Have you ever heard of Crohn’s disease? It’s not as well-known as heart disease or cancer but it has the ability to consume one’s life just as much. Crohn’s disease or Crohn disease is a type of inflammatory disease that’s chronic and affects the intestines. This disease causes ulcerations or breaks in a person’s mucosal lining of the large and small intestines. However, this disease can have an effect on the entire digestive system from the anus to the mouth. This disease is also known as ileitis, terminal ileitis, regional enteritis, granulomatous enteritis or colitis.
Crohn’s disease is closely related to a condition known as ulcerative colitis which is another type of inflammatory condition which only affects the colon. When they occur together, these diseases are referred to as IBD or inflammatory bowel disease. Unfortunately, Crohn’s disease doesn’t have any medical cure. When you acquire the disease, it will only fluctuate between periods of remission or inactivity and periods of activity or relapse. Therefore, the best thing to do if you suffer from this disease is to know how to manage it.
Both women and men are equally affected by Crohn’s disease. But it tends to occur more frequently in relatives or family members of patients who already have Crohn’s disease. This means that if you have a relative with Crohn’s disease, then you have a higher risk of developing the condition as well. The risk is even higher if you have a family member like a sibling who has the disease.
What Causes Crohn’s Disease?
Until now, the exact cause of Crohn’s disease is not yet known. Some experts suspect that it’s caused by an infection from a certain bacteria but they aren’t completely sure. The good news is that the disease isn’t contagious. One’s diet may have an effect on the symptoms of the condition but it’s highly unlikely that the diet will cause the disease.
The immune system’s activation in a person’s intestines seems to be relevant in IBD including Chron’s disease. A person’s immune system is made up of immune cells as well as the proteins produced by those immune cells. Basically, the immune cells and the proteins are responsible for defending the body against viruses, bacteria, fungi, and other foreign invaders which may cause harm to the body. When the immune system gets activated, this causes the tissues to get inflamed.
Normally, a person’s immune system gets activated only when he gets exposed to those harmful invaders. But for those with IBD, their immune systems get activated chronically and abnormally. This occurs even when there aren’t any known invaders and it would result in chronic ulceration and inflammation. This vulnerability to the abnormal activation of the body’s immune system can be inherited genetically. This is why first-degree relatives of those who have IBD are more prone to develop such diseases.
Just recently, the NOD2 gene has been established as a gene linked to Crohn’s disease. This is an important gene which determines how a person’s body responds to certain bacterial products. It was also found out that people who have mutations in this specific gene are more prone to developing the disease.
What are the Common Symptoms of Crohn’s Disease?
The most common symptoms of Crohn’s disease include diarrhea, weight loss, and abdominal pain. However, one may also experience fever, poor appetite, rectal pain, night sweats, and an occasional bout of rectal bleeding. Usually, though, the symptoms of this disease would depend on the extent, the location, and the severity of the inflammation. There are different subtypes of this disease and they have varying symptoms.
- When the inflammation affects the colon, it’s known as Crohn’s colitis. People with this condition may experience bloody diarrhea, abdominal pain, peri-rectal abscesses, and anal fistulae.
- When the inflammation affects the small intestine, it’s known as Crohn’s enteritis. People with this condition may experience diarrhea, abdominal pain, and obstruction of the area.
- When the inflammation affects the end of the person’s small intestine, it’s known as Crohn’s terminal ileitis. People with this condition may experience diarrhea, abdominal pain, and obstruction of the small intestine.
- When the inflammation affects the colon and the small intestine, it’s known as Crohn’s entero-colitis or Crohn’s ileo-colitis. People with this condition may experience bloody diarrhea, abdominal pain, and obstruction of the small intestine.
Crohn’s ileo-colitis and Crohn’s terminal ileitis are the most common subtypes of the disease. People who have these conditions may experience the same symptoms around their anal area. For one, the person may experience swelling of their anal sphincter’s tissue. They may also develop fissures and ulcers in the same area which, in turn, can cause pain and bleeding each time the person defecates. A person may also develop anal fistulae between their anus and the surrounding areas. Then pus and mucus might drain from the openings of the fistulae. Finally, peri-rectal abscesses may also develop which may cause tenderness and pain around the anus as well as fever.
What to Eat and What to Avoid When You Have Crohn’s Disease
We all know that good nutrition is important if you want to stay healthy. But it’s even more important if you aren’t at the peak of health or if your health is compromised by any kind of chronic disease. However, if you have Crohn’s disease, then maintaining proper nutrition can be really challenging. A lot of factors may contribute to nutritional issues for those who have this disease. When a person’s small intestine gets inflamed, it’s not able to function properly, therefore, it won’t be able to absorb the nutrients from the food eaten properly. When this happens, it’s called malabsorption and it would depend on the damage of the intestine as well as the severity or extent of inflammation.
