Q. My husband, who is 36, was recently diagnosed as having Crohn’s disease, also known as ileitis. For months, he had suffered abdominal pain, diarrhea and weight loss. We thought maybe he had picked up some strange form of diarrhea during a trip last spring. What is Crohn’s disease? Is it contagious? How long does it last? Does it have any complications? How do you treat it? Is it curable?
A. Crohn’s disease, also known as regional ileitis, is a type of chronic (long-term) inflammation of areas in the intestines. Although there are several theories, doctors don’t know what causes this uncommon disorder.
Crohn’s disease gets its name from the physician who first described it. Its other name, regional ileitis, refers to the fact that the condition usually affects different parts of the intestines rather than the entire intestine. Ileitis means inflammation of the ileum, the part of the small intestine most often affected.
The condition usually starts between the ages of 15 and 35 and affects men and women equally. Whites are affected more often than blacks and Jews more often than non-Jews. There is a slightly higher risk of this disorder in families where one member is already affected. About 100,000 Americans are being treated for Crohn’s disease.
The most common theory about what causes Crohn’s is that it is a disorder of one’s own immune system. In other words, it appears that something triggers the body’s own defenses to attack various parts of the body, causing inflammation and other injury. Besides this theory, doctors have also searched for bacteria or some other infection as a cause, but so far none has been found. For this reason, Crohn’s isn’t considered contagious. Also, there seems to be a genetic factor that makes someone more likely to develop Crohn’s disease.
It mainly affects your small intestine, but it can also damage your large intestine, or colon. Common symptoms are diarrhea, crampy abdominal pain, fever, fatigue and weight loss, with occasional bleeding from the intestines. At first, Crohn’s may resemble an attack of appendicitis. In such cases, an operation may be needed to tell what is causing the abdominal pain.
Doctors diagnose Crohn’s by several tests, including sigmoidoscopy — examining the lower intestine through a tube inserted in the rectum — and X-rays of the small and large intestines.
Once you get Crohn’s disease, it tends to stay with you. It may get better and worse at times, seemingly for no apparent reason. Some people may have only one or two attacks, while others have them every few months to every few years.
The complications depend on what parts of the intestines are affected. There may be obstruction or blockage of the intestines or a perforation, leading to an infected abscess in the abdomen. An unusual complication is a fistula, an abnormal passage often going from the intestines Once you get Crohn’s disease, it tends to stay with you. It may get better and worse at times, seemingly for no apparent reason. Some people may have only one or two attacks, while others have them every few months to every few years.
to the skin around the rectum. This passage is prone to infection and may cause skin abscesses that appear like large boils. Fistulas can also appear in other organs such as some parts of the intestines, the bladder or vagina.
Because it can affect the immune system, Crohn’s may cause problems unrelated to the intestines, for example, arthritis or inflammation of the liver, skin or eyes. People with Crohn’s have a higher risk of intestinal cancer than usual, although this problem is more frequent in those who have chronic ulcerative colitis.
Although there is no cure, medications can help control symptoms. Doctors use sulfasalazine, an antibiotic with anti-inflammation effects, or steroids like prednisone, which also have anti-inflammation action. You may also need antibiotics if you develop an infection of the intestines. Surgery is used to treat complications, such as obstruction, fistulas or intestinal abscess. Fistulas can also be treated with Flagyl, an antibiotic.
Although Crohn’s is a long-term condition, most people can live normal lives with medical treatment. Proper nutrition is important to counteract some nutrition-robbing effects of Crohn’s on the intestines. For instance, you may need vitamins, iron, calcium supplements and anti-diarrhea medication.