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Gastroenterology and Hepatology

Crohn's Disease

 

Graphic: crohn's disease

  The inflammation of Crohn's disease is nearly always found in the ileocecal region, the last few inches of the small intestine. However, Crohn's disease can occur anywhere along the digestive tract.
   

Crohn's disease is inflammation of the lining of the digestive tract that runs from the mouth to the anus. More commonly, it affects the lower part of the small intestine called the ilium, but it can occur anywhere along the gastrointestinal tract. Crohn's disease is unusual in that affected areas may be separated by segments of healthy tissue. Unlike chronic ulcerative colitis — another inflammatory bowel disease — Crohn's disease can cause inflammation and ulcers deep within the tissue lining. For more information or to schedule an appointment with a Virginia Mason gastroenterologist, call (206) 223-2319.

Signs and Symptoms of Crohn's Disease

Signs and symptoms of Crohn's disease may vary in type and intensity. The most common signs and symptoms are:

  • Diarrhea
  • Abdominal pain
  • Cramps
  • Rectal bleeding
  • Dehydration
  • Anemia
  • Weight loss
  • Malnutrition
  • Fatigue
  • Weakness
  • Constipation
  • Fever
  • Arthritis
  • Inflammation of the bile ducts
  • Skin and eye disorders
  • Brittle bones

Diagnosing Crohn's Disease

Your gastroenterologist may suspect Crohn's disease based on your medical history and a review of your symptoms, and will have you undergo several tests and procedures to help determine a diagnosis. These tests and procedures include:

  • BLOOD TESTS
    Blood tests are taken to determine both red and white blood cell counts. A low red blood cell count can indicate anemia, from bleeding within the digestive tract. Elevated white blood cells, which fight infection, indicate that inflammation is present.
     
  • STOOL SAMPLE
    A stool sample may be taken to rule out an infection.
     
  • SMALL BOWEL ENTEROSCOPY
    Small bowel enteroscopy or double-balloon enteroscopy (DBE) is an endoscopic procedure that uses a long, skinny, flexible tube with a miniature TV camera, to look at the esophagus, stomach and three to six feet of the small intestine. DBE is commonly used to help diagnose obscure gastrointestinal bleeding, inflammatory bowel disease, celiac disease, small bowel tumors, and a hereditary condition called polyposis syndromes.
     
  • COLONOSCOPY
    Your gastroenterologist may have you undergo a colonoscopy procedure using a colonoscope to view the colon and rectum, and may take a tissue sample (biopsy) to help in the diagnosis.
     
  • BARIUM X-RAY
    During this procedure you will drink a chalky substance that coats your throat, stomach and part of the small intestine. The liquid coating allows your gastroenterologist to see, on X-ray, abnormal areas of the upper gastrointestinal tract and small intestine. This procedure is also called a "barium swallow."
     
  • CT SCAN
    In addition to a colonoscopy, a CT scan can determine what areas of the digestive tract are inflamed.

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Treating Crohn's Disease

Medications and, in severe cases, surgery are common treatment for patients with Crohn's disease. Because it is a disorder of the immune system, in which the body attacks cells within the colon, the goals of treatment are to suppress inflammatory episodes (causing the disease to go into remission) and to improve quality of life. Unfortunately, the disease can flare up repeatedly, the reason why treatment is usually life long.

The Digestive Disease Institute at Virginia Mason is at the forefront in immune system research, specifically at Benaroya Research Institute at Virginia Mason, where scientists are unlocking the genetic causes of immune system disorders including rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease.

  • MEDICATIONS
    Prescription anti-inflammatory medications and immune system modulators are two classes of drugs commonly used in treating Crohn's disease and chronic ulcerative colitis. Both classes of drugs have side effects when used long term. Your gastroenterologist will talk to you in more detail about side effects that can develop when taking these medications.
     
    • Anti-inflammatory medications
      These drugs include 5-ASA (5-aminosalicylic acid) — sulfasalazine, olsalazine and mesalamine — that are also prescribed for patients with rheumatoid arthritis, as well as corticosteroids (prednisone).
       
    • Immune modulators
      Immune modulators suppress the body's immune system by interfering with the development of cells and proteins that lead to inflammation. These medications include 6-mercaptopurine (6-MP), azathioprine, cyclosporine and methotrexate.
       
    • Investigational drugs
      Newer medications coming onto the market are available within clinical trials, as are drugs used for other conditions that have been found to be effective against Crohn's disease and chronic ulcerative colitis. The Digestive Disease Institute at Virginia Mason is a leading center for investigational studies using these therapies.
        
  • SURGERY
    Surgery to remove affected areas of the digestive tract or the entire colon may be recommended when medications are no longer effective or when there is severe damage to the intestinal lining from bleeding, abscesses, perforation or blockage. The majority of patients with Crohn's disease — as many as 75 percent — will require surgery at some point in their lives. Your gastroenterologist and surgeon will talk with you in more detail about this treatment option.
     
  • NUTRITIONAL COUNSELING
    Patients with Crohn's disease often are at risk of malnutrition from the loss of nutrients as foods and liquids make their way through the digestive tract. Specialists within the Digestive Disease Institute at Virginia Mason help patients manage all aspects of their care, including nutritionists to help with nutritional needs. A nutritionist also can answer questions about what foods and liquids to avoid, such as milk products, alcoholic beverages, grains, and spicy foods that can make cramping and diarrhea worse when the disease recurs.

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