Ask the Doctors

Ask the Doctors: Crohn’s Disease

In 2015, about 3 million adults reported being diagnosed with inflammatory bowel diseases, or IBD, in the United States. Among these diseases is Crohn’s disease, which affects as many as 780,000 Americans, according to the Crohn’s & Colitis Foundation.

To increase informational awareness on the disease, faculty from the Section of Colon and Rectal Surgery answer common questions about Crohn’s disease and share helpful information about diagnoses and treatments.

“Crohn’s disease is a very manageable disease,” says Matthew Mutch, MD, Chief of the Section of Colon and Rectal Surgery. “The first steps in its treatment are medication, and typically surgical intervention is reserved for managing complications like obstruction, bleeding or symptoms that are not improved or resolved with medications.”

Crohn’s Disease: Frequently Asked Questions

What is Crohn’s disease?

 Crohn’s disease is a chronic inflammatory disease of the gastrointestinal, or GI, tract. It is usually found in the small intestine and colon but can occur anywhere in the GI tract from the mouth to the anus. The inflammation of Crohn’s disease involves the full thickness of the bowel wall. This is different from ulcerative colitis, another IBD, which is confined to just the inner lining of the colon.  

What causes Crohn’s disease?

The cause is currently unknown, but it appears to be a combination of genetic, environment, gastrointestinal and immune factors. Several studies have indicated that a major risk factor for developing Crohn’s is the presence of a family member with the disease. However, without the presence of an environmental factor, such as bacteria, virus or allergy, patients are unlikely to develop the disease.

What are the symptoms of Crohn’s disease?

When a person has Crohn’s, their body’s immune system reacts as if it’s under attack and responds as it would to any germ or infectious process. The inflammatory response causes abdominal pain, diarrhea, blood in the stool, infections, fistulas and strictures.

Symptoms of Crohn’s disease may range from mild to severe. Most people will go through periods in which the disease flares up and causes symptoms, alternating with periods when symptoms disappear or decrease.

Pain usually occurs around or beneath the navel — often in the lower right part of the abdomen — and seems to worsen after meals. Other symptoms include appetite loss, bleeding from the rectum, weight loss, fever, joint pain, fatigue and sores around the anal area.

How is Crohn’s disease diagnosed?

When a patient presents persistent symptoms such as abdominal pain, diarrhea and unexplained weight loss, various tests are performed before a Crohn’s disease diagnosis. A combination of tests is often needed because some symptoms of the condition are similar to other intestinal disorders.

Diagnostic tools include blood tests, stool samples, barium X-rays of the intestinal tract, flexible sigmoidoscopy, CT scans, MRIs and colonoscopies. The imaging studies and colonoscopies identify areas of inflammation, ulceration or structuring in the small bowel or colon.

Crohn’s disease progresses over time and there is no cure. The earlier Crohn’s is diagnosed, the better a patient’s chances are of controlling the symptoms.

How is Crohn’s disease treated?

Patients with Crohn’s disease can be treated medically or surgically.

The medical course uses medications to treat symptoms and prevent flares. Patients follow a step-by-step approach to medication therapy until the symptoms decline. If medications don’t help, the second step is corticosteroids to provide quick relief of symptoms and a decrease in inflammation. If the corticosteroids fail or if the patient cannot stop taking them without having symptoms, the next step is an immunomodulatory agent. Some physicians may also prescribe infliximab, a monoclonal antibody against the protein that causes inflammation, or then prescribe methotrexate.

Surgery is reserved for complications associated with Crohn’s disease that do not resolve with medical management. This often involves removing of the diseased segment of bowel and joining the two ends of the healthy bowel together. In patients with severe fistulas, a diverting ileostomy or colostomy is a surgical option. The part of the bowel past where the ostomy is created is allowed to heal. If healing is possible, then the ostomy can be closed. Many patients who pursue this option choose to keep the ostomy because they feel that life is much improved.

Because surgery is a significant component of treatment, the Washington University colon and rectal team encourages all Crohn’s patients to have some sort of relationship with a surgeon so that they can understand their options and receive help in their overall decision makings.

Why should I choose a Washington University colorectal surgeon?

“We are experts at inflammatory bowel diseases; this is what we do,” states Mutch. “We have a very close relationship and collaborative effort with our gastroenterologists that specialize in IBD, so you’ll get a team approach.”

To make an appointment with a Washington University colorectal surgeon, please call 314-454-7177 or fill out the online appointment form.