Crohn's disease

Crohn's disease is an inflammatory bowel disease that can affect the entire gastrointestinal tract, but most often the ileum, colon and anal area. While the exact cause was not known, it was thought to be related to over-reaction of the immune system triggered by certain environmental factors such as intestinal bacteria. Genetics may also play a role. The immune system attacks own body’s cells, causing inflammation of the intestine that starts as ulcers in the lining (mucosa) and can extent through the depth of the intestinal wall, leading to fistula. The disease can develop in a skipped manner involving one or multiple parts of the GI tract. It is a chronic condition that may flare up at times, go into remission and come back later, and unfortunately not curable with medication or surgery. Patients with Crohn's disease of the colon or rectum are at higher risk of developing colon or rectal cancer.

Symptoms and diagnosis of Crohn's disease

Common symptoms of Crohn's disease involving the small intestine or colon include abdominal cramping pain, nausea and bloating, loose stool, feeling more tired than usual and weight loss. Those involving the anorectal area often cause anal pain, swelling and drainage due to anal abscess, fistula or fissure. During acute flare (when inflammation is more severe), you may develop fever and more severe abdominal or anal pain. Diagnosis is made based on symptoms and physical exam, and colonoscopic exam findings. Direct visualization of the extent and severity of the inflammation of terminal ileum (last part of small intestine), colon and rectum, along with microscopic exam of biopsy taken during colonoscopy help establish the diagnosis. Additional blood test and often CT scan or MRI may be needed to better define the disease extent and differentiate it from other disease process such as ulcerative colitis.

Treatment of Crohn's disease

Medications with anti-inflammatory and immune-supressing actions are the first line of treatment and is often managed by a gastroenterologist. Medications are meant to control symptoms so patient can function and live a normal life. Diet and lifestyle changes may also help. Surgery may be needed to treat the following Crohn's-related complications:

Perforation causing severe life-threatening infection
Stricture - when intestine is scarred and narrowed, blocking stool passage
Anal abscess or fistula
Colon or rectal cancer

Abdominal surgery typically involves removal of the diseased intestinal segment. Dr. Choi may perform the surgery through laparoscopic (minimally invasive) approach or an open incision. During emergency or when patient is anticipated to have wound healing difficulty due to being severely ill and on maximum dose of immune-supressing medications, a temporary ostomy may be created. For anal abscess and fistula, surgery is meant to drain the abscess to relief the infection and often a seton (a thin rubber tubing) is placed in the fistula tract to promote drainage and prevent abscess from recurring, while medication treatment will control the anal symptoms. An ostomy is sometimes recommmended for patients with severe anorectal Crohn's disease. The necessity, timing and approach of surgery are indivdualized and are determined after a thorough assessment by Dr Choi and discussion with the patient.

Surgery to remove the diseased segment of intestine does not prevent Crohn's from occuring in other area of the GI tract. You have to continue with regular follow-up with your gastroenterologist, who often will recommend you to continue medication treatment indefinitely, and to monitor for recurrence of symptoms.