actually improve the condition of individuals with ulcerative colitis. Even so, it is for the best to stay on the safe side and avoid further complications by giving up smoking for good.[2][3]

Symptoms

Crohn’s disease can affect any part of the gastrointestinal system, but the most sensitive areas are the ileum (the last section of the small intestine) and the colon. Crohn’s is a medical condition that requires time to develop and fully affect the body, so it is only natural for its symptoms to act in a similar manner. Patients can as well experience remission where the illness’ signs are less severe or completely missing.

We have listed below the most common symptoms of Crohn’s disease:

  • Abdominal pain
  • Diarrhea
  • Blood in the feces
  • Fever
  • Nausea and vomiting
  • Tiredness
  • A loss of appetite
  • Weight loss
  • A feeling of fullness in the abdomen even after a bowel movement
  • A frequent need for bowel movement
  • Structures and fistulas
  • Peripheral arthritis
  • Swollen skin
  • Ulcers in various gastrointestinal system areas( from the mouth to the anus)
  • Eye inflammation

Children suffering from Crohn’s disease physically develop slower than others of the same age because inflammation affects the nutrient absorption. In some situations they might even experience delayed puberty and mental retardation. Luckily for them, specialists affirm that a diet rich in nutrient and professional support can more or less improve their condition and make them more responsive to therapy.

Who is Affected?

  • The disease can occur in men and women alike, as it does not depend on hormone levels or other distinctive elements between the two sexes(there is evidence that suggests boys might present a higher risk).
  • Most people who suffer from it are genetically predisposed due to a family history of Crohn’s disease.
  • Individuals who have parents with Crohn’s are more prone to develop it sooner or later, although there is no established rule in this regard.
  • Children, teenagers and young adults represent the condition’s primary segment of action
  • Statistics show that developed countries register more cases than the developing ones
  • Jewish of European descent and North Americans are at greater risk for the disease
  • Smokers and avid meat eaters are more likely to receive a positive diagnose following professional tests

How is it Diagnosed?

The diagnosis of Crohn’s disease can put severe pressure on the doctor who supervises the future patient. This happens because many inflammatory bowel disorders have similar symptoms in the beginning, and they become more distinct only as the disease advances. Early detection is essential for the suffering individual, in spite of potential problems the general physician might have to deal with while running the tests.

First, the GP will be interested in the symptoms, as well as the family’s medical history, recently used medication or how often and far the patient travels. This has to be done in order to exclude conditions unrelated to Crohn’s disease. The doctor might need a gastroenterologist’s help to obtain a second opinion. The following are some of the most common tests a physician will perform on a patient that shows Crohn’s disease symptoms:

  1. Colonoscopy: it is both the most accepted and efficient way to diagnose Crohn’s disease or any other inflammatory bowel disorder for that matter. The doctor uses an instrument called endoscope that is a long, thin tube with a small camera attached to it. The procedure is done by inserting the endoscope through a passageway so the doctor can look inside the colon and see any possible tissue damage. Afterward, the gastroenterologist might take tissue samples for laboratory analysis to confirm the diagnosis. Lately, doctors have started using smaller size camera that the patient can swallow as to allow a lower intestine inspection as well.
  1. Blood tests are the most efficient way for a doctor to establish possible anemia or infection. Also, the specialist will be able to see if there are antibodies in the blood, which may suggest that the body suffers from an autoimmune disease, possibly Crohn’s. However, inflammation is common in numerous medical conditions that involve the gastrointestinal system so a blood test might not be sufficient in establishing a definite diagnose.
  1. Stool tests: in addition, the feces might contain traces of blood. The physician will most likely require a stool sample from the patient. Even so, Crohn’s disease is not necessarily linked to internal bleeding, although there are some confirmed cases in this regard. Patients suffering from ulcerative colitis are more prone to colon lesions which lead to blood in the feces. Thus, this kind of test is usually not efficient enough to reach a final diagnosis.
  1. Radiologic tests: also known as imaging tests, they are useful when the doctor needs to see the possible small intestine damage that is otherwise not visible with the help of an endoscope. The commonly used ones are Computed Tomography scans and Magnetic Resonance Imaging scans which provide the physician with images of the small intestine. Both scans are useful in identifying bowel obstructions or fistulae as to ease the diagnosis establishment process and prevent potential complications.[4]

