How does Crohn’s disease start? Is it the same thing as ulcerative colitis? Do I have to change my diet permanently? If you or someone you know were recently diagnosed with Crohn’s, you have a lot of questions. We talked to a top gastroenterologist to get the answers about this inflammatory bowel disease. Plus, test your Crohn’s IQ with our quiz...
If you frequently suffer from chronic diarrhea, stomach cramping, nausea and fatigue, you may think you are just prone to tummy troubles. But you could have Crohn’s disease, an autoimmune disease that causes inflammation of the digestive or gastrointestinal (GI) tract.
“Crohn’s disease can attack any part of the GI tract from the mouth to the anus, but usually affects the small intestine and/or colon,” says Armen Simonian, M.D., head of gastroenterology at Capital Health Systems in Trenton, N.J., and chairman of the Department of Medicine.
“The disease can be mistaken for gut or parasitic infections, stomach flu, food poisoning, gluten allergy, irritable bowel syndrome, and even lupus or appendicitis,” he says.
Also, because Crohn’s is a systemic disease, it can manifest anywhere in the body, causing skin conditions, joint problems, eye diseases, arthritis and even gallstones, says Simonian.
Fortunately, with today’s treatments, which include anti-inflammatory drugs, antibiotics, corticosteroids, biologics, or immune suppressants and surgery, “some women have remissions that last years or the rest of their lives, although it’s more common for remissions to last months or a few years,” he says.
In this exclusive Lifescript interview, Simonian discusses the causes and complications of Crohn’s disease and its impact on women.
Is Crohn’s disease inherited?
Scientists believe you may inherit a genetic predisposition to the disease. In fact, about 20% of my patients have a close relative with Crohn’s.
If you have a relative with Crohn’s disease, you’re 10 times more likely to develop the disease. If a sibling has it, your risk jumps to 30%. If both parents have inflammatory bowel disease, your risk is 35%. Jewish people of European descent also have a greater risk.
How long does it take to diagnose Crohn’s disease?
In the past, most women had symptoms for two years before getting diagnosed because they went back and forth to their family physician and never saw a gastroenterologist.
Since symptoms of Crohn’s disease — chronic diarrhea, stomach cramping and nausea — are present in hundreds of conditions, it’s easy to understand why it isn’t more quickly diagnosed.
Today, with greater awareness of Crohn’s disease among family physicians and the public, and better access to diagnostic tests, like colonoscopy and CT [computerized axial tomography] scans, most women are diagnosed within six months.
How do physicians diagnose Crohn’s disease?
We use several tests and procedures, including endoscopy, colonoscopy, X-rays, CT scan and a biopsy to confirm results.
Colonoscopy is the best approach to monitor Crohn’s because it provides direct visualization of the intestines, so we can detect polyps and growths before they cause trouble.
Isn’t there an easier way than colonoscopy to monitor Crohn’s?
Unfortunately not. While the pill camera, or capsule endoscopy, is less invasive (you swallow a vitamin-sized pill embedded with a tiny video camera that takes 60,000 photos in six hours while traveling down your intestinal tract), it isn’t as effective at detecting polyps and abnormal growths as colonoscopy.
Also, because many patients with Crohn’s have narrowed intestines and stricture, the pill could get stuck and require an emergency procedure to remove it.
Over the past few years, colonoscopies have become much more comfortable. The worst part is preparation, which entails fasting and drinking an electrolyte-based solution to purge [the bowels].
Besides genetics, does anything cause or trigger Crohn’s?
There’s no specific trigger for Crohn’s, but certain environmental factors can predispose you to the disease. And some factors can protect you from the disease.
For example, if you were breast-fed as a baby, you’re less likely to get Crohn's. You’re also less susceptible if you eat lots of fruits and vegetables and less refined sugars.
On the flipside, oral contraceptives slightly increase the risk of Crohn’s, although it’s not clear why.
Over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, aspirin, naproxen and prescription NSAIDs like Celebrex and Motrin also increase the risk – possibly because they weaken intestines and make them more vulnerable to inflammation.
You’re also at higher risk if you smoke, because nicotine inflames and irritates the intestines.
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