Crohn's Disease

There's no known medical cure for Crohn's disease. However, therapies are available that may greatly reduce the signs and symptoms of Crohn's disease and even bring about a long-term remission.

What is it?

An estimated 500,000 Americans have Crohn's disease, an inflammatory bowel disease (IBD) that causes chronic inflammation of the intestinal tract. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complications.

Crohn's disease and ulcerative colitis are similar — so similar that they're often mistaken for one another. Both inflame the lining of your digestive tract, and both can cause severe bouts of watery or bloody diarrhoea and abdominal pain. But Crohn's disease can occur anywhere in your digestive tract, often spreading deep into the layers of affected tissues. Ulcerative colitis, on the other hand, usually affects only the innermost lining of your large intestine (colon) and rectum.

What causes it?

Crohn's disease begins with inflammation, most often in the lower part of the small intestine (ileum) or in the colon, but sometimes in the rectum, stomach, oesophagus or mouth. Unlike ulcerative colitis, in which inflammation occurs uniformly throughout an affected area, Crohn's disease can develop in several places simultaneously, with healthy tissue in between. In time, large ulcers that extend deep into the intestinal wall may develop in the inflamed areas.

No one is quite sure what triggers inflammation in Crohn's disease, but there's a general consensus as to what doesn't cause it. Researchers no longer believe that stress or diet are the main culprits, for instance, although both factors can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:

  • Immune System. Some evidence suggests that a virus or bacterium may cause Crohn's disease and that the digestive tract becomes inflamed when the body's immune system tries to fight off the invading microorganism. It's also possible that inflammation may stem from the virus or bacterium itself. One microorganism that may be involved in the development of Crohn's is Maycobacterium avium subspecies paratuberculosis (MAP), a bacterium that causes intestinal disease in cattle. Researchers have found MAP in the blood and intestinal tissue of many people with Crohn's disease, but only rarely in people with ulcerative colitis. Yet this doesn't necessarily mean that MAP causes Crohn's disease. Some researchers believe that a genetic susceptibility may trigger an abnormal response to the bacteria in some people, whereas others think the disease is caused by an abnormal immune response to bacteria that normally live in the intestine.
  • Heredity. About 20 percent of people with Crohn's disease have a parent, sibling or child who also has the disease. Mutations in a gene called NOD2/CARD15 tend to occur frequently in people with Crohn's disease and seem to be associated with an early onset of symptoms as well as a high risk of relapse following surgery for the disease. Scientists continue to search for other genetic mutations that might play a role in Crohn's.
  • Environment. Because Crohn's disease occurs more often among people living in cities and industrial nations, it's possible that environmental factors, including a diet high in fat or refined foods, may play a role.

What are the symptoms?

Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. They include:

  • Diarrhoea. The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't absorb this excess fluid, you develop diarrhea. Altered intestinal contractions also can contribute to loose stools. In mild cases, stools may simply be looser or more frequent than usual. But people with severe disease may have dozens of bowel movements a day, affecting both sleep and ordinary activities.
  • Abdominal pain and cramping. In Crohn's disease, inflammation and ulceration may cause the walls of part of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and occur with nausea and vomiting.
  • Blood in your stool. Food moving through your digestive tract can cause inflamed tissue to bleed, and your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don't see (occult blood). In severe disease, bleeding is often serious and ongoing.
  • Ulcers. Crohn's disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into – and sometimes through – the intestinal walls.
  • Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.

Other signs and symptoms

  • People with severe Crohn's disease may experience fever and fatigue as well as problems that occur outside the digestive tract, including arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.
  • The course of Crohn's disease varies greatly. You may have long periods without signs and symptoms, or you may have recurrent episodes of abdominal pain, diarrhea, and sometimes fever or bleeding.

Are there any natural therapies?

At present, there is no cure for Crohn's disease, however, many people with the disease or with Crohn's-like symptoms have found ways to relieve intestinal distress without drugs or surgery. Doctors specialising in Crohn's disease may be able to tailor a plan to suit the sufferers' needs. However, some natural alternatives include:

  • Slippery elm is a powdered form of fibre which absorbs large amounts of water – it forms a soothing protective layer over the inflamed and ulcerated tissue and may also be of assistance to bind the stool in episodes of diarrhoea.
  • Peppermint tea might help to reduce cramping.
  • Supplementation with antioxidant nutrients such as vitamin C and vitamin E and the mineral selenium is also recommended.
  • Probiotic supplements such as acidophilus and bifidus may help to restore bowel regularity, and are particularly indicated following treatment with antibiotics and steroidal medication.
  • If blood loss has occurred an iron supplement may be indicated – choose a formulation containing a gentle-to-the-stomach iron form such as iron fumarate in order to avoid aggravating the symptoms.
  • Dehydration can occur easily in patients with ongoing problems with diarrhoea. .
  • Loss of water soluble nutrients such as B vitamins and vitamin c may also occur with frequent diarrhoea.

What else can I do?

Sometimes you may feel helpless when facing Crohn's disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

There's no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up in your condition. It's a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions that may help:

  • Limit dairy products
  • Try low-fat foods
  • Experiment with fibre
  • Avoid problem foods
  • Eat small meals
  • Drink plenty of liquids
  • Consider multivitamins
  • Talk to a dietician
  • Exercise
  • Utilise deep breathing
  • Hypnosis

Did you know?

Some people find it helpful to consult a psychologist or psychiatrist who's familiar with inflammatory bowel disease and the emotional difficulties it can cause. Although living with Crohn's disease can be discouraging, the outlook is brighter than it was even just a few years ago.