By Katy Mena-Berkley
The pain is something we have all experienced at one point or another. Perhaps you overindulged in a dairy product that didn’t agree with you, or maybe you ate a piece of meat that had unfortunately been left out of the refrigerator for too long before it was cooked. In any event, you found it caused problems for your digestive system. What if that unpleasant experience threatened to plague you any and every day of the week? For people living with Crohn’s disease, this digestive distress is a daily reality.
Who Is Affected
Crohn’s disease affects an estimated 780,000 people living in the United States. And while no one is immune to the condition that impacts an equal number of men and women, the National Institute of Diabetes and Digestive and Kidney Diseases notes that individuals whose relatives have an inflammatory bowel disease (IBD) are at a greater risk for developing Crohn’s disease. “The exact cause of Crohn’s is unknown, but researchers believe there is likely some sort of genetic predisposition,” says Dr. Steven Kessler, a gastroenterologist with Erlanger Gastroenterology. “Twenty percent of people with Crohn’s have a family member who also has the disease.” It’s also most common in people ages 20 to 29, though the disease can strike at any age, and environmental factors like smoking play a role.
The good news is that if you are living with Crohn’s, there are solutions to help you manage your condition and improve your quality of life. But first, it’s helpful to know exactly what is happening in your body.
An Overreaction of the Immune System
Falling in the IBD category, Crohn’s disease creates irritation in the digestive system. “Crohn’s disease is a chronic inflammatory bowel disease that causes inflammation of your GI tract,” explains Dr. Kessler. “It can occur in any part of your GI tract, but it most commonly manifests in the small intestine and colon.”
As with other inflammatory diseases, Crohn’s is believed to be an overreaction of the immune system. Dr. Camille Sommer, a gastroenterologist with Gastroenterology Associates of Chattanooga, explains, “It is normal for our immune system to react to fight off what our body deems as something potentially harmful, like bacteria or viruses. However, with Crohn’s disease, the already genetically susceptible immune system reacts to a trigger that causes an inappropriately harmful response to our gut that doesn’t subside. When there is persistent inflammation in our GI tract, it can impair our ability to function and cause unpleasant symptoms such as abdominal pain, diarrhea, and rectal bleeding.”
Crohn’s disease can also cause inflammation in other systems of your body, specifically your eyes, joints, and even your skin. “Since Crohn’s disease is also associated with other extraintestinal manifestations, it’s important to make sure that patients also involve other specialists, such as ophthalmologists and dermatologists, in their care,” notes Dr. Sommer.
In the Event of a Flare-Up
Crohn’s disease follows a relapsing-remitting pattern, flaring up for periods of time and sometimes quietly disappearing for weeks or even years. At the height of an exacerbation, you may experience intense abdominal cramps, chronic diarrhea, rectal bleeding, and weight loss.
If you are experiencing symptoms you think could be related to Crohn’s disease, consider keeping a log of the foods you’re eating and when you’re having flare-ups. Dr. Chad Charapata, gastroenterologist on staff at CHI Memorial, says, “Symptoms of Crohn’s disease have significant overlap with other intestinal disorders such as ulcerative colitis, celiac disease, and irritable bowel syndrome. Consult your gastroenterologist for a history and physical exam so appropriate testing can be initiated.”
Tests range from blood tests that look at inflammatory and genetic markers associated with Crohn’s disease to CT scans that capture images of your entire bowel. “Initial testing usually includes a colonoscopy, which examines the terminal ileum (end of the small intestine) and colon,” explains Dr. Charapata. “If this exam is negative and symptoms continue, then small bowel imaging with MRI would be the next step.” Depending on the results, further testing may be required to confirm a diagnosis.
If your gastroenterologist determines that you do have Crohn’s disease, he or she may try a spectrum of options to counter the symptoms. One or a combination of treatments may help calm a flare-up and also prevent more from occurring in the future. “Because Crohn’s is chronic or ongoing, treatment is also considered chronic, and there are a variety of medications available,” explains Dr. Kessler. “Medications are chosen based on disease severity and the patient’s risk profile with a goal of controlling inflammation, controlling symptoms, and healing the intestinal lining.”
Anti-inflammatory drugs such as corticosteroid therapy can be effective as a first line of defense. You may respond quickly to this type of medication, but it is not a long-term solution and should only be used to calm inflammation that occurs during a flare-up of Crohn’s.
Immunosuppressant therapies may also ease inflammation. They may be taken by themselves or in combination with each other to provide the best results. This is a long-term treatment method.
Antibiotics can be helpful when you have developed abscesses or fistulas (abnormal connections between organs and other structures) that need to heal. They may also reduce the development of dangerous bacteria in the intestines. Simple over-the-counter fiber supplements can counteract diarrhea by thickening your stool, while acetaminophen can relieve mild pain.
If you are experiencing poor quality of life in spite of these treatments for Crohn’s disease, talk to your doctor about how surgery may help. By removing the diseased portion of your gastrointestinal tract, colon, and/or rectum, a surgeon can take steps to preserve your bowel and overall comfort level.
Living with Crohn’s disease is challenging, but you can take steps to manage your symptoms, minimize your risk of flare-ups, and make life more enjoyable. First and foremost, remember your medication. “It’s important to realize that Crohn’s disease is a chronic condition,” reminds Dr. Sommer.
“Even after you achieve clinical remission and have resolution of symptoms, patients should stay on their medication for maintenance.” Reducing stress is also beneficial. Make an effort to exercise regularly and perhaps explore calming practices such as yoga or tai chi. Spend time with people who love and support you, and consider joining a local support group for people who understand what you are experiencing. Living with a condition such as Crohn’s can be isolating – remembering you are not alone in the journey is important.
Paying close attention to your diet can be helpful as well. Take care to avoid foods and beverages that may trigger a flare-up, such as alcohol, caffeine, dairy products, and spicy dishes. Dr. Charapata explains, “It is very important to maintain adequate nutrition in order to give your body the energy it needs to fight inflammation. This includes a well-balanced diet high in protein, as well as healthy amounts of vitamin D and calcium to keep your bones strong.”
While managing Crohn’s takes planning and effort, it’s possible to find relief. Don’t let it detract from the things you love to do! HS