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Definition |
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Crohn's
disease is an inflammatory bowel disease that is a chronic condition that
may recur at various times over a lifetime. It usually involves the small
intestine, most often the lower part called the ileum. However, in some
cases, both the small and large intestine are affected. Sometimes,
inflammation may also affect the entire digestive tract, including the
mouth, esophagus, stomach, duodenum, appendix, or anus.
Crohn's
disease is also called ileitis or enteritis.
Crohn's
disease affects males and females equally. It appears to run in some
families, with about 20 percent of people with Crohn's disease having a
blood relative with some form of inflammatory bowel disease.
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Causes |
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There are
many theories regarding what causes Crohn's disease. One theory suggests
that some agent, perhaps a virus or a bacterium, affects the body's immune
system and triggers an inflammatory reaction in the intestinal wall.
Although there is a lot of evidence that patients with this disease have
abnormalities of the immune system, it is not known whether the immune
problems are a cause or a result of the disease.
Physicians
believe that there is little proof that Crohn's disease is caused by
emotional distress or by an unhappy childhood.
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Symptoms |
The
following are the most common symptoms of Crohn's disease. However, each
individual may experience symptoms differently. Symptoms may include:
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abdominal pain, often in
the lower right area
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diarrhea
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rectal bleeding
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weight loss
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fever
Some
people have long periods of remission, sometimes for years, when they are
free of symptoms. There is no way to predict when a remission may occur or
when symptoms will return.
The
symptoms of Crohn's disease may resemble other medical conditions or
problems. Always consult your physician for a diagnosis.
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Diagnosis |
People who
have experienced chronic abdominal pain, diarrhea, fever, weight loss, and
anemia may be examined for signs of Crohn's disease. In addition to a
complete medical history and physical examination, diagnostic procedures for
Crohn's disease may include the following:
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blood tests
(to determine if there is anemia resulting from blood loss, or if there is
an increased number of white blood cells, suggesting an inflammatory
process)
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stool culture
- checks for the presence of abnormal bacteria in the digestive tract that
may cause diarrhea and other problems. A small sample of stool is collected
and sent to a laboratory by your physician's office. In two or three days,
the test will show whether abnormal bacteria are present; to determine if
there is blood loss, or if an infection by a parasite or bacteria is
causing the symptoms.
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esophagogastroduodenoscopy (Also called EGD or upper endoscopy.)
An EGD
(upper endoscopy) is a procedure that allows the physician to examine the
inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted
tube, called an endoscope, is guided into the mouth and throat, then into
the esophagus, stomach, and duodenum. The endoscope allows the physician to
view the inside of this area of the body, as well as to insert instruments
through a scope for the removal of a sample of tissue for biopsy (if
necessary).



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biopsy
- a procedure performed to remove tissue or cells from the lining of the
colon for examination under a microscope.
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upper GI
(gastrointestinal) series (Also called barium swallow.)
- a diagnostic test that examines the organs of the upper part of the
digestive system: the esophagus, stomach, and duodenum (the first section
of the small intestine). A fluid called barium (a metallic, chemical,
chalky, liquid used to coat the inside of organs so that they will show up
on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive
organs.
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lower GI
(gastrointestinal) series (Also called barium enema.)
- a procedure that examines the rectum, the large intestine, and the lower
part of the small intestine. A fluid called barium (a metallic, chemical,
chalky, liquid used to coat the inside of organs so that they will show up
on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen
shows strictures (narrowed areas), obstructions (blockages), and other
problems.
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colonoscopy
- a procedure that allows the physician to view the entire length of the
large intestine, and can often help identify abnormal growths, inflamed
tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long,
flexible, lighted tube, in through the rectum up into the colon. The
colonoscope allows the physician to see the lining of the colon, remove
tissue for further examination, and possibly treat some problems that are
discovered.


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Treatment |
Specific
treatment for Crohn's disease will be determined by your physician based on:
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your age, overall health,
and medical history
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extent of the disease
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your tolerance for
specific medications, procedures, or therapies
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expectations for the
course of the disease
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your opinion or
preference
At this time there is no cure for Crohn's disease, however,
several methods are helpful in controlling it. The usual goals of treatment
are to:
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correct nutritional
deficiencies.
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control inflammation.
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relieve abdominal pain,
diarrhea, and rectal bleeding.
Treatment may include:
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medication
Abdominal cramps and diarrhea may be helped by medications, which often
lessen the inflammation in the colon. More serious cases may require
steroid medications, antibiotics, or medications that affect the body's
immune system.
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diet and supplements
No special diet has been proven effective for preventing or treating
Crohn's disease. Some symptoms are made worse by milk, alcohol, hot spices,
or fiber, but this may not be true for everyone. Large doses of vitamins
are useless and may even cause harmful side effects.
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supplements
Nutritional supplements or special high-calorie liquid formulas may
sometimes be suggested, especially for children with delayed growth.
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feeding through a vein
A small number of patients, who temporarily need extra nutrition, may need
periods of feeding by vein (intravenously).
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surgery
Crohn's
disease may be helped by surgery, but it cannot be cured by surgery. The
inflammation tends to return to the areas of the intestine next to the area
that has been removed. Surgery may help to either relieve chronic symptoms
of active disease that does not respond to medical therapy or to correct
complications, such as intestinal blockage, perforation, abscess, or
bleeding.
Types of surgery may include:
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drainage of abscesses or
removal of a section of bowel
(due to blockage, resulting in a shortened bowel)
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ostomy
Some
people must have part of their intestines removed, and a new method of
removing the stool from the body is created. The surgery to create the new
opening is called ostomy, and the new opening is called a stoma.

Different
types of ostomy are performed depending on how much and what part of the
intestines are removed, and may include the following:
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ileostomy
- the colon and rectum are removed and the bottom part of the small
intestine (ileum) is attached to the stoma.
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colostomy
- the rectum is removed and the colon is attached to the stoma. Sometimes,
a temporary colostomy may be performed when part of the colon has been
removed and the rest of the colon needs to heal.
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ileoanal reservoir
surgery
- an alternative to a permanent ileostomy, this procedure is completed in
two surgeries. First, the colon and rectum are removed and a temporary
ileostomy is performed. Second, the ileostomy is closed and part of the
small intestine is used to create an internal pouch to hold stool. This
pouch is attached to the anus. The muscle of the rectum is left in place,
so the stool in the pouch does not leak out of the anus. People who have
this surgery are able to control their bowel movements.
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More Resources |
National Institutes of Health
http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ |
VCU Health System
http://www.vcuhealth.org/content.asp?pageid=P00390 |
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