What is Crohn’s?
Crohn’s Disease is one of two types of Irritable Bowel Disease (IBD). Crohn’s is a chronic condition that involves an inappropriate immune response to the gastrointestinal (GI) tract. This results in chronic inflammation along the lining of the GI tract. The inflammation can exist anywhere throughout the GI tract, but most often is in the small bowel (ileum) or start of the colon (large intestine). Crohn’s can impact all 3 layers if the intestinal lining, whereas Ulcerative Colitis (UC), the other type of IBD, only involves the inner lining of the colon.
Inflammation is a result of the immune system’s response in an area of the body. Many people are familiar with what inflammation looks like when getting a cut or scrape on their skin. The skin turns red and may get hot and swollen. This is due to increased blood flow to that area so that the immune cells can access the site and start fighting off germs. The same process is taking place in the intestinal lining for someone with Crohn’s Disease, with a few caveats. The inflammation that occurs with a cut resolves relatively quickly. In Crohn’s Disease, the inflammation is chronic, meaning it is not temporary but lasts for a long time. Also, inflammation is typically a response to tissue damage or to germs invading the body. In Crohn’s disease, however, the exact cause of the inflammation is unknown.
Symptoms involved in Crohn’s Disease include abdominal pain, diarrhea, blood in stool, loss of appetite, and fatigue. Some people can experience malnutrition, weight loss, and even growth delays (in children). People with Crohn’s Disease are at higher risk of developing osteoporosis, kidney stones, skin rashes, joint pain, itchiness and redness of eyes, colon cancer, and blood clots1,2,3.
What causes Crohn’s?
A few factors have been found that contribute to a higher risk for developing Crohn’s, but specific, direct causes are not clear. First, there is a genetic component to Crohn’s Disease. People with a first degree relative with Crohn’s Disease are at higher risk for developing the disease as well. White people and people in Western countries have the highest risk of developing Crohn’s, and it is most often diagnosed in people in their teens or early adulthood (20s to 30s), but can occur at any time3,4. There are also some environmental and behavioral factors that can increase risk of developing Crohn’s, such as smoking, certain viral infections, psychological stress, certain medications, diet, and physical inactivity3,5,6.
How is Crohn’s Disease diagnosed?
A diagnosis of Crohn’s Disease is typically made after analyzing a piece of the intestinal lining, obtained through biopsy, under a microscope. This biopsy is taken during an endoscopy or colonoscopy, and the provider may also run other tests to rule out other possible diagnoses. A provider may order a blood test to test for anemia and inflammation, a stool analysis to check for parasite or infection, or an MRI or CT3.
What is the treatment for Crohn’s?
Treatment of Crohn’s Disease primarily consists of management of symptoms through medication and diet. Surgery can be necessary to relieve or correct some more serious complications. However, currently there is no cure for Crohn’s Disease.
Medical management of Crohn’s typically involves medications to suppress the immune system and reduce inflammation. Medication can involve immunomodulators, corticosteroids, biologics, anti-diarrheal medications or even antibiotics7. Ask your doctor or pharmacist about what medications might be recommended for you.
Dietary and lifestyle factors can impact the severity of Crohn’s disease as well. There is no one specific diet that is recommended for everyone in the management of Crohn’s Disease. However, trying different diets may help identify solutions that work for different individuals. Different diets could include an anti-inflammatory diet, an autoimmune protocol diet, a low FODMAP diet, or more8. You can also try keeping a food log to identify any specific food triggers that you may have. Consult a dietitian to discuss possible trial or implementation of one of these diets or to see if any of these could be a good option for you. Specifically during periods of Crohn’s flare-ups, a “low ruffage” or low fiber diet can help alleviate symptoms. This typically focuses on limiting insoluble fiber, such as the waxy skin of different fruits and vegetables, to rest the intestinal lining and allow the inflammation to subside.
People with Crohn’s Disease are also more likely to experience nutrient deficiencies due to decreased food intake during flare-ups, decreased absorption with inflammation of the gut lining, and increased incidences of diarrhea. Some supplements that could be beneficial for patients with IBD are calcium, folic acid, iron, vitamin B12, vitamin D, vitamins A, E, and K, and Zinc9. Ask your doctor about checking for possible nutrient deficiencies if this is a concern for you.
Lastly, including consistent exercise, drinking plenty of water, getting adequate sleep, and managing stress aids in the management of Crohn’s symptoms5.
What are possible complications of Crohn’s Disease?
Some possible complications of Crohn’s Disease include the development of a fistula (hole in the GI tract), stricture (narrowing of GI tract, often as a result of built up scar tissue), ulcers, or a bowel obstruction3. If complications arise, some patients may require surgery. If scar tissue has built up, causing narrowing of the intestine, or a fistula has formed, removing a section of the bowel can be helpful to prevent blockage. Some patients may have their colon completely removed in extreme cases. Diligence about daily management of Crohn’s Disease with medication and diet will help to prevent these complications. Work with your doctor and medical team to determine what the best course of treatment is for you.
If you are diagnosed with Crohn’s disease and would like more support, Avance Care is starting a free, quarterly support group for people with a variety of GI conditions. Whether you are newly diagnosed or have been living with IBD for many years, this group can help you with your GI symptom management. Join the support group email list by filling out the interest form below and someone will be in touch soon to get you started.
- Cleveland Clinic. (2020). Crohn’s Disease. Retrieved from https://my.clevelandclinic.org/health/diseases/9357-crohns-disease
- Crohn’s and Colitis Foundation. (2022). Overview of Crohn’s Disease. Retrieved from https://www.crohnscolitisfoundation.org/what-is-crohns-disease/overview
- Mayo Clinic. (2022). Crohn’s Disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
- Aniwan, S, Harmsen, WS, Tremaine, WJ, Loftus, EV Jr. (2019). Incidence of inflammatory bowel disease by race and ethnicity in a population-based inception cohort from 1970 through 2010. Therap Adv Gastroenterol.
- Crohn’s and Colitis Foundation. (2022). Environmental Triggers. Retrieved from https://www.crohnscolitisfoundation.org/research/challenges-ibd/environmental-triggers
- Dam, AN, Berg, AM, Farraye, FA. (2013). Environmental influences on the onset and clinical course of Crohn’s disease-part 1: an overview of external risk factors. Gastroenterol Hepatol.
- Crohn’s and Colitis Foundation. (2022). Medication Options for Crohn’s Disease. Retrieved from https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/medication
- Crohn’s and Colitis Foundation. (2022). Special IBD Diets. Retrieved from https://www.crohnscolitisfoundation.org/diet-and-nutrition/special-ibd-diets?gclid=CjwKCAiA3pugBhAwEiwAWFzwdUVj8jKvvzfX5RbSB7PMa84ueGAafJ9dspGr82PQZJU5MJC1W7Zw0hoClM4QAvD_BwE
- Crohn’s and Colitis Foundation. (2022). Vitamin and Mineral Supplementation. Retrieved from https://www.crohnscolitisfoundation.org/diet-and-nutrition/supplementation