What’s even worse, the pain and inflammation of the intestines usually associated with the disease tend to reduce a person’s appetite as well. So the person probably doesn’t consume enough food to supply his nutritional needs. Also, diarrhea which comes with the disease depletes the person’s supply of nutrients further. To make matters even worse, people with Crohn’s disease and other chronic illnesses actually require more nutrients and calories than people who are healthy.
When it comes to Crohn’s disease, there’s no specific diet to follow. But these people can help reduce their symptoms by staying away from certain foods and making some changes in their diets. The most common foods to avoid are milk along with other dairy products. Also, fatty, fried or spicy foods must be avoided along with foods that are high in fiber. Other foods which may worsen the symptoms of the disease include seeds, nuts, popcorn, and dried or raw vegetables and fruits. Finding out which foods one can tolerate requires some trial and error.
There are a lot of tasty foods out there which will provide people with adequate nutrition without irritating their digestive tract. Anyone who can tolerate dairy products can for yogurt, ice cream or even milkshakes made with ice cream. One may also eat cheeseburgers or pizza because they’re delicious, satisfying, and contain a lot of calories. However, consuming a lot of foods which are high in salt and fats can also cause other types of health issues such as high blood pressure or heart disease. For those who already have Crohn’s disease, they don’t need additional health issues such as these. So it’s best to just enjoy such treats once in a while if they don’t make the symptoms worse.
Aside from trying to eat the right foods, people with Crohn’s disease may also take some supplements. But the vitamin or mineral supplement would depend on a number of factors too. These include the person’s diet, which parts of his digestive tract are affected by the disease, and whether the person has already had surgery done on his small intestine. The best way to find out which supplement to take is to talk to one’s physician before making a choice.
Also, there are some things people with Crohn’s disease may do to feel better while eating and after eating too. For one, a person may use a food diary. Then he can start recording everything he eats as well with details such as which foods cause problems and which foods are tolerable. After finding out which foods are okay, then it’s time to stock up on those foods. Also, people with the disease would be better off eating small, frequent meals throughout the day. This is also very helpful in preventing or reducing the symptoms.
Medications and Treatment for Crohn’s Disease
Unfortunately, there’s no kind of medication out there which has the ability to cure Crohn’s disease completely. Usually, those who have Crohn’s disease may experience periods of flares and relapses followed by periods of remission. These fluctuations may last for a couple of months to a couple of years. During the time of relapse, the symptoms of the condition tend to worsen and when it’s time for remissions, those symptoms improve. Usually, the remissions happen because of the treatment either through surgery or medications. But sometimes remission can also happen even without treatment.
Crohn’s disease doesn’t have any cure so the treatment is done to achieve certain goals. These include inducing and maintaining remissions, minimizing the negative side effects of the treatment, and help improve the patient’s quality of life. Although the medications used for ulcerative colitis and Crohn’s disease are similar, they’re not always identical. Let’s take a look at the different medications used for the treatment of this condition:
These types of medications reduce the inflammation of the intestines much like those which reduce joint inflammation of arthritis. Some examples of such medications are 5-ASA compounds, corticosteroids, topical corticosteroids, and antibiotics.
5-ASA Rectal and Oral Medications
5-ASA medications are chemically similar to aspirin which is also an anti-inflammatory drug. This type of medication can be very effective in the treatment of Crohn’s disease if administered topically onto the intestinal lining that’s inflamed. But if the disease affects the small intestine and the upper colon, the medication must be taken orally. There are different kinds of 5-ASA medications available.
- Sulfasalazine or Azulfidine helps induce remissions for patients who have mild to moderate Crohn’s disease or ulcerative colitis. It can also be taken long-term to maintain the periods of remission. Unfortunately, this medication has some negative side effects. Because of this, it’s not used as often as the other types of medications.
- Mesalamine or Asacol is also effective in inducing remissions for those who have mild to moderate Crohn’s disease or ulcerative colitis. It’s also helpful for maintaining remissions and it’s quite effective as well for the treatment of Crohn’s ileo-colitis and ileitis.
- Mesalamine or Pentasa comes in capsule form and contains small spheres which contain 5-ASA. This is a sulfa-free medication which gets released into the intestine gradually. These days, this is the most commonly used compound as it’s also effective in the treatment of inflammation in the small intestine.
