Crohn's Disease

Crohn’s disease is named for Burrill Crohn, the gastroenterologist who first described it in 1932. Crohn’s disease is a recurring inflammatory disease of the gastrointestinal (GI) tract, similar to ulcerative colitis. Crohn’s disease most commonly occurs in the ileum (the lower part of the small intestine) and the colon (large intestine), but it can occur anywhere in the GI tract from the mouth to anus. 

Approximately 20 percent of all Crohn’s cases affect children and it can affect children as young as age 1. 

Did You Know?

Crohn’s disease is usually found in school-aged children and teenagers, but it can occur in people in their early 20s and 30s as well; the majority of individuals are diagnosed by age 30.

Symptoms

The symptoms of Crohn’s disease vary greatly from person to person. Some individuals will experience only mild symptoms while others may have severe symptoms or complications.

Some symptoms may include:

  • Diarrhea
  • Cramps/abdominal pain
  • Fever
  • Rectal bleeding
  • Loss of appetite
  • Loss of energy (fatigue)
  • Weight loss
  • Anemia
  • Poor growth
  • Constipation
  • Skin tags in the rectal area that may resemble hemorrhoids
  • Abscesses (pockets of pus) in the bottom (perianal) area

In mild forms, Crohn’s disease causes small erosions, called ulcers, along the GI tract. In more severe cases, deeper and larger ulcers form. These larger ulcers can stiffen in the bowels and cause obstruction (called strictures), or puncture the bowel walls, causing infection in the abdominal cavity and adjacent organs (called fistula).

Also, in more severe cases, this condition can involve other organs in the body, most commonly the joints (i.e. knees, ankles and wrists), the liver and the skin. The same type of inflammation that is seen in the GI tract can be observed in these other organs.

Causes

While the specific cause of Crohn’s disease is unknown, it has been suggested that the following factors may increase your risk of developing Crohn’s disease:

  • Heredity: having an immediate member of your family (such as a parent or sibling) with Crohn’s disease or ulcerative colitis increases the risk
  • Environmental factors: antigens in your environment may cause the inflammation
  • Immune system: your child’s immune system may overreact to normal intestinal bacteria causing the inflammation

How is Crohn’s Disease Diagnosed?

Crohn’s disease is diagnosed through a complete patient medical history, physical exam as well as diagnostic procedures which may include:

  • X-rays of the upper and lower GI
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Endoscopy: a lighted, flexible instrument (containing a computer chip and camera that is attached to a TV monitor) examines the upper or lower GI tract for any condition that can cause symptoms (see illustration below)
  • Colonoscopy: long, flexible instrument (containing a light and camera) examines the inside of the large intestine
  • Blood tests to check for anemia, signs of inflammation, general state of nutrition
  • Stool analysis to look for blood, signs of bacterial infection, malabsorption, parasites or the presence of white blood cells

Treatment

While there is no cure currently available, the symptoms of Crohn’s disease can usually be controlled with medication. Medications used to treat Crohn’s disease are directed at quieting the immune system in the GI tract.

Medications

  • Steroids: Most commonly used for patients with moderate to severe IBD(Example includes: prednisone)
  • 5-Aminosalicylic Acid (5-ASA): These medications have been widely used for IBD patients to decrease inflammation in the bowel. They have been effective in triggering and maintaining disease remission. (Examples include: sulfasalazine, asacol)
  • 6-Mercaptopurine (6-MP): This medication is given to those individuals who do not respond to or are unable take the 5-ASA or steroid medications. It directly inhibits the immune system that causes the intestinal damage of IBD.

Surgery

Surgery may be needed if a child’s medication is ineffective; a child has severe side effects from the medication; or a child develops complications such as fistulas, abscesses or bowl obstructions.

Surgery may help to correct complications and improve a child’s well-being and quality of life, but Crohn’s disease cannot be cured so the patient must be prepared in case the disease returns.