Crohn's Disease

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Crohn's Disease

Topic Overview

Picture of the lower digestive system

What is Crohn's disease?

Crohn's disease is a lifelong inflammatory bowel disease (IBD). Parts of the digestive system get swollen and have deep sores called ulcers. Crohn’s disease usually is found in the last part of the small intestine and the first part of the large intestine. But it can develop anywhere in the digestive tract, from the mouth to the anus.

What causes Crohn's disease?

Doctors don't know what causes Crohn’s disease. You may get it when the body’s immune system has an abnormal response to normal bacteria in your intestine. Other kinds of bacteria and viruses may also play a role in causing the disease.

Crohn’s disease can run in families. Your chances of getting it are higher if a close family member has it. People of Eastern European (Ashkenazi) Jewish family background may have a higher chance of getting Crohn’s disease. Smoking also puts you at a higher risk for the disease.

What are the symptoms?

The main symptoms of Crohn’s disease are belly pain and diarrhea (sometimes with blood). Some people may have diarrhea 10 to 20 times a day. Losing weight without trying is another common sign. Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and openings (fistulas) between organs.

Infections, hormonal changes, and smoking can cause your symptoms to flare up. You may have only mild symptoms or go for long periods of time without any symptoms. A few people have ongoing, severe symptoms.

It’s important to be aware of signs that Crohn’s disease may be getting worse. Call your doctor right away if you have any of these signs:

  • You feel faint or have a fast and weak pulse.
  • You have severe belly pain.
  • You have a fever or shaking chills.
  • You are vomiting again and again.

How is Crohn's disease diagnosed?

Your doctor will ask you about your symptoms and do a physical examination. You may also have X-rays and lab tests to find out if you have Crohn’s.

Tests that may be done to diagnose Crohn's disease include:

  • Barium X-rays of the small intestine or colon.
  • Colonoscopy or flexible sigmoidoscopy. In these tests, the doctor uses a thin, lighted tube to look inside the colon.
  • Biopsy. The doctor takes a sample of tissue and tests it to find out if you have Crohn’s or another disease, such as cancer.
  • Stool analysis. This is a test to look for blood and signs of infection in a sample of your stool.

How is it treated?

Your treatment will depend on the type of symptoms you have and how bad they are.

There are a few steps you can take to help yourself feel better. Take your medicine just as your doctor tells you to. Exercise, and eat healthy meals. Don't smoke. Smoking makes Crohn’s disease worse.

The most common treatment for Crohn’s disease is medicine. Mild symptoms of Crohn's disease may be treated with over-the-counter medicines to stop diarrhea. But talk with your doctor before you take them, because they may cause side effects.

You may also use prescription medicines. They help control inflammation in the intestines and keep the disease from causing symptoms. (When you don't have symptoms, you are in remission.) These medicines also help heal damaged tissue and can postpone the need for surgery.

Crohn’s disease makes it hard for your body to absorb nutrients from food. A meal plan that focuses on high-calorie, high-protein foods can help you get the nutrients you need. Eating this way may be easier if you have regular meals plus two or three snacks each day.

How do you cope with Crohn's disease?

Having Crohn’s disease can be stressful. The disease affects every part of your life. Seek support from family and friends to help you cope. Get counselling if you need it.

Many people with inflammatory bowel diseases look to alternative treatments to improve their well-being. These treatments have not been proved effective for Crohn’s disease, but they may help you cope. They include massage, supplements such as vitamins D and B12, and herbs like aloe and ginseng.

Frequently Asked Questions

Learning about Crohn's disease:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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Cause

The cause of Crohn's disease is unknown. This disease may result from an abnormal response by the body's immune system to normal intestinal bacteria.1 Disease-causing bacteria and viruses also may play a role.

Crohn's disease can run in families, so some people may be more likely than others to develop the condition when exposed to something that triggers an immune reaction. Environmental factors may also play a role in causing this disease.

Symptoms

The main symptoms of Crohn's disease include:

  • Abdominal pain. The pain often is described as cramping and intermittent, and the abdomen may be sore when touched. Abdominal pain may turn to a dull, constant ache as the condition progresses.
  • Diarrhea. Some people may have diarrhea 10 to 20 times a day. They may wake up at night and need to go to the bathroom. Crohn's disease may cause blood in stools, but not always.
  • Loss of appetite.
  • Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that you have a complication involving infection, such as an abscess.
  • Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss.
  • Too few red blood cells (anemia). Some people with Crohn's disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.