- Olsalazine or Dipentum also comes in capsule form which contains two 5-ASA molecules which are chemically bonded together. This medication can’t be absorbed by the intestine or the stomach. Instead, the intestinal bacteria can break the two molecules apart in order to release them into the person’s intestine. And since this intestinal bacteria are abundant in the colon and ileum, most of the 5-ASA gets released in those body parts. Therefore, this medication is most effective if your disease is only limited to your colon or ileum.
- Balsalazide or Colazal is another medication that comes in capsule form but this time, the 5-ASA is linked to another molecule with a chemical bond. This prevents the 5-ASA from getting absorbed prematurely. This medication, when taken, will reach the very end of the small bowel and the colon. There, the intestinal bacteria splits the 5-ASA along with the molecule it’s bound to in order to release it.
- Rowasa or Canasa are rectal medications which come in enema form and which are used when the inflammation is near or in the rectum. Usually, the medication is given at bedtime and patients are recommended to maintain the enema all throughout the night. These medications are effective in maintaining remission as long as the disease is limited to the rectum or distal colon.
These are ideal for treating patients who have moderate to severe Crohn’s disease. Corticosteroids are also used for patients who don’t respond to the 5-ASA medications. Unlike the 5-ASA medications, corticosteroids don’t need to be in direct contact with the inflamed tissues of the intestines for them to be effective.
Oral corticosteroids are potent types of anti-inflammatory medications. After being absorbed by the body, the medication exerts rapid anti-inflammatory actions all throughout the body. Because of this, corticosteroids are quite effective in the treatment of Crohn’s disease. If the patient is critically ill, the doctor may administer intravenous corticosteroids at the hospital. Although this type of medication is highly effective for the treatment, it’s not very useful in maintaining remission in the disease. Also, it’s not very helpful in preventing Crohn’s disease from returning after surgery.
There are different kinds of antibiotics used in the treatment of Crohn’s disease. These include:
- Metronidazole or Flagyl is used for treating different kinds of infections caused by bacteria and parasites. Therefore, it might have a good effect on patients with Crohn’s disease especially in those patients who have anal fistulae. But one needs to be careful when taking this medication because chronic use (meaning taking more than 1 gram daily) may cause permanent nerve damage. If the person experiences the symptoms of nerve damage or peripheral neuropathy, he must stop taking the medication immediately. Also, taking metronidazole with alcohol can cause headaches, flushing, cramps, severe nausea, and vomiting. Other side effects of this medication include headaches, appetite loss, a metallic taste in the mouth, and nausea.
- Ciprofloxacin or Cipro is an antibiotic which can be used alongside metronidazole.
These types of drugs help reduce the inflammation of tissues in two ways. First, they can decrease the population of the immune cells. Second, they can also interfere with the protein production in the immune system. However, since these medications reduce the activity of the immune system, taking them also increases the risk of developing infections. Still, the benefits of managing moderate or severe Crohn’s disease through such medications still outweigh the risks. Some examples of immuno-modular medications are:
- Azathioprine, Imuran or Azasan are medications which reduce the population of lymphocytes in the immune system. In low doses, this medication is very effective in the treatment of moderate to severe ulcerative colitis and Crohn’s disease. These are very valuable medications especially for patients who don’t respond to corticosteroids or for those who have a corticosteroid dependency. However, these medications aren’t effective in maintaining remissions.
Unfortunately, this medication will increase a person’s susceptibility to infections, liver and pancreatic inflammation, and the toxicity of the bone marrow. Also, this type of medication has a slow onset of action. Typically, a person won’t feel the full benefits of the medication until about 3 months or more have already passed. While waiting for the effects, doctors may prescribe corticosteroids to prevent the inflammation from getting worse.
These are medications which are made to be similar to other drugs which are already approved. Biosimilar medications are tested and made to have similarities with their reference drugs in terms of effectiveness, product safety, and the clinical uses. These biosimilar medications have to meet some certain strict standards for the FDA to approve them. However, these aren’t genetic forms of drugs since generic drugs usually contain the same ingredients as the original drugs. On the other hand, biosimilar drugs are highly-similar to the original drugs but they aren’t identical. Some examples of biosimilar medications are:
- Infliximab-abda or Renflexis which is the biosimilar medication of infliximab or Remicade. This drug is considered as a TNF blocker and it’s mainly used to reduce the symptoms and signs of Crohn’s disease. It’s also effective in inducing as well as maintaining remission in adults and children with moderate to severe Crohn’s disease. This drug is commonly used on people who’ve had an insufficient response to conventional treatment.
