Crohn’s Disease (CD) with its twin Ulcerative Colitis (UC), are two important inflammatory diseases of gastrointestinal system clubbed together as inflammatory bowel disease (IBD). Crohn’s Disease largely affects the small intestine but can also affect large intestine and stomach.

Dr Akhilesh Sharma, Senior Consultant Physician, Bombay Hospital says, “The incidence of IBD is rising in India possibly due to heightened awareness and better availability of medical facilities to diagnose such conditions.”

Crohn’s disease seems to run in some families and equally affects men and women. It can occur in people of all age groups, but is more often diagnosed between the ages of 20 and 30. Dr Sharma, “There is some genetic predilection for the development of these diseases but the environmental factors such as infections, life style and eating habits may also contribute.”

An abnormal immune system response is said to cause Crohn’s disease. The immune system mistakes bacteria, foods, and other substances as foreign and attack these “invaders” causing white blood cells to accumulate in the intestinal lining, producing chronic inflammation leading to ulcerations and bowel injury.

Symptoms

The range and severity of symptoms varies in Crohn’s disease.

• Abdominal pain most often in the lower right area
• Diarrhoea
• Reduced appetite
• Rectal bleeding that maybe serious and persistent, leading to anemia.
• Weight loss
• Arthritis
• Skin problems
• Fever
• Delayed development and stunted growth in children

Diagnosis

A thorough physical examination and a series of tests may be required to make a diagnose of Crohn’s disease.

• Blood tests to check for anemia, the white blood cell count are useful.
• Stool sample testing would indicate if here is bleeding or intestinal infection.
•  “There are certain markers,  when present in the blood support the diagnosis of the inflammatory bowel diseases.” says Dr Sharma.
• An upper GI series requires drinking 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.
• A sigmoidoscopy or a colonoscopy allows a visual examination of the intestines, any inflammation or bleeding can be detected. A biopsy can also be done during the procedure.
• Computerised tomography (CT) a special X-ray technique helps better understand the location and extent of the disease or to check for complications such as a partial blockages, abscesses or fistulas.
• Capsule endoscopy entails swallowing a capsule that has a camera in it which camera takes pictures, which are transmitted to a computer worn on the belt. The downloaded images are then checked for signs of Crohn's disease. The camera exits the body painlessly in the stool after the trip through the digestive system.

Dr Sharma cautions that, “Crohn’s disease can be confused with abdominal tuberculosis or amoebic infections of large intestine.”

Complications

The possible complications include:

• Intestinal obstruction: the disease thickens the intestinal wall, narrowing the passage causing sores, or ulcers, occur in the abdomen or in the intestines that form fistulas and affect surrounding tissues. Additionally, small tears called fissures may develop in the lining of the mucus membrane of the anus.
• Deficiency of proteins, calories, and vitamins as a result of nutritional complications.
• Dr Sharma says, “These diseases not only affect the intestine but also can affect the joints, skin and eyes.”

Treatment options

• The goal of treatment is inflammation control, correction of nutritional deficiencies, and the relief of symptoms like abdominal pain, diarrhoea, and rectal bleeding. The treatment options include drugs, nutrition supplements, surgery, or a combination.
• There is no cure. The disease usually recurs. Treatment can help reduce the recurrence rate. Crohn’s disease may need medical care for a long time, with regular monitoring.
• Dr Sharma says, “Many anti inflammatory medicines are effective against Crohn’s disease. Recently certain immune modulators and specific antibodies have also shown good results. Sometime IBD can have long remissions. Overall the disease activity is controllable with medications. In case of complications surgical intervention can be of help.”
• Additionally corticosteroids, antibiotics, anti-diarrhoea and fluid replacements and nutrition supplementation are advised.
• Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohn’s disease.

It is advisable to follow a nutritious diet and avoid any foods that seem to worsen symptoms. For those whose severity of symptoms are related to stress levels use relaxation techniques, such as slow breathing, eat well and get enough sleep

Pic: Sophie