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Crohn’s Disease (CD)

  • About CD

    How does your digestive system work?

    The digestive system is a collective of organs-from the mouth to the anus-that works together to convert food info absorbable nutrients, which provide energy for the body. 1

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    What happens in your digestive system affected by CD?

    Crohn’s disease chronic Inflammatory Bowel Disease (IBD) that leads to the development of inflammation in your digestive system. 2

    It can affect any part of the Gl tract, from the mouth to the anus. It most commonly affects the end of the small intestine where it joins the beginning of the colon. 3

    It may appear in “patches,” affecting some areas of the Gl tract while leaving other sections completely untouched. 4

    Anatomic distribution of Crohn’s disease 5

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    How are CD and other bowel disorders different?

    Many people are confused when it comes to the differences between inflammatory bowel disease(IBD), Crohn’s disease and ulcerative colitis.6,9
    Also, IBD shouldn’t be confused with irritable bowel syndrome(IBS).

    Crohn’s Disease

    Affected area
    Affects any part of digestive system
    Extent
    Occur in patches
    Cause
    Exact cause is unknown, but attributed to overactive immune system triggering inflammatory response
    Gender frequen
    Male = Female
    Classified as
    Structural disease
    • Ulcerative Colitis

      Affects large intestine only
      Uniform or continuous
      Exact cause is unknown, but attributed to overactive immune system triggering inflammatory response
      Male = Female
      Structural disease
    • Irritable Bowel Syndrome(IBS)

      Common in large intestine
      No inflammation cause
      Exact cause is unknown, but associated with the disruption on intestinal muscle contractions
      Male < Female frequent
      Functional Disorder

    While some symptoms may be similar at times, source and course of the conditions differ quite significantly.

    What causes CD?

    While multiple contributing factors have been found, the exact cause of Crohn’s disease is unknown. 1

    CD is associated with some risk factors including : 1

    • 1 Gender

      Males and females appear to be approximately equal.

    • 2 Age

      On average, people are more frequently diagnosed with CD between the ages of 20 and 30 although it can occur at any age.

    • 3 Family history

      People who have a family history of CD are more susceptible to the disease.

    • 4 Immune system disturbance

      Abnormal immune responses may attack the healthy cells of the body, causing the symptoms of CD.

    • 5 Other factors

      Environmental triggers such as smoking, stress, and unbalanced diet are associated with a higher risk of developing CD.

  • Symptoms

    What are the symptoms of CD?

    Crohn’s disease can occur in various areas of the Gl tract. Disease activity and severity can vary widely over time.10

    • Urgent need to move bowels and sensation of incomplete evacuation are other symptoms related to inflammation of the Gl tract. 6

    • Weight loss, night sweats and loss of normal menstrual cycle are general symptoms that may be associated with CD. 6

  • Diagnosis

    How is CD diagnosed?

    Your physician will likely use a combination of tests and check for contributing causes such as family history and medical pasts in order to diagnose Crohn’s disease.10,11

    Diagnosis of CD 10-12

    • Blood Tests

      To check for levels of red blood cells(or white blood cells) and whether you show signs of inflammation, infections, or anaemia.

    • Stool Samples

      Tested for signs for bleeding or inflammation, and to check whether your diarrhea is caused by an infection. Fecal calprotectin has been proposed as a noninvasive surrogate marker of intestinal inflammation in IBD.

    • Upper GI Endoscopy

      Looking at the interior of the esophagus, stomach, and small intestine when it is suspected that your symptoms are coming from the upper digestive system.

    • Sigmoidoscopy or Colonoscopy

      Looking at the interior of the rectum and colon when symptoms are suspected to be originating from the ileum or colon.

    • MRI and CT Scans

      Perform to obtain a more detailed image of organs and tissues.

  • Treatment

    How is CD treated?

    CD is a chronic condition that cannot be completely cured.1, 6, 11
    Therefore, the main goals of medical treatment are to achieve remission(the absence of symptoms), maintain remission(prevent flare-ups of symptoms) and improve quality of life.6,12
    Symptoms of Crohn's disease may range from mild to severe, and will vary from person to person.1
    Treatment choice depends on the severity, stage, location of disease, and the extraintestinal complications.

  • Tips & FAQs

    Living with CD

    CD is a chronic condition that is characterized by intermittent periods of active disease(flare-ups) and little or no disease activity(remission).1, 14
    About 50% of patients will be in remission or have mild disease over the next five years.10, 11
    Most of people with CD take a maintenance drug to help keep symptoms in check, even when CD is quiescent. 10, 14

    A flare is the reappearance of disease symptoms. The most common symptoms of CD are: 14,15


    • Frequent and/or urgent bowel movements
    • Diarrhea
    • Blood in stool or rectal bleeding
    • Abdominal pain

    You cannot completely prevent flare-ups of CD. But, there are several self managements that you can do to optimize your health:16

    Take all IBD medications regularly

    The best way to control CD and reduce the risk of flares is by taking medications as recommended by your doctor.

