Crohns Disease

Introduction

Crohn's disease is a common condition of the intestines (bowels) that affects approximately 600,000 people in the United States. Crohn's usually affects young adults (patients in their 20's and 30's) but can affect children and older adults as well. The cause of Crohn's disease is not known; however most experts agree that genetics (traits passed on from your parents), the environment, and the patient's immune system (cells that fight off infection) play an important role in the disease. Common symptoms of Crohn's disease include:

  • Diarrhea

  • Abdominal pain

  • Fistulas (tunnels from the bowel to skin surfaces)

  • Visual problems (blurred vision, red eyes or painful vision)

  • Joint pain or swelling

  • Skin rashes

  • Liver problems

Unfortunately, there is not a cure for Crohn's disease and patients must deal with the illness for their entire lifetime. Patients typically will have periods of active symptoms ("flares") followed by symptom-free periods ("remission"). The symptoms can have a negative impact on quality of life for patients. However, most patients continue to work and have productive lives.

Diagnosis

Medical illustration of a colonoscopy

Many different tests are used to diagnosis patients with Crohn's disease. Although blood tests are usually ordered, these are not unable to diagnosis Crohn's disease without further confirmatory testing. Blood tests often reveal that inflammation is present in the body. Frequently, patients can have low blood counts ("anemia") because of Crohn's disease. Some special blood tests are now offered that can help make an accurate diagnosis. A colonoscopy is required to help confirm the diagnosis of Crohn's disease.

A colonoscopy is a procedure performed when the patient is sedated that allows the doctor to view the entire colon and a portion of the small bowel called the ileum. Most patients with Crohn's disease will have abnormalities in the intestinal lining that can be seen during colonoscopy. Biopsies of the abnormal areas confirm the diagnosis of Crohn's disease. Other tests that can be used to diagnosis Crohn's disease or to look for complications of the disease (blockages, area of infections) include: upper endoscopy (EGD), upper GI series and small bowel follow through (X-ray test of intestines), CT (CAT) scan, barium enema, MRI, and capsule endoscopy.

Therapy

Current therapies to treat patients with Crohn's disease include aminosalicylates ("5-ASA"), steroids, immune suppressants, and biologic therapy (medications that block specific inflammatory molecules important in Crohn's disease). For some of these drugs, treatments are available in pill form, enemas, injections under the skin, and intravenous infusions. Although medical treatment can be effective in controlling the symptoms of Crohn's disease, patients must take medications continuously to prevent the symptoms from returning.

Patients typically receive drugs based on a pyramid or "Step up" approach. For example, if patients have mild symptoms, they receive less powerful therapies lower in the pyramid with fewer side effects. However, as symptoms worsen or if patients are sicker when diagnosed, they receive more aggressive therapies higher in the pyramid. Some experts are using more aggressive therapies earlier in the course of disease.

Despite medical therapy, up to 80 percent of patients will have surgery during their lifetime. Although surgery usually relieves symptoms of Crohn's disease, it does not offer a cure. One-third of patients require repeat operations without medical therapy. There have been many advances in surgery for Crohn's disease. One is the use of bowel-saving techniques such as stricturoplasty (repair of disease segments instead of removal) and minimally invasive surgery (laparoscopy).

Crohn's Disease Treatment Pyramid. Patients with mild disease enter the treatment pyramid at the bottom and receive medications appropriate for the level of disease severity.

Medical illustration of crohns disease treatment pyramid

Reasons to Consider the University of Maryland Medical Center for Treatment

Most gastroenterologists and surgeons can provide care for patients with Crohn's disease. However, the University of Maryland Inflammatory Bowel Disease Program has several unique aspects that set it apart from providers caring for patients with Crohn's disease:

  • Physician Expertise: Physicians and nurses have a focus and commitment to the care of patients with Crohn's disease. They have vast experience in diagnosing and treating this disorder.

  • Multidisciplinary Care: Because of the complexity of the disease, patients with Crohn's disease often require care from multiple providers. Patients in our program are able to see a gastroenterologist and surgeon at the same clinic site, often at the same visit when appropriate. In addition, the Digestive Health Center has nutrition services that will allow patients with Crohn's disease to have a complete nutrition evaluation at the initial visit. Other resources such as imaging, endoscopy, pathology, ostomy team and consult services are available at the University of Maryland Medical Center.

  • Timely Service: Our physicians strive to see all new patients within two weeks of the referral and to communicate our recommendations to referring physicians within one week of the office visit.

  • Patient Advocacy: Our physicians design treatment plans after extensive discussions with patients to ensure that their concerns are being met. We encourage an ongoing dialogue with our patients throughout the treatment process so that patients are actively involved in their care.

For more information about our services or treatment options or to refer a patient to the IBD Program, please call 410-706-3387.

This page was last updated: April 23, 2013

         
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