Tuesday, August 21, 2012

How Do You Know It's Crohn's?

How Do You Know It's Crohn's?

Diagnosing Crohn's can be difficult because its symptoms are similar to those of other conditions. Here's how your doctor will determine if you have it.

By Lisa Baertlein

It's believed roughly 500,000 Americans have Crohn's disease, a chronic condition that causes inflammation of the digestive tract. If you have abdominal cramps or pain a few hours after eating, frequent diarrhea, bleeding from your rectum, weight loss, night sweats, or a recurrent fever, you may be one of them. Diagnosing Crohn's can be especially challenging because its symptoms are so similar to those of several other conditions, but a visit to your doctor is the first step toward diagnosis and treatment.

Crohn's vs. Other, Similar Conditions

Because there is no single test that can determine whether or not you have Crohn's, your doctor will probably order a combination of tests to rule out other conditions with similar symptoms. Such conditions include:


An experienced gastroenterologist can often eliminate a diagnosis of irritable bowel syndrome relatively quickly because people with IBS do not usually experience pain during bowel movements, and their symptoms go away while they're sleeping. This condition also differs from Crohn's in that it is not commonly associated with significant weight loss, anemia, rectal bleeding, stool blood, or recurring fever — a sign of inflammation.

Celiac Disease

When trying to rule out celiac disease, your doctor may ask how you react to certain foods. Gluten, which is found in wheat, barley, rye, and possibly oats, damages the small intestine in people with celiac disease, and the resulting symptoms often mimic those of Crohn's. A diagnosis of celiac disease is confirmed when blood tests show elevated levels of immunoglobulin A (IgA), antitissue transglutaminase (anti-tTG) antibodies and antiendomysium antibodies (AEA).

Ulcerative Colitis and Diverticular Disease

Distinguishing among Crohn's, ulcerative colitis, and diverticular disease can be more difficult and time-consuming and can involve more tests. Your physician will take a detailed history and do a complete physical exam, which may include checking your abdomen for tenderness or masses and checking your rectum for hemorrhoids, tears, or narrowing. Preliminary lab work will probably include blood, stool, and urine tests to check for any internal bleeding, infection, or inflammation.

Your doctor may also order a test called the erythrocyte sedimentation rate (ESR), or SED rate, to find out whether inflammation has made your red blood cells sticky and prone to settling more quickly than usual. A higher-than-normal SED rate and an elevated C-reactive protein level provide confirmation of systemic inflammation — the hallmark of inflammatory bowel diseases, such as Crohn's and ulcerative colitis.

Blood antibody testing, though not 100 percent reliable, can help a doctor distinguish between Crohn's and ulcerative colitis, since people with Crohn's tend to be positive for the anti-Saccharomyces cerevisiae antibody, or ASCA, but negative for perinuclear antineutrophil cytoplasmic antibody, or pANCA. The opposite is usually true in people suffering from ulcerative colitis, which causes inflammation and ulcers in the lining of the colon and rectum.

General Diagnostic Techniques

If you are suffering from frequent diarrhea and abdominal cramps — and laboratory test results suggest that more investigation is needed — doctors have many ways to "see" what's happening in the gastrointestinal (GI) tract. X rays, computed tomography (CT) scans, ultrasounds, magnetic resonance imaging (MRI), and small scopes inserted through the mouth, nose, or anus can all pinpoint damage or abnormalities in the gut. Since some of the tests can be uncomfortable, painful, or embarrassing, it is important that you make your doctor aware of any physical or emotional concerns you may have and ask whether anything can be done to ease your worries.

Ordinary abdominal X rays are often used when a doctor suspects a small bowel obstruction, which occurs when inflammation thickens intestinal walls, making it difficult for food to pass through.

