Center for Digestive Diseases

UNM Hospitals Center
for Digestive Diseases

Address:
1001 Martin Luther King Ave. NE
Albuquerque, New Mexico 87106

Appointments:
(505)272-2530 or
(505)925-6000

Facsimile:
UNMH: (505)272-6839
CDD: (505)925-7849

Crohn?s Disease


What is Crohn’s disease?

Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract (GI tract).  In this disease inflammation (swelling and irritation) typically involves the last portion of the small intestine, called the ileum.  However, inflammation can occur anywhere within the GI tract, including the stomach, other parts of the small intestine or colon.  Chronic inflammation can eventually cause scarring that results in narrowing (called strictures).  Abscess formation or fistula (communications between the intestine and other organs) can also occur.


What are the symptoms of Crohn’s disease?

Patients with Crohn’s disease frequently develop chronic diarrhea and chronic abdominal pain.  Pain is frequently located in the right lower abdomen at the site of the terminal ileum (the last portion of the small intestine). Other symptoms can include fevers, chills, rectal bleeding, anemia, nausea or vomiting.


What are the complications of Crohn’s disease?

Some patients with Crohn’s disease may develop abscess, stricture or fistula.  Abscess is a localized collection of infection in the abdomen.  Patients with abscess usually develop increased abdominal pain and fevers.  This is typically treated with antibiotics and placement of a drain or surgery.  Stricture is a narrowing of the intestine that can occur as a result of chronic inflammation.  Stricturing typically occurs in the last portion of the small intestine (the terminal ileum) and patients often develop nausea and vomiting, abdominal distention and lack of appetite. Fistula is a (communication between the large or small intestine and the skin or bladder).  Fistula may develop in the area around the anus and patients may notice seapage of fluid from near the anus as a result. Fistula between the intestine and the bladder may cause recurrent urinary tract infections. Fistula may develop between the small intestine and the large intestine and this may result in increased diarrhea.  Prevention of complications of Crohn’s disease is a major goal in the treatment approach. Strict adherence to a medical regimen is vital in the prevention of these complications.


What causes Crohn’s disease?

The underlying cause of Crohn’s disease is still not known. Crohn’s disease involves several factors: inherited genes, the immune system, and the environment.  Crohn’s disease is likely the result of an abnormal reaction by the body’s immune system to bacteria, foods, and other substances that are actually harmless or beneficial. During this process, white blood cells accumulate in the lining of the intestines, producing chronic inflammation, which leads to ulcers, swelling, narrowing and bleeding. High levels of a protein produced by the immune system, called tumor necrosis factor (TNF), are present in people with Crohn’s disease and several effective treatments are directed at decreasing the levels of TNF.


How is Crohn’s disease diagnosed?

A careful history and physical examination by a doctor is the first step in evaluating a person for suspected Crohn’s disease. Blood tests, X-ray tests (CT scan and/or small bowel follow through), colonoscopy and upper endoscopy can often identify signs of chronic inflammation such as ulcers, swelling, bleeding and narrowing.


What is the treatment for Crohn’s disease?

Treatment may include medications and/or surgery.  The specific treatment depends on the location and severity of Crohn’s disease. Medications used in Crohn’s disease include anti-inflammation medications, steroids, immune modulators, biologics, antibiotics and antidiarrheal medications. 

Anti-inflammation medications: These medications are occasionally used in cases of mild inflammation of the small intestine or colon. Examples of these medications include: sulfasalazine, mesalamine, Asacol, Pentasa, Lialda, Apriso, Olsalazine, balsalazide.

Steroids: These potent medications decrease inflammation in the small and large intestine.  Examples of commonly used steroids include prednisone, budesonide (entocort) and solu-medrol.  These medications are frequently used initially during periods of moderate or severe inflammation.  Patients are typically started on large doses and have improvement in their symptoms fairly quickly and then the dose is slowly decreased over a few months.  Due to significant long-term side effects of infections, diabetes, bone thinning and fracture and weight gain these medications should not be used long-term.

Immune modulators: These are medications that suppress the immune system and thereby decrease inflammation. Examples of these medications include azathioprine and 6-mercaptopurine (6-MP).  These medications are slower to act, taking up to 3-4 months to be fully active. Therefore, steroids are often used in the short-term until these medications become effective.  Side effects of these medications include nausea, vomiting, risk of infection, pancreatitis, hepatitis and rare instances of lymphoma.

Biological therapies: These are medications that decrease or prevent inflammation by binding to a protein produced by the immune system, called tumor necrosis factor (TNF).  Examples of these medications include infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia). These medications are given either at an infusion center through the vein or as an injection into the skin at home. Possible side effects of these medications include infusion reactions, rash and rare infections.


For more information about crohn's disease please visit: http://www.ccfa.org/