    See your doctor regularly

    Well informed about the details of your symptoms and stay in close communication with your doctors.

    Quit smoking

    Smoking can make the symptoms of CD worse and can make it more difficult to treat.

    Eat a well-balanced diet

    Well-balanced nutrition is an essential part of staying healthy and minimizing the effects of the disease.

    Physical activity

    A regular exercise routine can improve overall health, and may be particularly beneficial for people with CD.

    A flare-up will probably not resolve by itself, and treatment will be needed. Maintenance drugs will be continued during a flare-up, and other drugs, diet modifications, or more treatment may be prescribed by your doctor to bring the disease back under control.15

    Frequently asked Questions

    1. Can Crohn’s disease progress into cancer?10, 17

    Patients with CD do have a slightly higher risk of developing colon cancer and lymphomas. This is dependent partly on the number of years you have the disease. Your physician may recommend periodic colonoscopies for full evaluation of the colon.

    2. Will CD patients need surgery?11

    Many individuals with Crohn's disease respond well to medical treatment and never need to undergo surgery. However, between 66 and 75 percent of people will require surgery at some point during their lives.

    3. What foods can/can't patients eat? What is a good diet plan?11

    There is no standardized diet that will be the solution for CD patients. However, adjusting your diet can be helpful to manage some of your symptoms, and can help your medications work better.

    Tips

    Tracking your diet with daily food journal can help you identify what foods and beverages work well for you and which ones don’t.11

    Diet and Nutrition Tips 6, 11

    Low-salt diet

    Used during corticosteroid therapy to reduce water retention

    Low-fiber diet

    Used to avoid blockages in CD patients with strictures and to avoid stimulating bowel movements

    Low-fat diet

    Typically recommended during a flare in CD when fat absorption may become an issue

    Lactose-free diet

    For those who have an intolerance to dairy products

    High-calorie diet

    For those who experience weight loss or growth delay

    Reduce the amount of greasy or fried foods

    It may cause diarrhea and gas

    Restrict carbonated beverages

    It may cause excessive gas

    Restrict caffeine

    It may cause a severe diarrhea

    Eat smaller meals at more frequent intervals

References

1. Crohn’s and Colitis UK. Crohn’s Disease. Crohn’s Disease Edition 7c. 2020.

2. Mayo Clinic. Crohn’s disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304 Accessed February 2020

3. CDC. What is inflammatory bowel disease (IBD)? Available at https://www.cdc.gov/ibd/what-is-IBD.htm Accessed February 2020

4. BioSpace. Inflammatory bowel disease insight report. Available at https://www.biospace.com/article/inflammatory-bowel-disease-insight-report-current-therapies-drug-pipeline-and-outlook/ Accessed February 2020

5. John’s Hopkins Medicine. Crohn’s disease. https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/small_large_intestine/crohns_disease.pdf Available at Accessed February 2020

6. Crohn’s & Colitis Foundation of America. Inflammatory Bowel Disease. Available at https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/updatedibdfactbook.pdf Accessed February 2020

7. PHARMWIKI. Inflammatory Bowel Disease. Available at http://tmedweb.tulane.edu/pharmwiki/doku.php/inflammatory_bowel_disease_ibd Accessed February 2020

8. Crohn’s & Colitis Foundation of America. IBS and IBD: Two Very Di erent Disorders. Available at http://www.ccfa.org/resources/ibs-and-ibd-two-very.html Accessed February 2020.

9. Mayo Clinic. Irritable bowel syndrome. Available at https://www.mayoclinic.org/diseasesconditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016 Accessed February 2020

10. IBDclinic. IBD treatment. Available at http://www.ibdclinic.ca/treatment/ Accessed February 2020

11. Crohn’s & Colitis Foundation. Living with Crohn’s Disease. Available at https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/living-with-crohns-disease.pdf Accessed February 2020

12. NYU Langone Health. Diagnosing Inflammatory Bowel Disease in Adults. Available at https://nyulangone.org/conditions/inflammatory-bowel-disease-in-adults/diagnosis Accessed February 2020

13. Crohn’s & Colitis Foundation. Types of medications for Crohn’s disease and ulcerative colitis. Available at https://site.crohnscolitisfoundation.org/resources/types-of-medications.html Accessed February 2020

14. Verywellhealth. What is an IBD flare-up? Available at https://www.verywellhealth.com/whatis-an-ibd-flare-up-1942490

15. Crohn’s & Colitis Foundation. Managing Flares and IBD Symptoms. Available at https://www. crohnscolitisfoundation.org/sites/default/files/2019-07/managing-flares-brochure-final-online.pdf Accessed February 2020

16. Harvard Health Publishing. Living with Crohn’s disease: recognizing and managing flares. Available at https://www.health.harvard.edu/blog/living-with-crohns-disease-recognizingand-managing-flares-2019112618410 Accessed February 2020

17. WJG. Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873872/pdf/WJG-22-4794.pdf Accessed February 2020

Abbreviations

CD, Crohn's disease; CT, computed tomography; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; MRI, magnetic resonance imaging;