Crohn's Disease Treatment in Delhi, India

Different parts of the digestive system can be affected by Crohn's disease. Types of Crohn's disease based on the parts of the intestine include:

1. Ileitis: In this type of Crohn's disease, the small intestine becomes inflamed and swollen.
2. Colitis: In this type of Crohn's disease, the large intestine becomes inflamed and swollen.
3. Ileocolitis: It is an inflammation of the small intestine and a part of the colon. Ileocolitis is the most common kind of Crohn's disease.

Upper Gastro-intestinal tract:

1. Gastroduodenal: In this, the stomach and the top of the small intestine are both irritated and inflamed.
2. Jejunoileitis: Patchy regions of inflammation appear in the top section of the small intestine (called the jejunum).

Crohn's disease may affect any part of the GI Tract from the mouth to the anus but mainly affects the small and large intestines in most patients. In some patients, the disease only affects the colon, a part of the large intestine. The intensity of symptoms can vary from mild to severe. Symptoms usually appear slowly, although they can sometimes appear quickly and unexpectedly. Few may experience no symptoms at all. The most common signs and symptoms of Crohn's disease include:

• Abdominal pain
• Diarrhoea
• Feature of intermittent bowel obstruction
• Fever
• Blood in stool
• Weight loss
• Symptoms like skin lesions, joint pain, eye pain, perianal lesion like fissures

In addition to symptoms that affect the digestive tract, individuals with severe Crohn's disease may also experience the following symptoms:

• Inflammation of the bile ducts or liver
• Kidney stones
• Anaemia (iron deficiency)
• Slow growth or sexual development in children

The exact cause of Crohn's disease is still unclear. Initially, diet and stress were thought to contribute to Crohn's disease, but now medical professionals believe these factors only worsen the condition. Several causes are most likely contributing to its development. They are:

• Immune system: The cause of Crohn's disease may be related to altered gut microbiota or altered immune response to host cells.
• Heredity: Crohn's disease is more prevalent in families, and genes may contribute to an individual's increased risk of developing the condition. A person is at higher risk if the family members have had Crohn's disease.
• Environmental: Several environmental risk factors are associated with Crohn's disease, most notably smoking.

A single test cannot diagnose Crohn's disease. To diagnose Crohn's disease, the doctor may probably perform several tests, such as:

• Blood tests: The doctor can suggest a blood test to check for infection or anaemia, a disease without enough red blood cells to oxygenate the tissues adequately. The blood sample can be checked for liver function, inflammatory levels, or TB.
• Stools test: Stool samples can be checked for infection-causing bacteria or, in rare cases, parasites or blood.
• Colonoscopy: In this test, a small, flexible, lighted tube with a camera at the end is used to see the whole colon and the end of the ileum. The doctor may also perform a biopsy during the procedure to collect tiny tissue samples for laboratory testing and diagnosis. The presence of granulomas, or clumps of inflammatory cells, may indicate a Crohn's diagnosis.
• CT Scan/MRI: Both can obtain precise pictures of organs and tissues. It helps assess fistula structures around the anal region or the small intestine. An MR enterography can be used to assess disease state or progression.
• Balloon enteroscopy: An overture and scope are used for this test. This allows the clinician to see deeper into the small bowel than ordinary endoscopes can. This method is helpful when a capsule endoscopy reveals anomalies, but the diagnosis is still uncertain.

Currently, there is neither a cure nor a medication that is effective for everyone with Crohn's disease. Reducing the inflammation that causes the signs and symptoms is one of the objectives of medical treatment. Another objective is to minimise complications to enhance long-term prognosis.

• Anti-inflammatory medications: Anti-inflammatory medications are frequently used as the initial course of treatment for inflammatory bowel disease. Corticosteroids are one of them, they lessen inflammation in the body, but they are not always effective for people with Crohn's disease. To enhance the effectiveness of other drugs, corticosteroids may be used with an immune system suppressor.
• Immune system suppressors: These medications lessen inflammation while focusing on the immune system, which creates inflammatory molecules. The suppressors cause side effects, so the patient must be regularly monitored. They could also make a person feel nauseous and throw up.
• Pain relievers: The doctor may prescribe pain relievers for minor pain, do not take any medications without consulting a doctor. Few of them can worsen the condition.
• Supplements and vitamins: The doctor can suggest vitamins and nutritional supplements if a patient has nutritional deficiencies based on the patient's clinical status
• Nutritional therapy: For patients with Crohn's disease, the doctor can suggest a specific diet consumed orally, through a feeding tube, or intravenously (nutrients are injected into a vein). This will enable the bowel to relax while also enhancing its overall nutrition. If patients have a narrow gut, the doctor may also advise a low residue or low-fibre diet to lower the chance of intestinal obstruction (stricture).
• Surgery: The doctor may suggest surgery if dietary and lifestyle changes, medications, or other therapies are ineffective in treating the signs and symptoms. The digestive tract's damaged segment is cut out during surgery, and the healthy pieces are subsequently reconnected. Additionally, surgery may be performed to drain abscesses and repair fistulas.

Several factors may increase the risk of Crohn's disease; they are:

• Smoking cigarettes: Cigarette smoking is the most significant risk factor for Crohn's disease. Smoking increases the severity of the condition and the likelihood of requiring surgery.
• Medication risks: Crohn's disease medications may increase the risk of acquiring malignancies, including lymphoma and skin cancer. They also increase the risk of infection. Medications like corticosteroids may increase the chance of developing diabetes, high blood pressure, cataracts, glaucoma, osteoporosis, and other disorders.
• Malnutrition: Diarrhea, gastrointestinal discomfort, and cramping can make it difficult to eat and absorb enough nutrition to keep a person fed. Anaemia is also common due to the disease's low iron or vitamin B-12 levels.
• Blood clots: Crohn's disease raises the risk of the formation of blood clots in veins and arteries.
• Anal fissure: This is a little tear in the skin or tissue surrounding the anus where an infection may develop. It frequently results in uncomfortable bowel motions and can cause a perianal fistula.
• Age: Although Crohn's disease can occur at any age, it's more likely to develop in young adults. Most Crohn's disease patients are diagnosed before the age of 30.
• Family background: The risk for Crohn's disease increases if a person has a family history of the condition. A person is likely to develop the condition if their parents or siblings already have it.
• Skin conditions: Many Crohn's disease patients develop a disorder known as erythema nodosum, pyoderma gangrenosum, oral ulcers, and sweet syndrome.
• Nonsteroidal anti-inflammatory drugs: Even if anti-inflammatory drugs may not directly cause Crohn's disease, they can lead to inflammation. Some drugs may cause intestinal inflammation, which worsens Crohn's disease.

Crohn's disease can be prevented by taking the following measures:

• Reduce intake of dairy products
• Drink plenty of water
• Take multivitamins
• Follow diet
• Manage stress
• Exercise regularly
• Quit smoking

There is no direct cure for Crohn's disease. Early diagnosis can help to control and prevent the symptoms. Most often, several treatments are combined for the best results. Most patients enjoy a healthy and happy life by taking a few precautions and making lifestyle changes.

Reviewed by Dr. Rajesh Upadhyay, Senior Director & Head, Gastroenterology, Hepatology & Endoscopy on 12-Jun-2023.

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