Crohn’s Disease
Learn more about Crohn's disease and how it is treated.
Overview
Crohn’s disease is a condition where inflammation and swelling in your digestive system leads to gastrointestinal symptoms. It is one of two main types of inflammatory bowel disease (IBD) conditions.
In Crohn's disease, the lining of the bowel is inflamed and has “skip lesions.” Skip lesions are areas with ulcers that are separated by areas of healthy bowel.
Crohn’s disease can affect any part of the gastrointestinal system. For many people, it affects the end of the small bowel where it meets the colon, an area called the terminal ileum.
Crohn's disease often begins in childhood or adolescence, though some people do not experience their first symptoms until after age 40. It is a lifelong condition marked by periods of flare-ups (when symptoms are active) and remission (when symptoms are absent).
Types of Crohn's disease
Where Crohn’s disease is located affects both its symptoms and how it is treated.
Terminal ileal disease occurs where the small bowel joins the colon. Symptoms include bloating, cramping and the difficulty tolerating fibrous foods such as fresh fruits and vegetables.
Small bowel disease occurs across multiple areas of the small bowel. Affected segments can become severely narrowed, causing bowel obstruction.
Colon disease refers to inflammation of the colon, the rectum, or both.
Fistulizing/penetrating Crohn’s disease occurs when ulcers extend through the bowel wall, forming a tunne l— called a fistula — to another part of the intestine or another organ.
Non-fistulizing, non-penetrating Crohn’s disease refers to Crohn’s disease without fistulas or abscesses.
Stricturing Crohn's disease involves a narrowing of the intestines that can be caused by scar tissue that develops over time.
Perianal Crohn's disease occurs when Crohn's disease affects the area near the anus, causing complications that require specialized care.
Diagnosis
Symptoms of Crohn's disease vary from person to person and can include:
- Diarrhea
- Abdominal cramping
- Weight loss
- Fatigue
- Nausea and vomiting
- Bloating or a feeling of fullness in the abdomen
- Joint pain or fever
- Rectal bleeding
If you are experiencing symptoms of Crohn's disease, your family physician or an IBD specialist may recommend one or more of the following tests:
- Blood tests
- Stool tests
- A colonoscopy to look at your large intestine
- An upper endoscopy to look at your esophagus and stomach
- A biopsy to test a small sample of inflamed tissue
- Medical imaging, such as X-rays, CT scans or MRIs
Treatment
Crohn's disease is managed with medication, surgery and lifestyle changes. We will work with you to develop a care plan that is specific to your needs. Our recommendations will depend on your age, general health, the severity of your condition and other factors in your life.
Monitoring
Ongoing monitoring is an important part of managing of Crohn's disease. You will have regular follow-up appointments with our IBD specialists to watch for changes and to adjust your care plan as needed.
You can expect regular testing that may include:
Medication
Medication helps control chronic intestinal inflammation. We work with each patient to choose medication that lessens or eliminates symptoms with minimal side effects.
Corticosteroids help control the immune system and lessen the inflammation and symptoms of Crohn’s disease over the short term. They are not recommended for long-term use due to side effects.
Immunomodulators modify the activity of the immune system to prevent ongoing inflammation. They can be used over the long term to maintain remission in some patients.
Antibiotics reduce infection and are used to treat the symptoms and complications of Crohn’s disease such as abscesses and fistulas.
Advanced therapies, such as biologics and small oral molecules, are the newest IBD treatments. Your care team will work with you to determine the best treatment plan.
Surgery
Some patients with Crohn’s disease require surgery. The type of surgery depends on where the disease is located.
Terminal ileal disease
Resection is when a surgeon removes the end of the small bowel and the beginning of the colon. This is called an ileocolic resection. The two ends are joined back together (anastomosis).
If there is infection or severe inflammation in the surgical area, a temporary ostomy may be needed while the area heals.
View this video for helpful information on Ileocolic resection for Crohn's disease by TVASurg – The Toronto Video Atlas of Surgery.
Small bowel disease
Resection is the recommended procedure when long sections of the bowel are affected by disease and the patient has not had a previous resection. A surgeon removes the affected portion of the bowel and joins the two ends back together (anastomosis).
Stricturoplasty is recommended when multiple short segments of the bowel are affected, or when the patient is at risk of short bowel syndrome from previous surgeries. It involves opening up narrowed areas of the bowel without removing them.
The decision between resection and stricturoplasty is usually made at the time of surgery, based on what is found and which option will offer the best outcome to the patient.
Colon disease
Ileorectal anastomosis is recommended when the colon is inflamed and the rectum is not. It involves removing the colon and joining the small bowel (ileum) to the rectum.
Proctocolectomy is recommended when both the colon and rectum are diseased. It involves removing the rectum and colon and creating a permanent ileostomy for bodily waste to pass externally.
Perianal disease
Perianal disease can result in fistulas, fissures and abscesses. Medication is usually the first treatment offered to the patient. If medication is not effective, surgery is often recommended and can include:
- Insertion of a draining tube to prevent abscesses
- A temporary ostomy to allow the perianal area to heal
- A proctectomy, which removes the rectum to create a permanent ostomy
View this video for helpful information on perianal disease by TVASurg – The Toronto Video Atlas of Surgery.
Ostomy
An ostomy, also called a stoma, is a surgically created opening, usually on the abdominal wall, that allows bodily waste to drain externally.
Temporary stomas may be used in for:
- Emergency or semi-urgent surgeries where resection and joining of the bowel is unsafe due to an infection in the abdomen
- Emergency or semi-urgent surgeries where resection and joining of the bowel is unsafe due to an infection in the abdomen
- Post-surgical complications, such as leaks from sites where the bowel has been joined
Permanent stomas may be needed when the rectum and anus are severely affected by disease.