William A. Faubion, Jr., M.D., Gastroenterology, Mayo Clinic: I'm Dr. Bill Faubion, a gastroenterologist at Mayo Clinic. In this video, we'll cover the basics of Crohn's disease. What it is? Who gets it? The symptoms, diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. Crohn's disease is an inflammatory bowel disease that causes chronic inflammation of the GI tract, which extends from your stomach all the way down to your anus. Different areas of the GI tract can be affected in different people, and it often spreads into the deeper layers of the bowel. It's estimated that over half a million Americans are living with Crohn's disease. It can be painful and debilitating, occasionally leading to severe complications, as well as emotionally stressful. And while there is no cure, once you've been diagnosed, treatment can help you get back to a more normal and comfortable life.
Who gets it?
There are a lot of particulars that figure into or aggravate Crohn's disease, but the exact cause is still unknown. It may involve an abnormal immune response against some microorganism in which your tissues are also attacked. Genetics might also play a role. And it's true that you're at higher risk if a first-degree relative has it. But that's really only seen in about 20% of cases. There is a correlation with age. Although it can show up at any stage of life, most people are diagnosed before 30. Ethnicity is a risk factor. Whites have the highest risk, especially among people of Ashkenazi Jewish descent. However, incidence is increasing among black people in North America and the UK. Non-steroidal anti-inflammatory medications or NSAIDS... they don't cause Crohn's disease, but they are known to trigger inflammation of the bowel and make it worse. They include common over-the-counter painkillers like ibuprofen, naproxen sodium, diclofenac sodium, and others. So if you've been diagnosed with Crohn's, make sure you talk to your doctor about what medications should be avoided. Many of these elements are out of our hands, but smoking is the most important controllable risk factor for developing Crohn's disease. It also leads to more severe disease and increased need for surgery. So if you smoke and you're diagnosed, now is a good time to quit.
What are the symptoms?
Crohn's disease can affect any area in the GI tract, but it's mostly found in the large and the small intestine. It can also be confined to one area or found in multiple segments. Symptoms can range in severity and it can depend on the area of the GI tract that's affected. You also may experience periods of remission when you have no symptoms or issues at all. The symptoms can come on gradually, but they can also show up suddenly. And these can include diarrhea, fever, fatigue, abdominal pain and cramping, blood in your stool, mouth sores, reduced appetite and weight loss. If your Crohn's disease has caused fistulas or inflamed tunnels in the skin near the anal area, you may notice pain or drainage. And in more severe cases, you may have inflammation of the eyes, skin, joints, liver or bile ducts, kidney stones, and anemia. In children, it can delay growth and development. Over time, Crohn's disease can lead to other complications, including bowel obstruction, ulcers, fistulas, anal fissures, malnutrition, and other health problems. It can also increase your risk for blood clots and colon cancer. Having these symptoms doesn't automatically mean you have Crohn's. But if you're experiencing anything that concerns you, it's a good idea to make an appointment with your doctor.
How is it diagnosed?
There's no single test for Crohn's disease, and it has similar symptoms to a lot of other conditions, so it can take a little time to get a diagnosis. First, your doctor is going to consider your medical history. Then your doctor may want to run a variety of tests or procedures. And at some point, your general practitioner may want to refer you to a specialist called a gastroenterologist like myself. A blood test can check for anemia and check for signs of infection. A stool study can test if there's blood present or rule out certain pathogens. A colonoscopy may be needed. This also allows your doctor to view your entire colon and the very end of the ileum using an endoscope, a small camera mounted on a thin flexible tube. They can take tissue samples for a biopsy at the same time. And the presence of granulomas or clusters of inflammatory cells, can essentially confirm the diagnosis. A CT scan might be ordered for a better look at the bowel and all of the surrounding tissues; or an MRI, which is especially good for evaluating fistulas around the anus or the small intestine. A capsule endoscopy can be done. Here you actually swallow the camera about the size of a large vitamin and it takes images of your digestive tract as it travels through. And a balloon-assisted enteroscopy may be done to get further into the bowel than a standard endoscope can if abnormalities have been found that need further investigation.
How is it treated?
Your doctor can work with you to find therapies that alleviate your symptoms. One of the main goals is to reduce the inflammation that produces painful and disruptive issues. Another is to limit complications over the long-term. There is currently no cure, but many treatments can provide a lot of relief, and in some cases, even long-term remission. These may include anti-inflammatory drugs like corticosteroids, immune system suppressants, and antibiotics. Certain biologics, which target proteins made by the immune system, can help. Antidiarrheals, pain relievers, and supplements can help counter other symptoms. Nutritional therapy and a special diet may be recommended. And in some cases where other measures aren't effective, surgery may be required. And that's to remove the damaged tissue. Some of these therapies may have side effects themselves. So be sure and review the risks and benefits with your doctor.
Crohn's disease can be physically and emotionally challenging, but there are things that can help. Although there's no firm evidence that any particular foods cause Crohn's disease, certain things seem to aggravate flare-ups. So a food diary can help you identify personal triggers. Beyond that, limit dairy products, eating smaller meals, stay hydrated, and try to avoid caffeine, alcohol, and carbonation. Consider multivitamins if you're concerned about weight loss. Or if your diet has become too limited, talk to a registered dietitian. And again, if you smoke, you should stop. It's important to take care of your mental health too. Find ways to manage stress, like exercise, breathing, relaxation techniques or biofeedback. Some symptoms like abdominal pain, gas, and diarrhea... they can cause anxiety and frustration. They can make it difficult to go out in public for any amount of time. It can feel limiting and isolating and lead to depression. So learn as much as you can about Crohn's. Staying informed can help a lot in feeling like you're in control of your condition. Talk to a therapist, especially one familiar with inflammatory bowel disease. Your doctor can give you some recommendations. And you might want to find a support group of people going through the same thing that you are. Crohn's disease is a complex disease. But having expert medical care and developing a treatment strategy can make it more manageable and even help you get back to the freedom of your normal life. Meanwhile, significant advances continue to be made in understanding and treating the disease, getting us closer to curing it or preventing it entirely. If you'd like to learn more about Crohn's disease, here are other related videos or visit mayoclinic.org. We wish you well.