Crohn’s disease is a disease that causes inflammation, or swelling, and irritation of any part of the digestive tract. In this part of the series, we will discuss the complications and possible treatments for Crohn’s disease.
Complications
The most common complication of Crohn’s disease is an intestinal blockage caused by thickening of the intestinal wall because of swelling and scar tissue. Crohn’s disease may also cause ulcers that tunnel through the affected area into surrounding tissues. The tunnels, called fistulas, are a common complication — especially in the areas around the anus and rectum — and often become infected. Most fistulas can be treated with medication, but some may require surgery. In addition to fistulas, small tears called fissures may develop in the lining of the mucus membrane of the anus. The health care provider may prescribe a topical cream and may suggest soaking the affected area in warm water.
Some Crohn’s disease complications occur because the diseased area of intestine does not absorb nutrients effectively, resulting in deficiencies of proteins, calories, and vitamins. Children with Crohn’s disease may fail to grow normally and may have low height for their age.
People with Crohn’s disease, particularly if they have been treated with steroid medications, may have weakness of their bones called osteoporosis or osteomalacia.
Some people with Crohn’s disease may have restless legs syndrome — extreme leg discomfort a person feels while sitting or lying down.* Some of these problems clear up during treatment for Crohn’s disease, but some must be treated separately.
Other complications include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or diseases related to liver function.
Treatment
Treatment may include medications, surgery, nutrition supplementation, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding.
Treatment can help control Crohn’s disease and make recurrences less frequent, but no cure exists. Some people have long periods — sometimes years — of remission when they are free of symptoms, and predicting when a remission may occur or when symptoms will return is not possible.
Medications
- Anti-inflammation medications: Most people are first treated with medications containing mesalamine, a substance that helps control inflammation. Possible side effects of mesalamine-containing medications include nausea, vomiting, heartburn, diarrhea, and headache.
- Cortisone or steroids: These medications, also called corticosteroids, are effective at reducing inflammation. Corticosteroids can cause serious side effects, including greater susceptibility to infection and osteoporosis, or weakening of the bones.
- Immune system suppressors: Immunosuppressive medications work by blocking the immune reaction that contributes to inflammation. Some people are treated with a combination of corticosteroids and immunosuppressive medications.
- Biological therapies: Biological therapies are medications given by an injection in the vein or in the skin. They bind to TNF substances to block the body’s inflammation response.
- Antibiotics: Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
- Anti-diarrheal medications and fluid replacements: Diarrhea and abdominal cramps are often relieved when the inflammation subsides, but additional medication may be needed. People with diarrhea should drink plenty of fluids to prevent dehydration.
Surgery
About two-thirds of people with Crohn’s disease will require surgery at some point in their lives.* Surgery becomes necessary to relieve symptoms that do not respond to medical therapy or to correct complications such as intestinal blockage, perforation, bleeding, or abscess. People with Crohn’s disease commonly need more than one operation because inflammation tends to return to the area next to where the diseased intestine was removed.
- Proctocolectomy: This surgery involves removing the rectum and part or the entire colon. People will receive sedation and general anesthesia during surgery. Most people need to remain in the hospital for one to two weeks, and full recovery can take four to six weeks.
- Ileostomy: During proctocolectomy, the surgeon also performs an ileostomy — an operation that attaches the ileum to an opening made in the abdomen called a stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. An ostomy pouch is then attached to the stoma and worn outside the body to collect stool. The majority of people with an ostomy pouch are able to live normal, active lives.
- Intestinal resection surgery: Sometimes only the diseased section of intestine is removed. The intestine is cut above and below the diseased area and the ends of the healthy sections are connected.
Because Crohn’s disease often recurs after surgery, people considering surgery should carefully weigh its benefits and risks compared with other treatments.
Nutrition Supplementation
The health care provider may recommend nutritional supplements, especially for children whose growth has been slowed. A small number of people may receive nutrition intravenously to help those who need extra nutrition temporarily, such as those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.
Points to Remember
- Crohn’s disease is a disease that causes inflammation, or swelling, and irritation of any part of the digestive tract.
- Crohn’s disease affects men and women equally and seems to run in some families.
- The cause of Crohn’s disease is unknown, but researchers believe it is the result of an abnormal reaction by the immune system.
- The most common symptoms of Crohn’s disease are abdominal pain and diarrhea.
- No special diet has been proven effective for preventing or treating Crohn’s disease, but it is important that people who have
- Crohn’s disease follow a nutritious diet and avoid any foods that seem to worsen symptoms.
- Some people with Crohn’s disease report having a flare up when experiencing a stressful event or situation. The health care provider may suggest a counselor or support group to help decrease stress for people with Crohn’s disease.
Have questions or need support? The Crohn’s and Colitis Advocate Program offers free personalized support, education, resources, and information. Visit www.crohnsandcolitisinfo.com to learn more and sign up.
Sources upon request.
Photo credit: Eraxion/Thinkstock