Crohn’s Disease

Happy Monday, and welcome to Medical Mondays! May 19th is World IBD Day, so I decided to choose one of em’ and will be talking about Crohn’s Disease today!

Crohn’s Disease (CD) is an idiopathic inflammatory disorder that can affect any part of the GI tract from the mouth to the rectum, and results in relapsing + remitting episodes of abdominal pain + diarrhea.

CD is thought to be due to a dysregulated proinflammatory response to the bacteria that lines the walls of the GI tract, which results in the release of inflammatory substances that injure the mucosa.

There is a bimodal distribution with Crohn’s, with the first peak of occurrence between ages 15-30 and a second peak between 60-70. It is more prevalent in females and Caucasians.

Clinical Presentation

• “Crampy” abdominal pain
• Diarrhea
• Fatigue/Anemia
• Fever
• Abdominal masses
• Weight loss
• Growth failure (specific to children; refers to a vertical growth rate that’s below the appropriate velocity for their age)

When it affects the colon, it can be difficult to distinguish it from ulcerative colitis (UC). Like UC, Crohn’s can also present with extraintestinal manifestations–for instance:

• Ankylosing spondylitis (arthritis of the spine)
• Uveitis
• Pyoderma gangrenosum
• Erythema nodosum
• Calcium oxalate kidney stones due to increased oxalate absorption
• Gallstones with terminal ileum movement due to decreased bile acid absorption

Diagnosis

Acute phase reactants (e.g. C-reactive protein level + erythrocyte sedimentation rate) are often elevated with inflammation. Folate, albumin, vitamin D + vitamin B12 levels can help to assess nutritional status.

The best tool for initial diagnosis is endoscopy with mucosal biopsy of the small intestine and colon, which will reveal “skip lesions” (skipped areas of inflammation), mucosal cobblestoning, strictures, and pseudopolyps. It will also reveal transmural inflammation and granulomas, which help to distinguish it from ulcerative colitis.

Barium enema + small bowel follow-through (where the patient swallows contrast while images are taken throughout the GI tract) can also aid in the diagnosis of Crohn’s.

Complications

Surgical intervention is recommended if any of the following present:

• Intestinal perforation
• Abscess
• Stricture formation (narrowing of the intestinal lumen, which can lead to bowel obstruction)
• Obstruction
• Fistula formation
• Toxic megacolon
• Development of cancer in areas of inflammation (e.g. colon)

Treatment

Mild to moderate CD can be treated with medications like 5-ASA (5-aminosalicyclic acid/mesalamine).

Severe CD is treated with steroids + DNA synthesis inhibitors (e.g. azathioprine or 6-mercaptopurine) and methotrexate.

Infliximab (Remicade) and Adalimumab (Humira) are monoclonal antibodies that act against TNF-alpha, which is involved in systemic inflammation + stimulation of the acute phase reaction. These biologic therapies can be used in “moderate to high-risk patients,” which are defined as follows:

• Age at initial diagnosis < 30yo
• Extensive anatomic involvement
• Perianal +/or severe rectal disease
• Deep ulcers
• Prior surgical resection
• Stricturing +/or penetrating behavior

For a personal account from a super badass living and kickin’ butt with Crohn’s, check out one of my favorite bloggers–Susie @ SuzLyfe! She also shared her top 5 related health concerns, which you can read about here.

Wanna help raise awareness? Join in on Get Your Guts In Gear and help raise awareness of Crohn’s disease, ulcerative colitis + related conditions through multi-day cycling events that benefit IBD organizations + patient advocacy groups!

• June 13-14, 2015: The Hudson River Valley, New York
• August 15-16, 2015: The Ohio Ride: Sandusky, Ohio

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Disclaimer: This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. Information for this post was gleaned from AAFP journal articles, UpToDate + other med school resources. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)