Barium enemas are commonly used to diagnose and evaluate the severity of Crohn's because they allow doctors to view the areas most affected by the disease. During the procedure, barium is placed in the intestines through a tube inserted in the rectum. The barium — a chalky, metallic white liquid — coats the inside of the GI tract and produces clear X-ray images. Air may also be used to expand the colon and further improve the images. This test is designed to help find ulcers, damage from inflammation, or narrowing of the bowel. Depending on the circumstances, your doctor may consider performing one of two other, similar tests. A test of the upper gastrointestinal tract requires that you swallow a barium-based liquid before having an X ray. Another procedure, called enteroclysis, delivers a barium-based liquid through a tube that's inserted through the nose and extends to the beginning of the small intestine — it can help show abnormalities in that area.

Computed tomography, or CT scanning, uses a series of X rays to create a detailed picture of the body's anatomy. CT scans can help your physician pinpoint inflammation, scarring, obstructions, infection, tears, and fistulas, which can result in abnormal connections between different parts of the intestine.

Magnetic resonance imaging, or MRI, uses magnetic fields to make an image of the body. MRIs are a particularly accurate tool for evaluating perianal (meaning "around the anal area") complications. Such complications include fissures, ulcers, abscesses, and fistulas, which may leak pus, mucus, or stool from the intestines through a hole near the anus.

Endoscopic Diagnostic Techniques

Your doctor may choose to run endoscopic tests, which use a camera inside a lighted, flexible tube to relay pictures to a video monitor. Such tests are usually used at the time of diagnosis to measure the extent of damage from inflammation.

Sigmoidoscopy is the most commonly performed endoscopic test used to confirm a Crohn's diagnosis. During the quick, 10- to 20-minute office procedure, a flexible sigmoidoscope is inserted into the rectum to examine the lower intestine, also known as the sigmoid colon, or to take a tissue sample for testing.

Colonoscopy is a 30- to 60-minute procedure that can be done in a doctor's office, outpatient GI facility, or a hospital. A lighted colonoscope is inserted into the rectum, allowing the doctor to get a view inside the rectum, the entire colon, and the end of the small intestine, known as the terminal ileum. This test is useful in confirming Crohn's of the ileum and for collecting samples of tissue for colon cancer screening. While sedation is not regularly used during sigmoidoscopy, it is often given to people undergoing colonoscopy.

Esophagogastroduodenoscopy, or EGD, may be used to see the esophagus, the stomach, and the first part of the small intestine if Crohn's of the upper gastrointestinal tract is suspected. The test, in which a scope is inserted through the mouth, usually takes 10 to 20 minutes.

Capsule endoscopy, in which a patient swallows a capsule-encased camera that feeds images to a recorder worn on his or her belt, is helpful in diagnosing Crohn's in the small intestine, according to recent studies. However, it is not recommended when a bowel obstruction is suspected or present, or for patients with areas of narrowing.

Living With Crohn's

Since Crohn's is a chronic disorder that can worsen over time, getting the right diagnosis is a worthwhile investment — even if it means going through some uncomfortable testing procedures. A proper diagnosis will help you and your doctor decide on the best treatments to improve your daily life, ease your symptoms, and potentially bring on remission.

Thursday, August 16, 2012



As you noticed, we began posting on this site and sending emails with some interesting facts and tips relating Crohn's and Colitis. The site will be a public medium for those of you who are interested in leaving their questions, comments and helpful information.

Please do so....

Tuesday, August 7, 2012

The Basics of Crohn's Disease

The Basics of Crohn's Disease

Everything you need to know about Crohn's disease, from causes to treatment options

By Michele Bloomquist

Doctors don't know much about the underlying causes of Crohn's disease, a condition marked by chronic digestive troubles. Still, the information that is currently available can help you learn to manage this often uncomfortable and unpleasant condition in order to live as close to the normal you knew before your diagnosis.

What Is Crohn's Disease?

Crohn's disease is an inflammation of the digestive (or gastrointestinal) tract, with painful symptoms such as constant stomach upset, bouts of diarrhea, and bowel obstructions. About 500,000 people in the United States are affected by Crohn's disease, and it's likely that many more suffer from it but haven't been diagnosed.