People with Crohn's disease also may have:

  • Sores in the mouth.
  • Nutritional deficiencies, such as lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food.
  • Bowel obstruction.
  • Signs of disease in or around the anus. These may include:
    • Abnormal tunnels or openings called fistulas that sometimes form between organs. These develop because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall. Fistulas may form between parts of the intestine or between the intestine and another organ such as the bladder, vagina, or skin. A fistula may be the first sign of Crohn's disease.
    • Pockets of infection (abscesses).
    • Small tears in the anus (anal fissures).
    • Skin tags that may resemble hemorrhoids. These are caused by inflamed skin.

Because there is some immune system involvement, you also may have symptoms outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.

Other conditions with symptoms similar to Crohn's disease include diverticulitis and ulcerative colitis.

What Happens

Crohn's disease is an ongoing (chronic) condition that may flare up throughout your life. The course of the disease varies greatly from one person to another. Some people may have only mild symptoms, while others may have severe symptoms or complications that, in unusual cases, may be life-threatening.

Crohn's disease may be mild, moderate, severe, or not active (in remission). It may be defined by the part of the digestive tract involved, such as the rectum and anus (perianal disease) or the area where the small intestine joins the large intestine (ileocecal disease). Some people may have features of both Crohn's disease and ulcerative colitis, the other major type of inflammatory bowel disease (IBD).

Crohn's disease can cause symptoms outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.

Because Crohn's disease can cause inflammation in parts of the intestines that absorb nutrients from food, it can cause deficiencies in vitamin B12, folic acid, or other nutrients. The disease can increase the risk of gallstones, kidney stones, and certain uncommon forms of anemia.

In long-term Crohn's disease, scar tissue may replace some of the inflamed or ulcerated intestines, forming blockages (bowel obstructions) or narrowed areas (strictures) that can prevent stool from passing through the intestines. Blockages in the intestines also can be caused by inflammation and swelling, which may improve with medicines. Sometimes blockages can only be treated with surgery.

If sores break through the wall of the intestines, abnormal connections or openings (fistulas) may develop between two parts of the intestines, between the intestines and other organs (such as the bladder or vagina), or between the intestines and the skin. In rare cases, this can lead to infection of the abdominal wall.

Crohn's disease of the colon and rectum that has been present for 8 years or longer increases the risk of cancer. With regular screening, some cancers can be detected early and treated successfully.

Most women who have Crohn's disease can have a normal pregnancy and deliver a healthy baby. The best idea is to wait until the disease is in remission before becoming pregnant. Women who become pregnant when their disease is under control are more likely to avoid flare-ups during pregnancy. Some medicines used to treat the disease can be used during pregnancy.

What Increases Your Risk

Factors that may increase your risk of developing Crohn's disease include:

  • Having a family history of Crohn's disease. Your risk increases if an immediate family member, such as a parent, brother, or sister, has the disease.
  • Having Ashkenazi Jewish ancestry.
  • Smoking cigarettes.

Factors that may cause Crohn's disease symptoms to flare up include:

  • Medicines.
  • Infections.
  • Hormonal changes.
  • Lifestyle changes.
  • Smoking.

When To Call a Doctor

Call a doctor immediately if you have been diagnosed with Crohn's disease and you have one or more of the following:

  • Fever or shaking chills
  • Light-headedness, passing out, or rapid heart rate
  • Stools that are almost always bloody
  • Severe dehydration
  • Severe abdominal pain or severe pain and bloating
  • Evidence of pus draining from the area around the anus or pain and swelling in the anal area
  • Repeated vomiting
  • Not passing any stools or gas

If you have any of these symptoms and you have been diagnosed with Crohn's disease, your condition may have become significantly worse. Some of these symptoms also may be signs of toxic megacolon, a rare complication of Crohn's disease that requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.

People who have Crohn's disease usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:

  • Your symptoms become significantly worse than usual.
  • You have persistent diarrhea for more than 2 weeks.
  • You have lost weight.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by Crohn's disease, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.

Even when the disease is not active (in remission), your doctor will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your doctor's office for advice.

Who To See

Your family doctor or general practitioner can diagnose Crohn's disease.