This drug can also be used to reduce the number of draining recto-vaginal and enterocutaneous fistulas. It can help maintain the closure of the fistula in patients suffering from fistulizing diseases. Aside from this, the drug can also be effective in the treatment of rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and ulcerative colitis.
Just like any other medication, Renflexis has some common side effects. These include different infections such as sinus infection, upper respiratory infection, urinary tract infection, throat infection, and bronchitis. A person may also experience headaches, abdominal pain, infusion-related reactions, chills or fever, hives, itching, diarrhea, nausea, and many more. The drug also has some serious side effects to look out for. These include liver injury, problems with the blood, allergic reactions, serious infections, psoriasis, heart failure, nervous system disorders, and Lupus-like syndrome.
- Infliximab-dyyb or Inflectra which is the biosimilar medication of infliximab or Remicade. This is a TNF blocker that’s effective in reducing the symptoms of Crohn’s disease. It can also help induce and maintain remission in adults who have moderate to severe Crohn’s. It may also be given to those who have had an inadequate response to traditional treatments.
Inflectra can also be used for reducing the number of draining recto-vaginal and enterocutaneous fistulas while maintaining the closure of the fistula. It can also help reduce the symptoms of Crohn’s disease in younger patients while inducing and maintaining remission. This drug is also effective for the treatment of rheumatoid arthritis, ulcerative colitis, psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis.
Of course, this drug also has some potential side effects. These include bronchitis, respiratory infections, sore throat, sinus infections, stuffy or a runny nose, and a lot more. After taking the medication, the reactions may occur after about 2 hours or so. This also has some severe side effects such as liver injury, disorders of the nervous system, serious infections, allergic reactions, heart failure, psoriasis, and Lupus-like syndrome.
Surgery for Crohn’s Disease
Aside from giving medications to the patient, surgery may also be done as part of the treatment. Still, there’s no type of surgery which will cure the disease. Even if the doctor will remove all the parts of the intestines affected by the disease, the inflammation typically recurs in the healthy intestines. This can happen after months or years of the surgery.
But still, surgery can be part of the treatment. Surgery can be done it remove the diseased part of the person’s small intestine which causes the obstruction. It’s also done in order to drain the pus from peri-rectal and abdominal abscesses. This is also effective as the treatment of severe anal fistulae which don’t respond to medication or drugs. Finally, surgery is also done for re-sectioning internal fistulae which cause infections.
Generally, after the doctor surgically removes the diseased parts of the intestines, the person can enjoy freedom from Crohn’s disease and all its symptoms at least for some time. If the surgery is successful, this may lead to a significant improvement in the person’s quality of life. Unfortunately, in a lot of patients, the disease eventually comes back and starts to affect the healthy intestines. Usually, the recurrent condition is found near the surgical site. As a matter of fact, about half of the people who have undergone surgery can expect the recurrence of the disease and its symptoms within a couple of years. There are some drugs such as 6-MP and Pentasa which have been beneficial in a number of patients in terms of reducing the risk of relapse after the surgery. Also, there is evidence that post-operative therapy which includes medication may delay the recurrence of the disease.
Coping With the Stress Caused by Crohn’s Disease
When a person lives with Crohn’s disease, it can be very stressful. Most people feel that the most stressful part of the disease is the unpredictable and frequently embarrassing symptoms and not the discomfort it brings. Because of this, a lot of people end up feeling angry, frustrated, guilty, resentful or even depressed about their condition. Although these negative feelings are understandable, they can only increase the stress felt by the one suffering from the disease.
If a person wants to reduce the stress he feels, he first needs to manage his expectations. To do this, one needs to understand the reality of Crohn’s disease along with the disease itself. This will help the person accept all the limitations and challenges he will be facing. When a person knows what to expect, it will help reduce the disappointment, frustration, and all the other negative feelings. Here are some tips to help cope with the stress of the disease:
- First of all, learn everything there is about Crohn’s disease and how it will affect the body. Knowing and understanding the symptoms of the disease will allow the person to determine what aggravates those symptoms and what makes them better. Also, acceptance is a huge relief especially for those who don’t know how to manage stress well.
- It’s also very helpful to get involved in terms of managing the disease. If the person takes control, he will be able to manage his disease better. People should partner up with their physicians to make better decisions together in terms of his health and the disease. Ask a lot of questions in order to understand all the benefits and risks of the treatment options available.
- Also, the person must educate his friends and family about the disease and all its limitations. After learning more about the disease, explain to them how it works and how it affects one’s body and life. This will keep one’s friends and family well-informed which, hopefully, will make them more supportive and understanding of the condition.
