Crohn’s Disease

What is Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract from mouth to anus. Crohn’s Disease can cause inflammation in any part of digestive tract. This often leads to stomach pain, fatigue, diarrhea, constipation, weight loss, rectal bleeding, and more (1).

There’s a lot of information in this article. Here’s a quick table of contents to help you get around:

• What Causes Crohn’s Disease?
• Is Crohn’s Disease Autoimmune?
• Signs and Symptoms
• How Crohn’s Disease is Diagnosed
• Lab Tests to Determine Crohn’s
• Finding the Right Doctor
• Questions to Ask Before Choosing a Doctor
• Ongoing Questions for Your Doctor
• Is Crohn’s Disease Curable?
• Treatment Options and Support
• Crohn’s vs. Ulcerative Colitis

What Causes Crohn’s Disease?

Currently, there is no single known cause for Crohn’s Disease. However, scientists believe that Crohn’s disease is caused by a combination of these factors…

• Immune system problems
• Genetics
• Environmental factors

Is Crohn’s Disease Autoimmune?

Yes, Crohn’s Disease is autoimmune. For some reason, the immune system in those with Crohn’s disease reacts inappropriately. This causes it to attack its own healthy tissues, causing inflammation and damage to the digestive tract. This often effects other areas of the body called “extraintestinal manifestations.”

Common Symptoms

Here is a list of common symptoms associated with this disease. But, this does not mean that you will have all of these (1).

• Diarrhea
• Constipation (in rare cases or if strictures have developed)
• Abdominal cramping and pain
• Fatigue
• Very frequent bowel movements
• Blood in stool
• Fistulas
• Strictures
• Reduced appetite
• Anemia
• Fever
• Blockages
• Mouth ulcers or canker sores
• Rectal Pain

Extra-intestinal Manifestations:

Here are some manifestations that may occur outside of the intestines due to Crohn’s Disease (2).

• Eye Problems – Episcleritis, Scleritis, and Uveitis
• Joint pain
• Headaches
• Skin Issues – Erythema Nodosum, Sweet’s Syndrome, Pyoderma Grangrenosum, etc.
• Bone Issues – thinning and weakening bones
• Kidney Stones or inflammation of the kidneys
• Liver Complications – gallstones, Primary Sclerosing Cholangitis
• Risk of Blood Clots
• Anemia

How Crohn’s Disease is Diagnosed

Unfortunately, there is no single test to determine if a patient has Crohn’s disease. Your doctor will likely use a variety of tests to determine if you have Crohn’s disease.

• Endoscopies and Colonoscopies: An endoscopy is a procedure where your doctor will insert an endoscope (a small tube with an attached camera) through the mouth. This helps provide a clear view of your upper GI tract, and parts of the small intestine. A colonoscopy, on the other hand, is a procedure where a colonoscope is inserted through the anus to view the large intestine. Both procedures are methods used to detect and view inflammation and abnormalities in the intestines that may indicate IBD. Biopsies may be taken in either procedure for more in depth analysis (3).
• Small Intestine Imaging: Small intestine imaging may take place via X-ray, CT scans, or MRI’s. An oral contrast is drank prior to these imaging tests in order to allow for visibility of the intestines.
• Capsule Endoscopy or “PillCams”: A capsule endoscopy or “pillcam” is a procedure in which patients swallow a pill-sized camera. The pillcam captures images of the bowel and small intestine as it moves through the GI tract. This can aid in the diagnosis of Crohn’s Disease. It an also be used to detect inflammation and abnormalities in those who already have a diagnosis (4).
• Blood Tests: There is a chart here that explains the benefit of various types of blood tests (and whether they are used in clinical practice). This article from the US National Library of Medicine is a good one to consider; albeit quite scientific.

Possible Lab Tests to Determine Diagnosis:

• Blood Tests: Your doctor may suggest an anemia blood tests to determine if you have enough red blood cells to carry oxygen adequately.
• Stool Tests: In addition, you may need to provide a stool test so you doctor can look for hidden blood or other issues in your stool.

Finding the Right Doctor:

There are differences between a Gastoenterologist and an IBD-specialist. Be sure to use the Crohn’s and Colitis Specialist Search found here and use other online doctor review sites. 

