Crohn’s disease

Diagnosis

After excluding other possible explanations for your symptoms and signs, a diagnosis of Crohn’s disease is typically reached by your doctor. It’s important to note that Crohn’s disease cannot be diagnosed through a single test.
To aid in the diagnosis of Crohn’s disease, your doctor may conduct a series of tests, including:

Laboratory exams

• Blood tests. Blood tests may be recommended by your doctor to check for infection or anemia, a condition where there aren’t enough red blood cells to provide enough oxygen to your tissues.
  In order to check for levels of inflammation, liver function, or the presence of dormant illnesses like tuberculosis, your doctor may also order additional tests. It’s also possible to test your blood for the presence of infection-fighting antibodies.
• Stool studies. You could be asked to give a sample of your feces so that your doctor can check it for organisms like infection-causing bacteria or, in rare cases, parasites or occult blood.

Procedures

• Colonoscopy. Using a small, flexible, lighted tube with a camera at the end, this test enables your doctor to see your whole colon as well as the very end of your ileum (terminal ileum). Your doctor may also perform a biopsy during the operation to obtain small samples of tissue for laboratory examination and possible diagnosis. Granulomas, or collections of inflammatory cells, may point to a Crohn’s diagnosis.
• Computerized Tomography (CT). A CT scan, a specialized X-ray method that offers more detail than a regular X-ray does, might be performed on you. This examination examines the entire bowel and also the tissues outside the gut.

A particular type of CT scan called a CT enterogram involves ingesting an oral contrast agent and receiving intravenous contrast images of the intestines. In many medical facilities, this test has taken the place of barium X-rays because it produces better images of the small bowel.

• Magnetic Resonance Imaging (MRI). To produce finely detailed images of organs and tissues, MRI scanners use a magnetic field and radio waves. When examining a fistula in the anal region (pelvic MRI) or the small intestine (MR enterography), MRI is especially helpful.

MR enterography can occasionally be used to monitor the state or course of an illness. The danger of radiation exposure may be reduced by using this test instead of CT enterography, especially in younger patients.

• Capsule endoscopy. You will ingest a capsule with a camera inside it for this test. Your small intestine is photographed by the camera, which transmits the images to a recorder you wear on your belt. After being transferred to a computer, the images are then viewed on a monitor to look for indicators of Crohn’s disease. In your stool, the camera leaves your body painlessly.

Endoscopy with biopsy may still be required to confirm the Crohn’s disease diagnosis. If a stricture or obstruction in the intestine is suspected, a capsule endoscopy should not be done.

• Balloon-assisted enteroscopy. An overtube and a scope are the tools utilized for this test. This enables the physician to see further into the small bowel than is possible with a typical endoscope. When a capsule endoscopy reveals anomalies but the diagnosis is still uncertain, this approach can be helpful.

Treatment

Currently, there is no universally effective medication or cure for Crohn’s disease. The primary goal of medical treatment is to reduce the inflammation that leads to symptoms and manifestations. Another objective is to minimize complications and improve long-term prognosis. In ideal cases, this approach can result in symptom relief and extended periods of remission. It is important to note that the effectiveness of treatment can vary from person to person, and finding the most suitable approach often involves a process of trial and error.

Anti-inflammatory drugs

Inflammatory bowel illness is frequently treated first with anti-inflammatory medications. They consist of:

• Corticosteroids. Prednisone and budesonide, two corticosteroids, can lessen inflammation in your body, but they don’t always work for people with Crohn’s disease.

Short-term (3 to 4 month) symptom improvement and remission are both possible with corticosteroids. To maximize the effects of other drugs, corticosteroids may also be used with an immunosuppressant. They finally tapered off after that.

• Oral 5-aminosalicylates. In general, these medications are not helpful for Crohn’s disease. They include the sulfa-containing medication sulfasalazine and mesalamine. Although oral 5-aminosalicylates were once frequently utilized, they are now generally thought to have very little benefit.

