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gastroenterology and hepatology illness

Crohn’s Disease

Crohn’s disease is characterized by inflammation in the gastrointestinal tract. It belongs to class of diseases called inflammatory bowel disease. The other illness in this category is ulcerative colitis. Unlike ulcerative colitis, Crohn’s disease is characterized by inflammation occurring throughout the gastrointestinal tract from the mouth down to the anus. Ulcerative colitis on the other hand is associated with inflammation restricted to the colon. Another differentiating factor is the fact that the inflammation and Crohn’s disease is transmural, meaning that it extends from the innermost lining of the bowel called mucosa to the outer most lining of the bowel called serosa. This predisposes patients with Crohn’s disease to certain specific complications like narrowing of the bowel lumen or strictures and/or abnormal connections between loops of bowel called fistulae.

Similar to ulcerative colitis, we believe that Crohn’s disease arises from a combination of genetic factors and environmental triggers. Therefore patients with Crohn’s disease more likely to have a family history of inflammatory bowel disease than healthy controls. Genetic and environmental factors lead to exaggerated mucosal immune response in which the body mounts a self destructive inflammatory response to the lining of the bowel.

Patient’s present with symptoms of abdominal pain, diarrhea, rectal bleeding. Due to the transmural nature of the inflammation in Crohn’s disease, they may also present with bowel obstruction, bowel perforation which leads to abscess formation in the abdomen as well as abnormal connections between bowel loops or between a bowel loop and the surrounding structure like the urinary bladder or vagina. This can lead to symptoms such as recurrent urinary tract infections or passage of stool through the vagina. Crohn’s disease can also present with extra intestinal manifestations such as arthritis, inflammation and scarring of bile ducts, skin and eye manifestations. Long-standing Crohn’s colitis also predisposes to colon cancer which requires periodic surveillance with colonoscopy and biopsies.

Crohn’s disease is diagnosed on clinical grounds supported by the results of cross-sectional imaging studies like CT scan or MRI as well as endoscopic procedures such as an upper gastrointestinal endoscopy or EGD as well as a colonoscopy with ileoscopy which involves intubation of the last part of the small bowel or terminal ileum with the scope.  Biopsies are frequently obtained during endoscopy/colonoscopy which revealed chronic inflammation and ulceration supporting the diagnosis.

There has been an amazing improvement in the management of Crohn’s disease 3 decades with approval of biologic therapy such as infliximab, adalimumab, vedoluzimab and ustikinumab. Thanks to biologic treatment, the incidence of hospitalization for flareup of Crohn’s disease, development of complication of Crohn’s disease requiring surgery and bowel resection have been dramatically reduced.

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