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Miss sharmila Guptha MBBS MD FRCS - Colorectal Laproscopic Surgery

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Crohn's Disease

Crohn’s disease is a chronic inflammatory disorder causing inflammation of the tissue lining the digestive system presented with characteristic symptoms such as abdominal pain and diarrhea It is one of the condition among “inflammatory bowel diseases”. It most commonly involves the lower part of the small intestine, the ileum and may also be called ileitis or enteritis. It is a hereditary disease and can occur in people of all age groups but is common in younger people between the ages of 20 and 30.

The exact cause for Crohn’s disease is unknown, except for theories that suggest the mechanism of the disease. One of the theories suggests that it is an autoimmune disorder or abnormal functioning of immune system that attacks the normal microbial flora in the intestine and body’s own tissues. As a result of white blood cells (WBCs) get accumulated in the intestinal lining causing chronic inflammation and ulceration. However it is not clear whether autoimmune disorder is a cause or a result of the Crohn’s disease.

The symptoms of Crohn’s disease may be mild to severe, intermittent with a flare-up period. Abdominal cramps usually in the lower right area and frequent loose stools are the common symptoms. Other symptoms include rectal bleeding, loss of appetite, weight loss, fever, pain in the joints, and skin sores or lumps. Children suffering from Crohn’s disease may have a stunted growth.

Physicians diagnose the condition based on careful physical examination and diagnostic tests such as blood tests to check for anemia, WBC count, and stool test to check for blood in the stools (rectal bleeding). Barium enema may be ordered in which patient may be asked to drink barium solution following which X-rays will be taken. The barium is absorbed by the lining of the small intestine and appears white on X-ray, so that any abnormality in the intestine can be identified. Your doctor may also perform a sigmoidoscopy or a colonoscopy test to visualize and examine the intestinal lining to check for any inflammation or bleeding. A biopsy sample tissue may be taken from the intestinal lining for examination under a microscope.

The objectives of treatment for Crohn’s disease are to relieve symptoms of inflammation such as pain, diarrhoea, rectal bleeding and to make up for the nutritional deficiencies. The treatment options include medications, nutritional supplements, and surgery.

Medications: Medications such as anti-inflammatory drugs, corticosteroids, immunomodulators, antibiotics, antidiarrhoeal agents may be prescribed to relieve the symptoms.

Nutrition supplementation: Your doctor may recommend intake of high calorie liquid formula, particularly for children with growth retardation.

Surgery: Surgical treatment is considered as an option if the symptoms do not resolve with medical therapy and if complications such as intestinal blockage, perforation, abscess or bleeding occur. Surgery involves removal of the affected part of the intestine. In conditions where the large intestine is affected, surgical removal of the entire colon is performed by a procedure called colectomy. Because of the tendency to recur even after surgical treatment, the risks and benefits of surgery will be compared with other treatment options before making up the decision for surgery.

In most of the cases, the treatment includes combinatorial approach and for longer periods with regular follow-up visits.

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