The Fundamentals of Crohn's Disease

Crohn's disease is much more than a stomach ache. It's chronic digestive distress accompanied by factors that negatively affect quality of life, such as exhaustion, joint pain and other seemingly random full-body symptoms.

Like every condition in the inflammatory bowel disease (IBD) family, Crohn's disease is marked by swelling of the gastrointestinal (GI) tract. But Crohn's is special for a few reasons. The most common distinction is its classification as an autoimmune disease. That means harmless stomach bacteria are mistaken for foreign bodies and the body's defenses respond accordingly, in a similar way to ulcerative colitis.

What truly sets Crohn's disease apart from other chronic digestive issues is its unfortunate versatility. The inflammation—it wreaks bodily havoc and leads to symptoms—can manifest anywhere in the digestive tract.

Imagine a tube that's sometimes straight and sometimes curled that extends from your mouth to your anus. When you consider that the disease can affect anywhere on that path, the frustrating ambiguity of the condition begins to make more sense.

Crohn's, despite possessing unknown origins, is thought to be caused by genetics, environmental factors (such as stress) and the immune system.

Can you inherit Crohn's and who's most at risk?

While the condition affects females and males at roughly equal frequencies—slight variations exist based on age and location—the pattern across the globe is less clear. Some will characterize Crohn's disease as a condition mainly found in "developed" nations. This initially fits given that Canada is the Crohn's capital of the world; the United States and Scandinavian nations also rank highly. However, Japan is one of the wealthiest nations yet bears some of the lowest rates.

Ethnic predilections are just as murky, with more anomalies than answers. Families of Ashkenazi Jewish descent are more likely to suffer from Crohn's; yet, non-Hispanic African Americans are America's fastest-growing group of patients.

On the familial level, 1 in 5 Crohn's patients have a blood relative with some form of inflammatory bowel disease. Some Crohn's patients don't have any relatives with a similar diagnosis, however, and plenty of people related to those with Crohn's show no sign of the disease.

A healthy lifestyle in general may reduce the risk of IBD, according to research. Many studies have also suggested that active cigarette smokers are twice as likely to be diagnosed with Crohn’s disease, ulcerative colitis or microscopic colitis. More evidence is required for a solid analysis.

The medical community knows of no scientifically acknowledged cause of Crohn's disease.

"Although some patients find that dietary changes are helpful in managing symptoms, this intervention does not specifically cure inflammation," said New York City-based gastroenterologist Pratima Dibba, M.D. "Patients should also be aware that Crohn's disease is not caused by anything they may have done to induce the disease."

Certain bacteria are theorized as the culprits but only recently has a name emerged: adherent-invasive Escherichia coli (AIEC). And it takes an overabundance of it. Even then, the cause of Crohn's disease isn't proposed as entirely bacterial.

Recent studies also suggest there's a specific gene that makes individuals more or less vulnerable to Crohn's disease. That said, this theory is in an early stage and no experiments or trials have been conducted.

What are the types and stages of Crohn's disease?

Crohn's symptoms develop gradually or suddenly depending on the case. The early stage is typically characterized by the following:

• Loss of appetite
• Fever
• Exhaustion
• Pain and redness in the eyes
• Non-acne red spots on the skin

As Crohn's disease progresses, mouth sores, weight loss, bloody or black stools, anal drainage and pain, and medicine-resistant diarrhea can dominate a patient's life.

The symptoms of late-stage Crohn's disease can differ significantly from the early stage, according to Dung Trinh, M.D., the founder of the Healthy Brain Clinic in Long Beach, California.

Potential differences between early and late-stage Crohn's include:

• Increased frequency and severity of symptoms. As Crohn's disease progresses, it can lead to more frequent and severe symptoms such as abdominal pain, diarrhea and fatigue.
• Increased risk of complications. Late-stage Crohn's disease can increase the risk of serious complications such as bowel perforation, abscesses, fistulas (abnormal connections between different parts of the digestive tract) and colon cancer.
• Increased risk of infections. People with advanced Crohn's disease may be at higher risk for infections due to weakened immune function.
• Intestinal damage. Over time, chronic inflammation in the digestive tract caused by Crohn's disease can lead to scarring and narrowing of the intestines or blockages in the intestinal walls. This can cause more severe symptoms and may require surgical intervention.
• Nutritional deficiencies. Malnutrition is a common complication of late-stage Crohn's disease due to the impaired nutrient absorption caused by inflammation in the digestive tract.

"One study revealed that complications—such as fistulas, strictures and abscesses—were seen in up to 50 percent of patients who were diagnosed up to 20 years prior," Dibba said. "While a disease's course may vary between individuals, it is always important to seek medical attention earlier rather than later."

The bottom line

Dibba noted that there is a light at the end of the tunnel.

"Crohn's disease can absolutely go into remission," she said. "It is crucial for patients with Crohn's disease to maintain appropriate follow-up with their gastroenterologist to find the right medication for them and this may take some time."

Remission can be as much a stroke of luck as strictly adhering to doctor's orders.

"Remission can occur spontaneously or as a result of treatment," Trinh said. "Medications such as anti-inflammatory drugs, immunosuppressants and biologic therapies can be effective in achieving remission in some people with Crohn's.

"It is important to note that while remission can provide relief from symptoms, it does not mean that the underlying condition has been cured."