To help you manage Crohn's disease, you will probably be referred to a gastroenterologist.

To be evaluated for surgery, you may be referred to a:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Crohn's disease is diagnosed through a medical history and physical examination, imaging tests to look at the intestines, and laboratory tests.

Crohn's disease can be difficult to diagnose. The disease may go undiagnosed for years because symptoms usually develop gradually and the same part of the intestine is not always involved. Other diseases can also have the same symptoms as Crohn's disease. But Crohn's disease tends to cause the intestine to have a cobblestone appearance, which can help doctors diagnose it. The pattern results from the repeated formation and healing of sores (ulcers) in the intestine.

Tests used to diagnose Crohn's disease include:

  • Flexible sigmoidoscopy or colonoscopy, in which a lighted viewing instrument is used to look at the inside of the colon. In general, colonoscopy is the preferred test because it can be used to examine the entire colon. Sigmoidoscopy reaches only the last part of the colon.
  • Abdominal X-ray, which provides a picture of possible obstruction in the abdomen.
  • Upper gastrointestinal (UGI) series with small-bowel follow-through to examine all of the small intestine. In this test the doctor examines the upper and part of the middle portions of the digestive tract. After you swallow a "shake" made of a white liquid (barium) and water, continuous X-rays (fluoroscopy) are taken to track the movement of the barium through the esophagus, stomach, and the small intestine. A video monitor displays the images.
  • Upper gastrointestinal endoscopy, which allows your doctor to look at the interior lining of your esophagus, stomach, and duodenum with a thin, flexible imaging instrument called an endoscope.
  • Barium enema, a test that allows the doctor to examine the large intestine (colon). For a barium enema, a white liquid (barium) is inserted through the rectum into the colon. The barium outlines the inside of the colon so that it can be more clearly seen on an X-ray.
  • Computed tomography (CT) scan, which uses X-rays to produce detailed pictures of structures inside the body. A CT enterography may be done. This type of CT scan looks specifically at your small intestine for signs of Crohn's disease.
  • Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.
  • Standard blood tests and urine tests, which may be used to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) blood test may be done to look for infection or inflammation.

A biopsy of a sample of tissue from the lining of the intestine, collected during sigmoidoscopy or colonoscopy, can be used to confirm the diagnosis of Crohn's disease. A biopsy also may be done to find out whether a tumour is present. Multiple biopsies for cancer screening are often done in people who have had Crohn's disease of the colon or rectum for 8 years or more. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and remove only a tiny piece of tissue.

A stool analysis is often done, depending on symptoms, to look for blood, signs of bacterial infection, malabsorption, parasites, or the presence of white blood cells. This test can be used to distinguish Crohn's disease from irritable bowel syndrome (IBS), which is a less serious condition that sometimes has similar symptoms.

Other examinations and tests that may also be used to evaluate Crohn's disease include:

  • Video capsule endoscopy (VCE), in which you swallow a tiny camera that records its trip through your digestive tract by sending images to a recording device that you wear on a belt. Your doctor later examines the images by downloading them from the recording device. The camera passes out of your body in stool within 10 to 48 hours. VCE is particularly useful in examining the small intestine, which is difficult to see with other endoscopic tests.
  • Small bowel enteroscopy, which uses a longer, lighted flexible tube with a tiny camera that sends pictures of the small intestine to a video screen. This helps the doctor look at the small intestine. The doctor can also take small samples (biopsy) of the tissue.
  • Blood tests to find antibodies, which can sometimes help the doctor tell if you have Crohn's disease or ulcerative colitis. These tests include anti-neutrophil cytoplasmic antibody with perinuclear staining (pANCA), anti-Saccharomyces cerevisiae antibody (ASCA), and outer membrane porin C (Omp C).

Early Detection

No screening test exists for Crohn's disease at this time. But if you have had Crohn's disease affecting the colon or rectum for 8 years or longer, discuss with your doctor whether you need screening for colon cancer. Screening usually involves taking multiple-tissue biopsies during routine colonoscopy.

Treatment Overview

The main treatment for Crohn's disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery. The type of symptoms you have and how bad they are will determine the treatment you need.

Initial treatment

Your doctor will most likely start with the traditional first-line treatment for Crohn's disease. He or she will then add or change medicines if you are not getting better.