Crohn's affects men and women about equally, and it may run in families. About 20 percent of those with Crohn's have a close family member (a parent or sibling) with the same symptoms. Crohn's can occur at any age, but most people first experience symptoms between the ages of 15 and 35.

The Symptoms of Crohn's Disease

The most common symptoms of Crohn's disease are abdominal pain and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, anemia, and fever can also occur. The symptoms can come and go, and they can be worse in some people than in others.

What Causes Crohn's Disease?

Doctors and researchers aren't sure exactly what causes Crohn's. Some speculate that the disease is an autoimmune reaction to normal substances in the gut (like bacteria and food) that the immune system mistakes for foreign invaders and is compelled to "attack." Others believe that genetic abnormalities cause Crohn's. Another possible culprit is thought to be proteins produced by the immune system.

How Is Crohn's Disease Diagnosed?

There is no single medical test that is used to diagnose Crohn's. Instead, a number of tests are often used to detect symptoms: blood tests check for anemia and signs of infection, and stool samples can determine whether blood is present in the GI tract. X-rays of the upper and lower digestive tract can also help confirm a diagnosis of the condition, while a sigmoidoscopy or colonoscopy (procedures in which a small camera attached to a lighted scope is used to see inside the intestine) can show what's going on inside the bowel. In addition, a biopsy of bowel tissue allows doctors to examine the tissue on a cellular level.

Complications of Crohn's Disease

Crohn's is associated with an increased risk for other digestive problems, including bowel obstructions, fistulas (small ulcerlike sores inside the intestine or rectum), fissures (small cracks in the intestinal tract), and infections. Nutritional problems are also common because the inflamed digestive tract often cannot properly absorb nutrients from foods as they pass through it. This nutritional deficit can contribute to additional complications of Crohn's that seemingly have no connection to the digestive tract, including arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, and other diseases of the liver and biliary system. Some of these secondary health issues disappear on their own with proper treatment for Crohn's, while others must be treated separately.

How Is Crohn's Disease Treated?

Because Crohn's disease can differ so much from person to person, you and your medical professional may have to try several approaches to find what works best.

Lifestyle changes, medications, nutritional supplementation, and surgery are all options used to treat Crohn's disease.

Drug therapies may consist of anti-inflammatory drugs, cortisone or steroids, immune system suppressors, inflammation-response blockers, antibiotics, antidiarrhea medications, and fluid replacements. Remember, over-the-counter medications, herbs, and supplements are drugs too, so be sure to tell your health care providers about any that you use. That way, they can take steps to reduce the risk of dangerous drug interactions.

Nutritional supplementation may be necessary to offset the bowel's inability to absorb nutrients, especially in children and teens whose long-term growth and development are at risk without proper nutrition. While no specific foods have been implicated in causing Crohn's, some patients report that their symptoms improve when they avoid certain trigger foods. These may include spicy foods, dairy, alcohol, and whole grains.

Between two-thirds and three-quarters of people with Crohn's will have some surgical procedure related to its treatment. Surgery may be needed to relieve symptoms or to treat problems such as bowel obstructions, perforations, abscesses, or bleeding in the intestine. Even after surgery, symptoms can return in other parts of the bowel. Always weigh the decision to undergo surgery carefully with your doctor to determine whether it's the best option in your case.

Can Lifestyle Affect Crohn's?

Taking excellent care of your health is especially important when you have a chronic health condition like Crohn's. The basic habits of healthy living — eating a well-balanced diet, eating in moderation, getting regular exercise, and reducing sources of stress — are critical when you have Crohn's. Bad habits, like smoking and drinking excessively, will make matters worse.

A Future With Crohn's Disease

While Crohn's disease may never be completely cured, there are steps you can take to make living with this illness less painful, difficult, and disruptive to your daily life. Remember, the illness can come and go throughout your lifetime. When Crohn's disease flares up, be sure to take action quickly. Doing so will ensure that you'll be in control of Crohn's disease, not the other way around.