Treatment

There is no well-established Crohn’s disease treatment, therefore the chances of remission for extended periods are small and the patient will probably suffer from it his entire life. Even so, there are ways to alleviate some of its symptoms. Likewise, the remission might be a relatively long-termed one, although not permanent, for individuals who strictly follow the specialist’s advice.[5][6]

Crohn’s disease is generally treated with one or more of the following medical treatments:

Anti-inflammatory drugs (first used after the doctor has established the treatment):

Corticosteroids are some of the most powerful and efficient anti-inflammatory medicines. They naturally occur in the adrenal cortex of vertebrates but can be synthesized in laboratories. They are associated with immune regulation and a decrease in cell inflammation. The most popular ones are budesonide(believed to present the least side effects), prednisone and methylprednisolone. Doctors used them only in the situations when other treatments failed to help the patient. Even so, they represent a short-term medication due to the fact that they present numerous side effects and might damage the individual’s physical health. They include:

  • High blood pressure
  • Diabetes
  • Hyperglycemia
  • Cataract and retinopathy
  • Skin problems
  • Osteoporosis
  • Muscle loss

Aminosalicylates: there are four basic aminosalicylates a doctor will use for treating Crohn’s disease, namely balsalazide, mesalamine, olsalazine and sulfasalazine. They all provide relief from inflammation, but seem to be more useful for the colon and less for the small intestine, as some of them are administrated as enemas. Specialists regard them as generally safe and helpful for patients suffering from Crohn’s disease in spite of adverse effects such as nausea, vomiting or diarrhea.

Antibiotics: studies suggest they might reduce the number of harmful bacteria that contribute to inflammation. There is however little scientific information in regards to their real A GP will generally prescribe Metronidazole or Ciprofloxacin which improve a Crohn’s disease patient’s general condition but do not necessarily heal the gastrointestinal system.

Immune system suppressors: while they might reduce inflammation, the immune system suppressors can as well trigger unwanted modifications in the immune system function that can produce inflammation-causing compounds as a result. The patient must use them for more than six months in a row to actually feel an improvement in his physical condition. Some of the most popular suppressors include: Azathioprine, Adalimumab, Cimzia, Infliximab, Cyclosporine, Mercaptopurine, Methotrexate, Natalizumab and Vedolizumab. Most, if not all, are associated with cancer occurrence, liver diseases and even brain issues. Always make sure to consult with a doctor before using any of them as their side effects are extremely damaging. Pieces of information found online don’t match a specialist advice and should not be addressed as such.

Doctors also recommend their patient’s antidiarrheal drugs, Vitamin B12, Calcium and Vitamin D supplements and pain relievers. More natural alternatives include the use of probiotic or herbal supplements, acupuncture or homeopathy.

Surgery: as stated before, there is no known cure for Crohn’s disease. While it might be beneficial in other situations, surgery can help a Crohn’s disease patient only to the extent to which a damaged portion can be removed as to provide the individual with some sort of relief. The doctor recommends it as the ultimate solution, but its effect is a temporary one in most cases so the patient will most likely perform other surgeries throughout his life.[7]

Prevention

People with Crohn’s disease tend to feel helpless when facing the illness because there seems to be no way out of it. While science has yet to offer us the cure, there are ways through which we can ease the pain, control the symptoms and even extend the remission period.

Here is some advice that might help you. Always make sure you consult with your general physician and discuss them together beforehand:

  • Limit dairy products consumption
  • Reduce red meat and processed meat intake as much as possible
  • Avoid high-fat foods as well as sweets packed with sugar and simple carbohydrates
  • Avoid spicy food and alcohol(eliminate them from your diet if possible)
  • Drink plenty of water
  • Eat small meals
  • Quit smoking
  • Try yoga and meditation(studies show there is a connection between stress and symptoms of both IBD and IBS)
[8][9]

 

Sources   [ + ]

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257437/
2. https://www.ncbi.nlm.nih.gov/pubmed/10958212
3. http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/causes/con-20032061
4. http://www.nhs.uk/Conditions/Crohns-disease/Pages/Complications.aspx
5. https://www.ncbi.nlm.nih.gov/pubmed/26533498
6. https://www.ncbi.nlm.nih.gov/pubmed/22450143
7. http://www.webmd.com/ibd-crohns-disease/crohns-disease/digestive-diseases-crohns-disease?page=2#3
8. http://www.healthline.com/health/crohns-disease
9. https://en.wikipedia.org/wiki/Crohn%27s_disease#Management

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