What is Crohn’s disease?
Crohn’s is a disorder of chronic intestinal inflammation. Although it can affect any part of the GI tract from the esophagus to the colon, the most commonly affected areas include the ileum (last segment of the small intestine) and the colon. In fact, most patients will present either with ileal disease, colonic disease or ileo-colonic disease.
What are symptoms of Crohn’s disease?
Crohn’s can present with several symptoms. While the most common symptom is chronic diarrhea, other symptoms can include bloody stool, fatigue, weight loss, abdominal pain (specifically in the right lower abdomen), vitamin deficiencies, nutritional deficiencies, weight loss, growth failure, and sweating at night.
When should I see a doctor for Crohn’s disease?
You should seek medical attention if you are concerned that you have developed symptoms of Crohn’s disease and want to discuss them with a gastroenterologist. Although Crohn’s can present with many different symptoms, these symptoms (diarrhea, abdominal pain, weight loss) are not limited to the diagnosis of Crohn’s disease and may be due to another disease process.
You should also consider seeing a gastroenterologist if you already have a diagnosis of Crohns and you have uncontrolled symptoms, such as chronic diarrhea, chronic abdominal pain, fatigue, nutritional deficiencies, vitamin deficiencies, etc.
How does a gastroenterologist diagnose Crohn’s disease?
There is not one single test that solidifies a diagnosis of Crohn’s disease, but instead, the diagnosis comes together by evaluating multiple pieces of information together as a whole. The evaluation first starts with a careful review of a patient’s symptoms, such as diarrhea, abdominal pain, weight, nausea, etc. This initial office visit also includes reviewing any previous information, such as lab work, stool studies or CT scans.
If no lab work, stool studies or imaging has already been obtained, then you will likely need basic lab work and imaging such as an abdominal x-ray or a CT of your abdomen. Colonoscopy with examination of the terminal ileum (last part of the small intestine) is also a vital part of evaluating a patient for Crohn’s, as Crohn’s exhibits inflammation within the intestine, and is most likely to involve the colon or the ileum.
What are treatments for Crohn’s disease?
There are several different treatment options for Crohn’s disease. Choosing the correct treatment first depends on making the diagnosis of Crohn’s, then evaluating the severity of the inflammation and disease state. More milder cases of Crohn’s disease can be treated with milder drugs, such as budesonide or sulfasalazine.
Other patients may require more intensive therapy with a drug classed called immune-modulators, that includes azathioprine (Imuran), 6-mercaptopurine, and methotrexate. Patients with moderate to severe disease benefit most from a drug class called biologics, and these drugs include infliximab (remicade), adalimumab (humira), certolizumab (cimzia), ustekinumab (stelara), and vedolizumab (entyvio). Often, we will combine an immune-modulator with a biologic in order to boost a patient’s response to a biologic.
If symptoms are unable to be controlled by medications or if a patient has developed a complication related to Crohn’s (such as a stricture, abdominal abscess, or fistula (abnormal connection between the bowel and surrounding organs), then a patient may require surgery.
Thoroughly evaluating a patient and choosing their best treatment option is our goal for you.