Mild symptoms may respond to an antidiarrheal medicine such as loperamide (Imodium, for example), which slows or stops the painful spasms in your intestines that cause symptoms.

For mild to moderate symptoms, your doctor will probably have you take:

  • Aminosalicylates (such as sulfasalazine or mesalazine). These medicines help manage symptoms for many people who have Crohn's disease.
  • Antibiotics (such as ciprofloxacin or metronidazole). These may be tried if aminosalicylates are not helping. They are also used to treat fistulas and abscesses.
  • Corticosteroids (such as budesonide or prednisone). These may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection.
  • Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine or mercaptopurine. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.
  • Biologics (such as infliximab or adalimumab). Your doctor may have you try these medicines if you have not had success with other medicines for Crohn's disease. In some cases, these medicines are tried before some of the other medicines that are listed above. They are also used to treat fistulas.

Severe symptoms may be treated with corticosteroids given through a vein (intravenous, IV) or biologics. With severe symptoms, the first step is to control the disease. When your symptoms are gone, your doctor will probably have you start taking one of the medicines listed above to keep you symptom-free (in remission).

Ongoing treatment

Ongoing treatment is designed to find a medicine or combination of medicines that keeps Crohn's disease in remission.

If aminosalicylates or immune system suppressors keep your disease in remission, you will continue taking the medicines. Your doctor will want to see you about every 6 months if your condition is stable or more frequently if you have flare-ups. You may have lab tests every 2 to 3 months.

Corticosteroids may be given to stop inflammation if you have flare-ups of symptoms. If you need to take corticosteroids for an extended time, you also may receive calcium, vitamin D, and prescription medicine to prevent osteoporosis.

Biologics are also used as maintenance medicines.

Treatment if the condition gets worse

If you have a very bad flare-up of Crohn's disease, you will most likely need IV corticosteroids (like hydrocortisone) to get the disease under control.

Some severe cases of Crohn's disease need to be treated in the hospital where you would receive supplemental nutrition through a tube placed in your nose and down into the stomach (enteral nutrition). In other cases, the bowel may need to rest, and you will be fed liquid nutrients in a vein (total parenteral nutrition, TPN). Supplemental nutrition may be needed if you are malnourished because of severe Crohn's disease in the small intestine. Nutritional support is especially important for children who are not growing normally because of severe disease.

Surgery may be needed if no medicine is effective, if you have serious side effects from medicine, if your symptoms can be controlled only with long-term use of corticosteroids, or if you develop complications such as fistulas, abscesses, or bowel obstructions. Surgery involves removing the affected portion of the intestines, preserving as much of the intestines as possible to maintain normal function. Crohn's disease tends to return to other areas of the intestines after surgery.

Prevention

Crohn's disease cannot be prevented, because the cause is unknown. But you can take steps to reduce the severity of the disease.

  • Medicines taken regularly may reduce sudden (acute) attacks and keep the disease in remission (a period without symptoms).
  • Most experts recommend acetaminophen (Tylenol, for example) for pain relief rather than non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. NSAIDs have been linked to flare-ups.
  • Do not smoke. Smoking makes Crohn's disease worse.
  • Eat a healthy diet.
  • Never use antibiotics unless they have been prescribed for you by a doctor.
  • Get regular exercise.

Home Treatment

If Crohn's disease does not cause symptoms, no treatment is needed. Mild symptoms may respond to antidiarrheal medicines or changes in diet and nutrition. For more information about making good food choices, see:

Click here to view an Actionset. Bowel Disease: Changing Your Diet.

In general, doctors recommend that you do not use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. These medicines may cause flare-ups of Crohn's disease. But some people may be more likely to have flare-ups from NSAIDs than others. Talk to your doctor about whether to avoid these medicines.

If you have had or are planning to have surgery that will create an opening from the intestines to the outside of the body through which stool passes (ostomy), you may feel self-conscious or embarrassed. After a period of adjustment, most people are able to resume all of their usual activities. In fact, life may be better than it was before surgery because you may no longer suffer painful symptoms. Support groups are available for people with ostomies. For more information on taking care of your ostomy, see:

Click here to view an Actionset. Bowel Disease: Caring for Your Ostomy

Children who have Crohn's disease may feel self-conscious if they do not grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing the disease than adults, so your support is especially important.

