Understanding Crohn’s Disease, Types and Symptoms

Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes Crohn’s disease (CD) and ulcerative colitis. Crohn’s disease inflames the digestive tract and causes inflammation and discomfort. This chronic inflammatory bowel disease (IBD) affects the digestive tract from mouth to anus. However, it primarily affects the small intestine (ileum) and the first part of the large intestine. The disease got its name from Dr Burrill Crohn, who initially identified it in 1932.

Irritable bowel disease (IBD) is an illness that runs in families. It can affect anyone at any age. However, teenagers and young adults are the most commonly affected. As per CDC studies, most people with IBD are diagnosed in their 20s and 30s. Crohn’s disease isn’t dangerous, but it can lead to severe and even fatal complications. Furthermore, the most effective approach for avoiding hazardous effects is controlling inflammation.

Types of Crohn’s disease

Crohn’s disease can affect various parts of the digestive system. Four types of Crohn’s disease are:

• Ileitis: causes the small intestine to swell and inflame (ileum).
• Ileocolitis: An inflammatory condition that affects the small intestine and a portion of the large intestine (colon). The most common manifestation of Crohn’s disease is ileocolitis.
• Jejunoileitis: A common condition in which the upper portion of the small intestine becomes inflamed in patches (called the jejunum).
• Gastroduodenal: The stomach and the small intestine’s top are affected by inflammation and irritation (the duodenum).

Crohn’s Disease: Causes and Risk Factors

The exact causes of this condition are unknown. Earlier, diet and stress were considered as the primary causes. However, recent studies establish the fact that diet and stress might worsen symptoms, but they are unlikely to cause inflammatory bowel disease. However, all signs point to many variables involved. For example, in genetically prone children, it is triggered by a mix of environmental, immunological, and bacterial factors. In addition, several factors, such as heredity and a malfunctioning immune system, are likely to play a role in its development. C

Primary Causes

Heredity

Genes may play a role in making people more susceptible to Crohn’s disease. It is more common in people whose family members suffer from the disease. However, most people with Crohn’s disease don’t have a family history of this disease.

Immune System

A virus or bacteria may trigger Crohn’s disease. However, scientists are yet to identify such a trigger. An abnormal immune response occurs when the immune system fights the invading microorganism. For example, it causes the immune system to attack the digestive tract cells. In addition, bacteria in the intestines can trigger your immune system to assault your healthy cells.

Risk Factors

Some of the Risk Factors associated with Crohn’s disease are as follows:

1. Cigarette Smoking

Smokers are more likely than non-smokers to develop Crohn’s disease. The most important controllable risk factor for Crohn’s disease is cigarette smoking. Smoking also causes more severe illness and increases the likelihood of requiring surgery. Therefore, it’s critical to quit smoking if you do.

2. Age

People in their 20s are the most likely to be diagnosed with Crohn’s disease. However, most persons with Crohn’s disease are diagnosed before they reach the age of 30. On the other hand, the condition can be detected at any age.

3. Oral contraceptives 

Oral contraceptives like naproxen sodium (Aleve), and diclofenac sodium do not cause Crohn’s disease but promote bowel inflammation, which can worsen the condition.

4. Ethnicity

Although Crohn’s disease can affect persons of any ethnicity, white people are at the most significant risk, mainly of Eastern European (Ashkenazi) Jewish origin. However, Crohn’s disease is becoming more common among Black people in North America and the United Kingdom.

Symptoms of Crohn’s Disease

Inappropriate immune symptoms are the primary cause of Crohn’s symptoms. There are various symptoms at different times. However, sometimes, it is difficult to notice any symptoms. Conditions may also worsen from mild to severe. In addition, when symptoms resurface or decline, it is known as a flare-up or relapse. 

Primary Symptoms

The following are some of the more prevalent Crohn’s disease indications and symptoms:

1. Abdominal Pain

Crohn’s disease patients experience cramps. These cramps usually manifest themselves in the lower right abdomen. However, they can occur anywhere along the digestive tract. Pain isn’t always the only indicator of the disease’s development.

2. Bleeding

Crohn’s disease can produce tears (fissures) in the anus lining. These fissures cause discomfort and bleeding, particularly during bowel movements and in case of infections.

3. Diarrhoea

If the inflammation damages the colon, it may lead to digestive problems like stomach aches and diarrhoea.

4. Weight Loss

People with Crohn’s disease may experience a drop in body weight. However, they would realise that they are losing weight even without attempting to.

5. Perineal Involvement

There is also evidence that patients with Crohn’s disease may also experience spontaneous perineal ulceration, nonhealing painless fissures, waxy perineal oedema fistulae, abscesses, or stenosis. In addition, it causes inflammation at or near the anus. The symptoms include pain, itching, bleeding, purulent discharge, and stool incontinence.

