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Inflammation of Crohn’s Disease

Abdominal pain? Loss of Appetite? Could be a serious diagnosis.

By Sandra Hoogerwerf, MD

Abdominal pain, loss of appetite and weight loss may seem like just another case of an upset stomach, but might signal a more serious diagnosis like Crohn’s disease.

Inflammation of Crohn’s disease may affect each individual in different ways. In many, it affects just the large part of the small intestine. In others, it’s confined to the colon. Symptoms can range from mild to severe which can develop gradually or suddenly. Symptoms might also fall into remission, or a period of time where you have no signs or symptoms. When the disease is active, signs and symptoms might include diarrhea, abdominal pain and cramping, blood in the stool, ulcers, reduced appetite and weight loss. Women might experience worsening of abdominal pain and diarrhea during the premenstrual and menstrual periods of their cycle. Severe Crohn’s disease might cause fever, fatigue, arthritis, eye inflammation, mouth sores, skin disorders, liver and bile ducts inflammation or delayed growth and sexual development.

Abdominal pain is one symptom that’s common.

The exact cause of Crohn’s disease remains unknown. Many researchers believe that a number of factors including heredity and a malfunctioning immune system play a role in the development of the disease. When the immune system tries to fight off any invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract. Crohn’s is more common in people who have a family history of the dis- ease leading experts to believe that one or more genes may make people more susceptible to it. However, it has been noted that people with the disease might not have a family history.

There are many risk factors that are attributed to the disease, some of which can be controllable. Cigarette smoking is the most important controllable risk factor for developing the disease. Smoking leads to more severe disease and a greater risk of surgery in regards to Crohn’s. A diet high in fat and refined foods also plays a role in developing Crohn’s disease. Other risk factors include age, ethnicity and family history.

For women, Crohn’s disease often leads to other health complications, especially in the reproductive system. Women in the child-bearing age may experience complications involving fertility and pregnancy. It’s not uncommon for women to experience this same inflammation around the ovaries, uterus, vaginal canal, perineum and the vulva due to the disease’s proximity to these organs.

Women with Crohn’s will commonly experience complications of anemia, dysmenorrhea and even ulcers of the perineum. For women who are pregnant and suffering with Crohn’s, there are many complications of concern during pregnancy, especially those involving nutrition and medication-related side effects. During delivery, complications are usually rare, but some women might experience the development of fistulas, an abdominal connection between two parts inside of the body, around the site of an episiotomy.

The psychological impact of the disease is varied among most women. However, because of the pain and complications associated with diet and health, many women experience socialization issues due to complications with sexuality and body image. Perineal pain with intercourse is common in women with a perineal fistula or abscess. Some patients complain of severe rectal pressure during intercourse or are sexually inhibited because they fear rectal incontinence.

Women who suffer from gynecological complications often require the use of hormonal replacement therapy or other forms of hormonal-based treatments to manage the menstrual cycle regularity and to help control inflammation and pain associated with the proximal inflammation of the GI tract.

There is no current cure for Crohn’s disease and no treatment works for everyone. The goal for medical treatment is to reduce inflammation-triggering symptoms and improving long-term prognosis by limiting complications. In the best cases, medical treatment may lead to symptom relief and also long-term remission. Treatment for Crohn’s includes drug therapy that might include anti-inflammatory drugs, immune system suppressors, antibiotics and other medications. Special diets might also be recommended improving overall nutrition and allowing the bowel to rest. In the past, supplements of calcium and B-12 vaccinations have been used to suppress the disease. If drug therapy is not effective, patients might also elect for surgery, which improve symptoms of the disease. Those suffering from Crohn’s also have an increased chance of colon cancer, which is 90 percent curable if detected through a colonoscopy early enough.

It is important to consider visiting a doctor when experiencing symptoms such as abdominal pain, blood in the stool, unexplained fever and ongoing bouts of diarrhea that don’t respond to over-the-counter medications in order to help manage symptoms.

Dr Sandra Hoogerwerf graduated Cum Laude with a Doctorate of Medicine from the Erasmus University in Rotterdam, The Netherlands. She subsequently completed her internal medicine residency at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, and her clinical gastroenterology fellowship at the University of Texas Medical Brach in Galveston, Texas. In addition, she completed a gastroenterological research fellowship at the Johns Hopkins University in Baltimore, Maryland. Before joining Borland-Groover Clinic in 2010, she served as an Assistant Professor of Medicine at the University of Michigan Medical Center in Ann Arbor, Michigan. Dr. Hoogerwerf has a longstanding interest in women’s health issues, functional bowel and motility disorders.

She has published on a variety of topics including the management of gastrointestinal disease in pregnancy, acid suppressive therapy and reflux disease, irritable bowel syndrome and motility disorders such as achalasia.