Questions to Ask Before Choosing Your Doctor:

These are a few questions to ask when you establish a new doctor to support your Crohn’s Disease:

• How quickly can I be seen in an emergency?
• Will diet aid in healing? (This is a good way to ask without making them feel threatened. If the answer is no…run!) 
• How do I contact the office if I’m having problems or complications? (Do they have an online portal for quick communication?)
• Do you offer alternative methods of healing alongside medicine? (Dietary and supplemental approaches to correct deficiencies, alongside more extensive blood work)
• How often do you take labs, and what will you be testing for? (Many medications require testing, and many doctors do not keep up with this. It is good to know the doctor’s approach to this, and compare to the medication’s suggestions. Remember: A proactive doctor is a good doctor. You want one who will work to manage your condition, not just put a band-aid over symptoms). 
• What is your philosophy on colonoscopies? (Routine, or when symptomatic? *compare this to your philosophy)  -Do you believe in a bottom-up or top-down approach? *insurance may play a huge part in this, as well as the severity of your condition

On-going Questions for your Doctor:

Once you have established the best Crohn’s Disease doctor for you, here are some questions you will want to ask on-going:

• Do you offer pre-treatment for infusions? (to prevent reactions)
• How often do you take labs, and what will you be testing for? *When being placed on a new medication (Many medications require testing, and many doctors do not keep up with this. It is good to know the doctor’s approach to this, and compare to the medication’s suggestions). 
• Are there certain patients who can eventually be medication free, or do you continue medication for precaution? *This may depend on the severity of your condition upon diagnosis. Keep an open dialogue with your doctor to come up with a plan that you both feel comfortable with.

Is Crohn’s Disease Curable?

Unfortunately no, Crohn’s Disease is not curable. However, there are many treatments that can provide patients with a high quality of life, and many consecutive years of remission. Some of these treatments include dietary changes.

Treatment of Crohn’s Disease

There is no single treatment for Crohn’s Disease. The best course of treatment will vary from patient-to-patient. You should work with your gastroenterologist in order to establish a the best treatment plan for you. We also recommend working with a functional specialist alongside your gastroenterologist. This will help establish a healthcare team that prioritizes treatment from a holistic perspective (find a functional specialist practitioner here).

Crohn’s Disease Diet

We believe that there is no diet that is right for everyone. Each individual’s body reacts differently to food, and nutrition sources. Many people thrive off just eating a “clean” diet, while others need more specific diets.

However, many patients with Crohn’s Disease have found that the SCD is a helpful diet to begin eliminating foods to determine the root cause. In its essence, the SCD Diet is an elimination diet. There is an “Intro” stage, and then 5 more stages to follow in which you should monitor your body’s reactions to each new food reintroduction. Here is an easy breakdown of these stages.

Crohn’s Disease Medication

Everything from anti-inflammatory drugs, to immune suppressants, to biologics are given to Crohn’s Disease patients. Medications vary widely, and you should receive your recommendation by a licensed physician. However, like mentioned above, we recommend that you work with a functional specialist alongside your gastroenterologist. This will help to create a treatment plan using the least invasive drugs for your condition.

Here are some of the most common medications used to treat/manage CD, but all treatments depend on severity of the condition (5):

• Steroids – Prednisone and Budesonide
• Oral 5-aminosalicylates – Mesalamine and Sulfasalazine
• Immune Systems Suppressors – Azathioprine, Mercaptopurine, and Methotrexate
• Biologics – Natalizumab, Vedolizumab, Infliximab, adalimumab, certolizumab pegol, and Ustekinumab
• Antibiotics
• Anti-Diarrheals
• Pain Relievers

Additional support supplements include:

• Multi-vitamin (due to absorption issues)
• Calcium (most CD patients cannot tolerate dairy, so adequate Calcium intake is important)
• Vitamin D (many CD patients are severely vitamin D deficient, contributing to fatigue symptoms. Vitamin D has also been proven to anti-inflammatory properties).
• Turmeric/Curcumin (clinically proven to have anti-inflammatory properties. Most manufacturers include black pepper to assist with absorption. However, black pepper is a gut irritant and should be avoided in CD patients. Instead, take on an empty stomach to improve bioavailability.)
• Vitamin B12 (may also help with fatigue, but users should have their levels checked before started any new regimen)

Additional Stress Reliever Support:

Here are some great stress relievers that are helpful for Crohn’s disease diagnosis:

• Journaling
• Yoga
• Prayer/Devotions
• Meditation
• Supplements such as: Gaba, Ashwagandha, 5HTP, Fish Oil (Be sure to use the correct DHA to EPA.
• Exercise (For example, low weights, walking, hiking, biking.)
• Infrared Sauna
• Support Groups: Information on how to find them in your area, how to connect with other CD patients, CCFA groups, MeetUp.com, etc.

Crohn’s Disease vs Ulcerative Colitis

The difference between Crohn’s Diseae vs Ulcerative Colitis, is that ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

You can learn more about Ulcerative Colitis here.

Get your Questions Answered about Crohn’s Disease

References

(1) https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304

(2) http://www.ibdclinic.ca/what-is-ibd/complications/

(3) https://www.crohnscolitisfoundation.org/what-is-crohns-disease/diagnosis-testing

(4) https://www.ibdrelief.com/learn/diagnosis/tests/endoscopy-tests-for-ibd/capsule-endoscopy-for-crohns-disease

(5) https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309