Other Symptoms

The other early symptoms of Crohn’s Disease are:

• Nausea: Crohn’s disease causes stomach pain that is less crampy and acute and more like nausea. It can also be accompanied by vomiting.
• Fever: Crohn’s patients may experience fever due to a deep-tissue infection. It happens if their condition is severe enough to result in an abscess.
• Fatigue: Patients may feel exhausted if the body is in an inflammatory state.
• Deep ulcers in the intestine (“cobblestone”) look
• Appetite loss.
• Redness or pain in the eyes
• Joint pain or tenderness
• Stunted growth (in children) 
• Delay in the flow of food and causing severe cramping.
• A weak pulse
• Severe belly pain
• Chills with shaking

Since it is a chronic disease, children might develop physical and emotional, social, and family problems. Additionally, stress and some foods like drinks and high-fibre diets might worsen symptoms for some people.

Symptoms in Females

Females face some specific Crohn’s symptoms such as:

• Anaemia
• Crohn’s disease can affect libido and body image. That can cause pain and different types of discomfort. 
• You may experience irregular menstruation due to effects on hormone function. 
• Iron deficiency affects the absorption of nutrients and can lead to intestinal bleeding. 
• If symptoms affect areas near the anus, you may experience pain or vaginal discomfort during sex.
• Labor complications
• Miscarriage, premature birth, and low birth weight

Possible Complications of Crohn’s Disease

1. Intestinal Obstruction

Crohn’s disease thickens your intestinal lining. As a result, the thickened portions of your intestines might narrow over time, causing your intestines to become blocked. In addition, a bowel blockage, also known as a partial or total intestinal obstruction, can prevent food or stool from moving through your intestines. This causes complete constipation and abdominal pain which can only be removed surgically.

2. Abscesses

Inflammation that travels through your intestine’s walls may cause abscesses. Abscesses are walled off spaces where an infection has occurred and been closed from affecting the rest of the body. It is painful, gets progressively larger and is filled with pus.

3. Fistulas

Inflammation in Crohn’s disease can cause tunnels, or fistulas, in the walls of your intestines. Fistulas are aberrant connections between organs or between organs and the skin. As a result, they have the potential to get contaminated. Once infected they become red, swollen and very painful. If near the anus – they can cause severe pain when passing motion

4. Anal Fissures

Anal fissures are tiny tears in the anus that can cause itching, severe pain- especially when passing stools and bleeding.

5. Ulcers 

Sores in your mouth, intestines, anus, or perineum can result from inflammation anywhere throughout your digestive tract.

6. SIBO (Small Intestinal Bacterial Overgrowth)

Your gut is filled with bacteria that aid in digestion. If this occurs higher up in your digestive tract than usual, you may have gas, bloating, tummy pain, and diarrhoea.

7. Strictures

The inflammation of Crohn’s disease causes your digestive tract to narrow and thicken. Depending on how much of your intestine is blocked, they can be moderate or severe. Cramping, stomach pain, and bloating are some of the symptoms.

8. Colon Cancer

It is a type of cancer that affects the intestine. If you have Crohn’s disease that affects your colon, you’re more likely to get colon cancer. According to general colon cancer screening guidelines, people without Crohn’s disease should have a colonoscopy every ten years starting at age 45.

9. Malnutrition 

Malnutrition occurs when your body lacks the vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.

10. Blood clots 

They are in veins, and arteries are more likely in people with Crohn’s disease.

Other health issues 

Crohn’s disease can affect other sections of the body and produce complications. Anaemia, skin ailments, osteoporosis, arthritis, and gallbladder or liver illness are among these issues.

Crohn’s Disease: Diagnosis

Crohn’s diagnosis is performed in two ways: Physical Examination and Diagnostic Tests.

Physical Examination

The doctor will generally undertake the following during the physical examination:

• Examines the abdomen for enlarged areas
• Listen to sounds in the abdomen using a stethoscope and tap or feel your belly to see whether it’s uncomfortable or tender and if the liver or spleen is abnormal or enlarged.

Diagnostic Test

The following lab tests are helpful to identify Crohn’s disease:

Primary Tests:

• Blood tests to check iron levels in your blood.
• Stool samples for the identification of infection caused by bacteria.
• Colonoscopy to examine the colon. The process includes inserting a light-emitting tube into your anus and advancing into your colon.

Barium Enema (Type of colon X-ray) 

The process includes inserting a tube into your anus and injecting a barium liquid into it. The use of barium allows doctors to visualise the colon more clearly.

