Crohn's Disease

Overview

Crohn’s disease is an incurable inflammatory disorder that can affect any part of the gastrointestinal tract. The gastrointestinal tract is a system of body organs responsible for carrying and digesting food, absorbing nutrients, and getting rid of waste. Inflammation (red, swollen, and tender areas) always affects the innermost lining of the gastrointestinal tract, called the mucosa. However, the disease can affect the deeper layers of the gastrointestinal wall and even extend through the entire bowel wall.

CAUSES

The exact cause of Crohn’s disease is unknown. Current research is exploring the possible connection of the disease to immune system problems and bacterial infections.

Figure 1. Diagram showing Crohn’s disease affecting the last part of the small bowel (ileum and/or the large bowel (colon)

SYMPTOMS

Crohn’s disease can present as abdominal disease, anorectal (anus and rectum) disease, or both. Patients with Crohn’s disease are at greater risk of developing a fistula.  A fistula is a small tunnel that tracks from one portion of bowel to either another portion of bowel, another organ, or the skin. Symptoms vary widely among patients and often come and go over a long period of time. These include: 

• Abdominal cramping 

• Abdominal pain 

• Ongoing diarrhea 

• Chronic constipation 

• Bleeding with bowel movements 

• Fever 

• Extreme tiredness 

• Weight loss 

• Drainage from the skin around the anus 

• Abscesses (infections) around the anus that recurcome back 

• Anal fissures 

DIAGNOSIS

During the first visit, your colon and rectal surgeon will perform a thorough medical history and physical exam. To aid in diagnosis, they may also examine the inside of the bowel using a flexible instrument with a lighted camera. X-ray studies and laboratory tests such as stool samples and blood tests may also be done. This evaluation will provide information on the extent of disease and help guide treatment.    

MEDICAL TREATMENT

Medications are always the first option unless emergency surgery is required. Several treatment approaches are used at the onset and for the long term to help patients control their disease. The most common initial therapy includes anti-inflammatory medications. Diet and lifestyle changes can also help. 

SURGICAL TREATMENT

Surgery may be needed when patients develop disease-related abdominal and anorectal complications. Emergency surgery may be performed when a patient has either a perforation (a hole in their bowel) or a blockage of the bowel. Both of these conditions can be life-threatening. Immediate surgery may also be required for an abscess near the anus.

Abdominal surgery: Surgery is typically performed when the patient’s symptoms are no longer being controlled with their medications.  This usually means there is a section of bowel that is either too scarred or narrow to function properly.  The surgery can be performed either through an open approach or a minimally invasive approach. Your surgeon will decide on the safest approach based on your individual case.

The most common procedure is removal of the last portion of the small bowel and the first portion of the large bowel to relieve an abnormal, narrowed section (called an ileocolic). Following removal of this part of the bowel, the remaining bowel is reconnected if possible. The end of the bowel can also be brought out through a surgical opening in the skin of the abdominal wall. This procedure (called an ostomy) redirects waste (feces) from the bowels.

Anorectal surgery: This is most commonly done to open and drain anorectal abscesses. A seton (small drain) may be left in place for a period of time until the infection clears up. Surgery is also used to treat anorectal fistulas. In combination with this procedure, an ostomy may be created, but usually only in severe cases.

POST-TREATMENT PROGNOSIS

It is important to follow up with your physicians so they can devise an ongoing management plan to control your symptoms. When you have Crohn’s disease, you must stay on medication throughout your entire life. Crohn’s that impacts the colon (large intestine) increases your risk of colon cancer. This risk goes up after 8 to 10 years of ongoing colon involvement. For those patients, it is key to undergo regular follow-up colonoscopies (examination of the colon using a flexible instrument with a lighted camera).

HOW CAN I REDUCE RECURRENCE?

Recurrence is most common in patients who stop taking their medications, so it is vital to follow your physician’s orders. Smoking negatively impacts every organ in the body and presents health risks for everyone, so quitting is advised. For patients with Crohn’s disease, smoking has been linked to higher recurrence rates, so quitting can reduce this risk. 

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus.  They have completed advanced surgical training in the treatment of these diseases, as well as full general surgery training.  Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum, and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.