Immune system suppressors

These medications also lessen inflammation, but they focus on your immune system, which creates the inflammatory molecules. These medications may work more well together for certain people than they do separately.

Among the immune system suppressors are:

• Azathioprine and mercaptopurine. These immunosuppressants are the ones that are most frequently used to treat inflammatory bowel disease. To avoid adverse effects including liver inflammation and diminished resistance to infection, taking them necessitates continuous monitoring with your doctor and routine blood testing. They might also make you feel queasy and throw up.
• Methotrexate. When other medications don’t work effectively for treating Crohn’s disease, this drug may be utilized. For adverse effects, you must be regularly monitored.

Biologics

This group of treatments focuses on immune system protein. Biologics of the following kinds are used to treat Crohn’s disease:

• Vedolizumab. This medication prevents certain immune cell molecules called integrins from attaching to other intestinal lining cells, which is how it functions. A gut-specific medication for Crohn’s disease, vedolizumab. Natalizumab, a drug that is comparable to vedolizumab and was originally used to treat Crohn’s disease, is no longer prescribed because of potential side effects, including a fatal brain condition.
• Infliximab, adalimumab and certolizumab pegol. These medications, also referred to as TNF inhibitors, function by neutralizing the immune system protein tumor necrosis factor (TNF).
• Ustekinumab. This was recently approved to treat Crohn’s disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
• Risankizumab. This drug, which targets the interleukin-23 molecule, was just authorized for the treatment of Crohn’s disease.

Antibiotics

In persons with Crohn’s disease, antibiotics can lessen leakage from fistulas and abscesses and even occasionally heal them. Additionally, some experts believe that antibiotics aid in lowering dangerous bacteria that may be contributing to intestinal inflammation. The medications ciprofloxacin (Cipro) and metronidazole (Flagyl) are frequently recommended.
In addition to reducing inflammation, certain medications can help alleviate the signs and symptoms associated with Crohn’s disease. However, it is crucial to consult your doctor before taking any over-the-counter drugs. Depending on the severity of your condition, your doctor may recommend one or more of the following treatments:

• Anti-diarrheals. By giving your stool more bulk, a fiber supplement like psyllium powder or methylcellulose might treat mild to moderate diarrhea. Loperamide may be useful for cases of more severe diarrhea.

In some patients with strictures or specific illnesses, these drugs might not work or even be hazardous. Before using these medications, please speak with your doctor.

• Pain relievers. Your doctor could advise acetaminophen for minor pain but not ibuprofen or naproxen sodium. These medications can worsen your disease and are likely to make your symptoms worse.
• Vitamins and supplements. Your doctor can suggest vitamins and dietary supplements if you’re not getting enough nutrients.

Nutrition therapy

If you have Crohn’s disease, your doctor may advise a special diet administered by mouth, a feeding tube, or nutrients injected into a vein (parenteral nutrition). This will enable the bowel to rest while also enhancing your overall nutrition. In the short term, bowel rest may lessen inflammation.

Your doctor might prescribe immune system suppressors together with short-term dietary therapy. In order to make people healthy before surgery or when other treatments are unable to control symptoms, enteral and parenteral nutrition are frequently employed.

If you have a constricted colon, your doctor may also advise a low residue or low-fiber diet to lower your chance of intestinal blockage. The goal of a low residue diet is to decrease the size and frequency of your feces.

Surgery

Your doctor might advise surgery if dietary and lifestyle modifications, pharmacological therapy, or other therapies don’t help you feel better. Almost half of Crohn’s disease patients will need at least one operation. Crohn’s disease cannot be cured by surgery.

Your digestive tract’s diseased section is cut out during surgery, and the healthy pieces are subsequently reconnected. Additionally, surgery may be done to drain abscesses and seal fistulas.

Surgery for Crohn’s disease typically only has short-term advantages. The disease frequently reappears close to the rejoined tissue. To reduce the chance of recurrence, it is advisable to use medication after surgery.