Crohn’s disease is a form of inflammatory bowel disease (IBD) that causes visible manifestations of inflammation in the digestive tract, including ulceration and bleeding in the lining, as well as thickening and narrowing in some parts of the bowels. Crohn’s can affect any part of the GI tract but occurs mostly in the small intestine and may lead to more serious conditions such as cancer or bowel obstruction, which sometimes requires surgical intervention.
Although Crohn’s disease is a distinct clinical condition, it is also categorized as an autoimmune disease, where the body reacts to an unknown stimulus and attacks its healthy tissue. Many patients with Crohn’s have a concomitant (or associated) autoimmune disorder like thyroid or celiac disease.
With Crohn’s disease, the lag between initial symptoms and diagnosis can be years, and bloating is often one of the early symptoms. Other symptoms of Crohn’s disease include:
- Bacterial imbalance
- Bowel obstruction
- Eye inflammation
- Joint pain
- Mouth ulcers
- Lactose intolerance
- Skin nodules (pyoderma gangrenosum and erythema nodosum)
- Vomiting after meals
- Weight loss
The cause of autoimmune diseases like Crohn’s is unknown, yet emerging evidence suggests that gut bacteria play a major role; lack of exposure to bacteria and parasites early in life, bacterial overgrowth, and antibiotic use are all strongly associated with the development of Crohn’s disease. These risk factors increase an individual’s susceptibility to disease by suppressing the natural development of the immune system, allowing pathogenic bacteria to proliferate and destroying the integrity of intestinal lining, and killing off good bacteria respectively.
Although the vast majority of people with Crohn’s don’t have a family history of the disease or a genetic susceptibility, more than one hundred gene mutations are associated with Crohn’s disease, and those with Eastern European Ashkenazi Jewish descent have a four- to five-fold increased risk of developing Crohn’s. Yet not everyone who is genetically susceptible develops the disease; an environmental trigger must be present that unmasks the genetic risk and leads to symptoms. This environmental trigger most often involves gut bacteria, as described above.
Tests and procedures that are used to diagnose Crohn’s disease include:
- Blood tests: levels of specific markers of Crohn’s disease are assessed, specifically protein and mineral levels and white and red blood cell counts
- Stool analysis: a stool sample is taken and analyzed for blood and/or microbes
- Colonoscopy: a test used to investigate the colon during which a thin, flexible tube with a camera on its end is inserted into the rectum
- Video capsule endoscopy: a pill containing a video camera is swallowed; as it travels through the digestive tract, it records, and the video is evaluated
- Barium X-ray: barium is administered orally, called an upper GI series, or anally, called a barium enema, and appears white on x-ray, making it easier to see Crohn’s- related manifestations in the intestines
- CT scans: an imaging test more sensitive than an x-ray that can detect detailed characteristics in the intestinal wall in the intricate loops of the intestines, allowing for better detection of bleeding
- Sigmoidoscopy: a small tube with a camera on its end is used to look at the sigmoid colon (large intestine segment closest to the rectum) and is inserted through the rectum
Prescription medication is the most common treatment option (yet not always the most effective) used to treat Crohn’s disease and may include one or a combination of the following medications:
- Aminosalicylates (5-ASA): reduce inflammation
- Antibiotics: kill off pathogenic bacteria and are used to treat bacterial infections and bacterial overgrowth that often accompany Crohn’s
- Corticosteroids: reduce inflammation
- Immunomodulators: decrease immune activity
Although prescription medications are often the conventional go-to treatment for Crohn’s disease, most people benefit greatly from an integrative approach that includes nutritional intervention and stress reduction.
A modified Paleo diet, in combination with high-dose prescription-strength probiotics, is extraordinarily successful for inducing Crohn’s remission and reducing or eliminating the need for medications.
Some studies have suggested that parasites, especially helminths, like hookworm and pig whipworms, can be an effective therapy for Crohn’s disease –the theory is that infection with helminths can restore the body’s autoimmune system to a more balanced state, decreasing the response to stimuli and reducing inflammation in the gut. Although hookworm therapy isn’t without risk (risks include rashes, itching, anemia, and diarrhea), recent studies show an overall benefit for conditions like Crohn’s.
Fecal Microbiota Transplant (FMT)
Crohn’s disease has clinical data to support the use of FMT, although FMT is not first line therapy, and should only be considered after standard treatments, including significant dietary modification and probiotics, have proved ineffective.