- Another thing people who suffer from Crohn’s disease can do is seek support from other people. It will be very helpful if the person can communicate his needs openly. Remember that people cannot read minds. So if the person wants to talk about his feelings or ask for help in terms of coping, then he should approach people whom he knows he can count on.
- Although the disease can be frustrating, people who suffer from it should remain active and involved in their lives. It’s a fact that remaining physically active can reduce stress levels. Also, it will be very helpful for the person to remains socially and mentally healthy as well. When the person withdraws from others, this will increase the feeling of isolation along with all the other negative feelings. On the other hand, staying engaged with others will help people feel more “normal.”
- Finally, it’s also important to allow oneself to feel sick. If a person doesn’t feel well enough to perform his daily tasks, he should take a break and resume when he feels better. This can only happen if the person already accepted his condition. Then he will be able to give himself permission to take time off and not be stressed. Remember that Crohn’s disease isn’t predictable so people won’t always know when they will feel sick.
Socializing and Traveling With Crohn’s Disease
When a person suffers from chronic diseases, this means that he has chronic symptoms as well. This also means that the person would have to deal with an aspect of his condition regularly. This is why it’s essential for the people surrounding the patient to understand the disease and what he’s dealing with. The person should also consider informing the people in his workplace about his condition. This is especially true if he would want to keep on working despite the condition.
Just the possibility of Crohn’s disease flares can sometimes hinder people from having an active social life. But this doesn’t have to be the case. People with Crohn’s disease can continue socializing with others as long as they plan their activities ahead of time. Doing this will also help the person feel more comfortable whenever he goes out. Here are some helpful tips for socializing and traveling with Crohn’s disease:
- People should always know what to expect no matter where they will go. Before agreeing to go to an event, it’s important to find out all the details of the venue, how long the event will last, and other relevant information.
- Smoking, taking drugs, and drinking alcohol can have different effects on people with Crohn’s disease. However, all these actions may pose health risks to the liver and GI tract and may also have an effect on the medication the person is taking. So if possible, try to avoid these when going out with family or friends.
- When it comes to relationships, it’s always a good idea to communicate openly. For instance, if a person just started a new relationship and found out that he has Crohn’s disease, the best thing to do is to inform his partner. That way, the person will know whether he can count on his partner for support or not.
- Traveling is also tricky when one has Crohn’s disease but it’s not impossible. Before going on a trip, it’s important to plan well and do a lot of research. This will help make the trips smoother for everyone involved.
- Also, it’s a good idea to talk to the doctor about any travel plans. A doctor may be able to give valuable advice or suggestions on how to handle the disease while on a trip. It would also be smart to bring the doctor’s contact information on the trip. Also, take copies of insurance or healthcare cards just in case.
- The person should also do a lot of research about the destination so he knows what to expect. Learn about the accommodation, activities which can be done, the local cuisine, and more.
- When traveling, it’s also important to bring all the medication needed for treatment. In fact, it’s probably a better idea to bring more medicines just in case. When bringing medication, it’s best to bring them in their original packaging in case there are any questions about the pharmaceuticals. Aside from medications, bring extra tissues as well as other supplies one might need to deal with the disease.
- Finally, the foods one eats during travel should be close to his regular diet at home. One can even bring dry goods and other packable foods which he regularly eats. This will help minimize the risk of consuming something bad while traveling.
You Can Also Help Your Loved Ones Cope With Crohn’s Disease
It’s different when a person sees a loved one suffering from Crohn’s disease. Sometimes, it’s hard to accept that the person doesn’t have any control over the condition of a person he loves. But this doesn’t mean that he can’t do anything to make things easier for the one who has the disease. In fact, people with Crohn’s disease will have to rely on their loved ones more than ever for support, care, and understanding.
Of course, it’s important to respect the privacy of the one with the disease. If the person has some uncomfortable or embarrassing symptoms or has to undergo invasive examinations or tests, don’t push him to talk about them in detail. Instead, be there when he needs to talk and try to understand what he is going through.
To show support, one can offer to go along when the person needs to visit the doctor. Often, doctor visits can be very stressful for people with Crohn’s disease. So being there for them will already be very helpful. It’s also important to be encouraging. Again, there’s no need to push the person to act like nothing’s wrong or to talk about the disease. Just help the person focus on his goals and be there when times get difficult. Remember that actions speak louder than words. People who have chronic diseases such as this one will definitely appreciate it when their loved ones show that they care and that they are genuinely listening to their concerns.