Diagnosis & Treatments of Crohn’s Disease
I was diagnosed with Crohn’s Disease after I had a colonoscopy and showed active signs of inflammation and ulceration in my intestines. I have been on several treatments and because my disease tends to be on the moderate/severe side I am currently on a biologic medication which I self-inject twice a month. I have had several surgeries, some minor to help correct some fistulas and others major to remove parts of my diseased intestine and I currently have an ileostomy. The biggest medication side effect I deal with is the reduced immunity so I tend to catch colds and other infections fairly easily.
Testing & Diagnosis
There is no single test really to determine if someone has an IBD. The GI symptoms of Crohn’s can often be similar to a wide range of other issues so it’s usually a matter of figuring out what you don’t have to narrow down the options. These tests will usually include blood tests, stool (poop) tests, and x-rays with the use of a contrast.
Once other diseases/infections are ruled out, usually the next step is a scope (endoscopy or colonoscopy) where a small camera on a lighted tube is entered into your digestive system so they can take a look around and collect small tissue samples for biopsy. An endoscopy goes in the mouth and down the throat and a colonoscopy enters through the other end of the digestive system. While these scope procedures sound awful, they aren’t that bad and are usually done as outpatient procedures under sedation. Sometimes additional scanning such as a CT scan, MRI, or swallowing a pill-sized camera is also used to get a better idea of what is going on inside.
Since CD is a chronic illness it doesn’t really get “cured”. Through treatments the goal is to bring the disease under control by reliving/eliminating symptoms, allow tissues to heal, and to decrease the frequency of disease flares. There can be a wide variety of severity as well as symptoms associated with Crohn’s Disease and so treatment options can vary from patient to patient. Doctors will review the results from tests and the symptoms the patient is dealing with to create the best treatment plan. It is useful for patients to keep a log or journal of their symptoms so they can share with their doctor and to continue to have regular check-ins with their doctor to review how the treatments are working and if any changes need to be made. Treatment usually involves medication or a combination of medications, alterations to diet/nutrition, and in some cases surgery.
There are several medication options, I’ll go over some highlights but if you want to know more I suggest clicking here for lists and videos about the different medication options as well as talking with your doctor about the various options. As with any medication, there are a range of side-effects that come with these medications. One of the most common is reduce immunity but check with your doctor/pharmacist on the know side effects if you start any medications.
- Aminosalicylates (5-ASA) – They are thought to be effective in treating mild-to-moderate episodes of Crohn’s disease and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.
- Corticosteroids – Corticosteroids nonspecifically suppress the immune system and are used to treat moderate to severely active Crohn’s disease. (By “nonspecifically,” we mean that these drugs do not target specific parts of the immune system that play a role in inflammation, but rather, that they suppress the entire immune response.) These drugs have significant short- and long-term side effects and should not be used as a maintenance medication.
- Immunomodulators – Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.
- Antibiotics – Antibiotics may be used when infections—such as abscesses—occur in Crohn’s disease. They can also be helpful with fistulas around the anal canal and vagina.
- Biologic Therapies – These medications represent the latest class of therapy used for people with Crohn’s disease who have not responded well to conventional therapy. These medications are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation.
Crohn’s Disease is not believed to be caused by bad diet and nutrition, but alterations may help reduce symptoms and increase the absorption of nutrients. If you are interested in more info about diet & nutrition with IBD, there is a good online webcast: http://programs.rmei.com/Nutrition2018/
Usually one of the last treatment options is surgical. About 2/3 to 3/4 of patients with Crohn’s Disease end up needing surgery at some point. Surgery becomes necessary when medications can no longer control symptoms, or if you develop a fistula, fissure, or intestinal obstruction. Surgery often involves removal of the diseased segment of bowel. Sometimes the bowel may have to be rerouted through an artificially created hole (stoma) in the abdomen. A colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall.
“Crohn’s Diagnosis & Testing.” Crohn’s & Colitis Foundation. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/crohns-diagnosis-testing.html, n.d. Web. 2 Dec. 2018.
“Crohn’s Disease Medication Options.” Crohn’s & Colitis Foundation. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/crohns-medication.html, n.d. Web. 2 Dec. 2018.
“Crohn’s Treatment Options.” Crohn’s & Colitis Foundation. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/crohns-treatment-options.html, n.d. Web. 2 Dec. 2018.
“Diet and Nutrition.” Crohn’s & Colitis Foundation. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/diet-and-nutrition/, n.d. Web. 2 Dec. 2018.
“Types of Medications for Crohn’s Disease and Ulcerative Colitis.” Crohn’s & Colitis Foundation. http://www.crohnscolitisfoundation.org/resources/types-of-medications.html, n.d. Web. 2 Dec. 2018.