Perianal Crohn's Disease
Treatment, causes, symptoms, diagnosis
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Crohns Disease & Perianal Crohn's Disease - Treatment, causes, symptoms, diagnosis.
If you have been diagnosed with Crohn's disease, it is important to know how to manage your primary symptoms but also to recognize that secondary health complications may arise. Perianal disease is a secondary health complication that is common in Crohn's disease.
Perianal Crohn's disease has been reported in 13% to 43% of patients with Crohn's disease.i Most often, the symptoms of perianal disease begin as simply inflammation followed by the development of fistulas and abscess.
This site is designed to help you understand more about the diagnosis and treatment of Crohn's disease, and hence ulcerative colitis as well, and its impact on the day to day lives of patients and their families.
What is Crohn's Disease? What is the definition on Crohn's disease?
Crohn's disease, also known as regional enteritis, is an inflammatory disease which may affect any part of the gastrointestinal (GI) tract from the mouth all the way down to the anus; as a result, the symptoms of Crohn's disease vary among afflicted individuals.
Crohn's disease is an autoimmune disease, caused by the immune system attacking and causing inflammation in the GI tract. It is classified as a type of inflammatory bowel disease (IBD).
The other type of inflammatory bowel disease is called ulcerative colitis, and in about 10% of cases of inflammatory bowel disease, the diagnosing surgeon is unable to state whether it is is Crohn's disease or ulcerative colitis, as the two conditions are very similar to each other. Some even refer to both as Crohn's colitis.
Crohn's disease is characterized by areas of inflammation with areas of normal lining between, in a symptom known as “skip lesions”. The area of inflammation in Crohn's disease is nearly always found in the ileocecal region, which consists of the last few inches of the small intestine (ileum) where it joins the first part of the large intestine (cecum).
Crohn's disease is a chronic (ongoing) disorder characterized by inflammation of the digestive or gastrointestinal (GI) tract. Although it can involve any part of the GI tract, from the mouth to the anus, it most commonly affects the small intestine and/or colon. When the disease flares up, the inflammation may cause abdominal pain, diarrhea, which may or may not be bloody, and generally feeling unwell.
Our bodies have an immune system that protects us from disease and infection. But if you have an autoimmune disease, your immune system attacks itself by mistake, and you can get very sick.
Who Gets Crohn's Disease?
Crohn's disease tends to run in families so we know that genes definitely play a role in the etiology of the disorder. Studies have shown that if a person has a relative with Crohn's disease, his or her risk of developing this disease is about 10 times greater than that of the general population. If that relative is a sibling (brother or sister), the risk is 30 times greater.
Interestingly, smokers are three times more likely to get Crohn's disease than nonsmokers.ii
What Are the Symptoms of Crohns Disease?
Since Crohn's disease can affect any part of the GI tract, it can cause a wide variety of symptoms that vary among individuals. That's why it's important for you to know which part of your intestine is affected by Crohn's disease.
Nevertheless, the hallmark symptoms of Crohn's disease are:
Abdominal pain may be the initial symptom of Crohn's disease. The pain is commonly cramp-like and may be relieved by defecation. It is often accompanied by diarrhea, which may or may not be bloody. Flatulence and bloating may also add to the intestinal discomfort.
Loss of appetite and subsequent weight loss also may occur. Fatigue is another common complaint. Children who have Crohn's disease may suffer delayed growth and sexual development.
Perianal discomfort may also be prominent in Crohn's disease. In fact more than 50% of individuals with Crohn's disease will develop perianal disease.
Crohn's disease may also cause complications outside the GI tract such as skin rashes, arthritis, and inflammation of the eye.
Many people with Crohn's disease have symptoms for years prior to the diagnosis. The usual onset is between 15 and 30 years of age but can occur at any age. People with Crohn's disease will go through periods in which the disease flares up, is active, followed by times of remission –periods in which symptoms disappear or decrease.
While Crohn's disease is a serious chronic illness with many complications, it is not considered a fatal disease. Most people will continue to lead useful and productive lives, especially if treatment for perianal Crohn's Disease is made available, as well as treatment for Crohn's Disease in genreal.
How is Crohn's Disease Diagnosed?
The diagnosis of Crohn's disease can sometimes be challenging, and a number of tests are often required to assist the physician in making the diagnosis.
A colonoscopy is the best test for making the diagnosis of Crohn's disease as it allows direct visualization of the colon and the terminal ileum. Finding a patchy distribution of disease, with involvement of the colon or ileum but not the rectum, is suggestive of Crohn's disease.
A biopsy taken during the colonoscopy may help confirm the diagnosis. This procedure involves the removal of a small piece of tissue for closer analysis.
Because Crohn's disease often mimics other conditions and symptoms may vary widely, it may take some time to arrive at the correct diagnosis.
Crohn's Disease references:
i American Gastroenterological Association medical position statement: perianal Crohn's disease. Gastroenterology 2003; 125: 1503-1507.
ii Cosnes J. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice. Best Pract Res Clin Gastroenterol 2004; 18: 481-496.
Written by Dr. Kirchgessner, edited by Donald Urquhart
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