Barium Swallow or Barium Oesophagram 

It is an X-ray of the throat and oesophagus. Patients have to drink a thick liquid called barium. It enhances the visibility of your oesophagus and stomach on X-rays. Follow the doctor’s recommendations before and after the test.

Upper Gastrointestinal Endoscopy 

It is a procedure that involves seeing into the digestive tract, including the oesophagus and stomach, with an endoscope. Inside the digestive tract, samples will be gathered and sent to a lab for analysis. Endoscopy can also be used to diagnose internal bleeding.

Magnetic Resonance Imaging (MRI) 

An MRI scanner creates comprehensive images of organs and tissues using a magnetic field and radio waves. For example, a fistula surrounding the anal area (pelvic MRI) or the small intestine can be evaluated using MRI (MR enterography).

Computed Tomography (CT)

A type of X-ray that delivers more information than a regular X-ray. The entire colon and tissues outside the bowel are examined in this test. CT enterography is a CT scan that gives you a better picture of your small intestine. According to general colon cancer screening guidelines in many medical centres, this test has taken the place of barium X-rays.

Ultrasound test

It involves taking photos of the digestive system using sound waves.

Crohn’s Disease: Treatment

Crohn’s disease is characterised by intermittent symptoms and has no proven cure. Recurrences can be minor or severe, and they might occur infrequently or frequently. However, most people can continue to live productive lives with adequate treatment. Taking actions to reduce stress and maintain a healthy immune system may also aid in managing your symptoms.

Treatment for Crohn’s disease includes anti-inflammatory drugs, immunosuppressive medications, and antibiotics. 

Possible alternatives for Crohn’s disease treatment

The other alternative supplements for Crohn’s Disease include:

• Laxatives
• Anti-diarrhoea medicines
• Dietary counselling
• Supplements containing iron
• Supplements containing vitamin D
• Injections of vitamin B12
• Supplements for calcium

Dietary Guidelines for Crohn’s Disease

The following are the primary objectives of dietary intervention for Crohn’s disease patients:

• First, eat foods that boost your immune system. It will help avoid infections and disease consequences.
• Assess and improve your overall health.
• Prevent deficient states and nutritional inadequacies, leading to osteoporosis and other common disorders.
• Avoid malnutrition.
• Reduce inflammation in Crohn’s disease-affected regions.
• Improve and correct intestinal transit.
• Determine if you have any allergies and food intolerances.

Foods to Eat to curb Crohn’s Disease

According to a study, Adults with IBD were more likely to have low dietary fibre intake than adults without IBD. In addition, women with IBD were more likely to have more sugar-sweetened beverages and total added sugar than women without IBD.

Crohn’s Disease Patients should have the following food and diet supplements:

• High Beta-Carotene Foods: Papaya, mango, carrot, pollen, and pumpkin.
• Soluble fibre: Intake of Soluble fibre before meals to avoid the laxative impact of bile.
• Zinc: Wheat germ
• Lactic bacteria: Lactase enzyme aids in the digestion of dairy products. Patients can have Yogurt who have a tolerance to dairy. In the opposite situation, taking probiotics as a supplement is recommended.
• Fat-Soluble Vitamins: Vitamin A, D, K, E
• Probiotics help strengthen the intestinal flora and improve the intestine’s overall health.
• High Quercetin Foods: Onion, apple, red cabbage, and broccoli
• Glutamine: It helps with digestion, colon cell nutrition, muscle tissue regeneration, and diarrhoea and stomach discomfort relief.

Foods to Avoid

People living with Crohn’s Disease should avoid the following foods:

• Oranges, spinach, and sausages
• Alcohol, coffee, and heat.
• Butter and full-fat dairy
• Foods that cause flatulence include cabbage, cauliflower, whole grains, carbonated beverages, and beans with skin.
• Foods containing sorbitol include candy, gum, and light or zero-calorie beverages.

Even when there is the disappearance of symptoms of Crohn’s disease for long periods, it is critical to maintain a healthy lifestyle and follow the Crohn’s Disease Diet Plan. 

• Exercise regularly.
• Consume nutritious foods.
• Avoid Smoking 
• Manage Stress

Conclusion

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that causes your digestive tract to swell and become irritable. It can cause weight loss, abdominal pain, diarrhoea, and rectal bleeding. Crohn’s disease therapies usually regulate your symptoms and allow you to live an active life. 

Crohn’s disease is a chronic illness for most sufferers, with flare-ups and remissions. Most people will have a reasonable quality of life with the help of appropriate drugs and, on rare occasions, surgery. However, depending on the location and extent of the disease, a person with Crohn’s may develop serious complications. If Crohn’s disease symptoms progress, it usually happens slowly. The longer the disease persists and progresses, it increases the likelihood of more severe disorders. These complications can even require surgery to treat them