Medications

Medicines usually are the treatment of choice for Crohn's disease. They can control or prevent inflammation in the intestines and help:

  • Relieve symptoms.
  • Promote healing of damaged tissues.
  • Put the disease into remission and keep it from flaring up again.
  • Postpone the need for surgery.

Medication Choices

The choice of medicine usually depends on the severity of the disease, the part of the intestines that is affected, and whether complications are present. Medicines that are used for Crohn's disease include:

  • Aminosalicylates (such as sulfasalazine or mesalazine).
  • Antibiotics (such as ciprofloxacin or metronidazole). Antibiotics are used to treat fistulas.
  • Corticosteroids (such as budesonide or prednisone). Corticosteroids usually stop symptoms and put the disease in remission. But they are not used as long-term treatment to keep symptoms from coming back.
  • Medicines that suppress the immune system (such as azathioprine, mercaptopurine, and methotrexate). These may be needed to help keep the disease in remission.
  • Biologics (such as infliximab or adalimumab). These may be used for people who develop abnormal connections between the intestines and other organs (fistulas) or who have severe Crohn's disease that does not respond to other medicines.
  • Cyclosporine and intravenous (IV) corticosteroids may be needed for severe cases.

What To Think About

Most of these medicines also can be used in children.

If you are pregnant or planning to become pregnant, talk to your doctor about which medicines might be okay to take for Crohn's disease. Sometimes, severe Crohn's disease can harm your baby more than the medicines you are taking to keep it under control. Some medicines, though, should never be taken when you are pregnant. Your doctor can tell you which medicines are okay for you while you are pregnant and nursing.

Surgery

Surgery is rarely done for Crohn's disease and it is not a cure. When surgery is needed, as little of the intestines as possible is removed to preserve normal function. The disease tends to return in areas that were previously not affected, and you may need surgery again.

Surgery may be needed for Crohn's disease if no medicine can control your symptoms, if you have serious side effects from medicines, if your symptoms can be controlled only with long-term use of corticosteroids, or if you develop complications.

Surgery Choices

Surgery is not usually done for Crohn's disease. If you do have surgery, it will most likely be one of the following:

  • Resection: The diseased portion of the intestines is removed, and the healthy ends of the intestine are reattached. Resection surgery does not cure Crohn's disease, which often comes back near the site of surgery.
  • Strictureplasty: The surgeon makes a lengthwise cut in the intestine and then sews the opening together in the opposite direction. This makes the intestine wider and helps with obstruction of the bowels. This is sometimes done at the same time as resection or when a person has had resection in the past. Strictureplasty is used when the doctor is trying to save as much of the intestine as possible.
  • Proctocolectomy and ileostomy: The surgeon removes the large intestine and rectum, leaving the lower end of the small intestine (the ileum). The anus is sewn closed, and a small opening called a stoma is made in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body, where stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.
Click here to view an Actionset. Bowel Disease: Caring for Your Ostomy

Another procedure that may be done is balloon dilation. This is not a surgery. The doctor runs an endoscope through your intestines from your anus. The endoscope is a long, thin tube that has a video camera on the end. Next, the doctor uses the endoscope to thread an uninflated balloon across the stricture (the narrowed part of the intestine). When the balloon is inflated, it makes that part of the intestine wider. The balloon is deflated and then removed. Balloon dilation is a new technique and not as much is known about its long-term success compared to the surgical procedures listed above. Balloon dilation might be done if you want to put off a more complicated surgery for a while or if you have had surgery before and the doctor wants to save as much of the intestines as possible.

What To Think About

These surgeries can be done on children. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.

In rare cases, intestinal transplant is used to treat Crohn's disease. In this complex procedure, the small intestine is removed and replaced with the small intestine of a person who has recently died and donated his or her organs.

Other Treatment

Some people who have Crohn's disease need additional nutrition because severe disease prevents their small intestine from absorbing nutrients. Supplemental liquid feedings may be done through a tube placed in the nose and down into the stomach (enteral nutrition) or through a vein (total parenteral nutrition, or TPN). Supplemental feeding may be needed when:

  • Crohn's disease is not controlled with standard treatment.
  • Short bowel syndrome occurs. This happens when so much of the small intestine has been surgically removed or is affected by the disease that you cannot properly digest food and absorb enough nutrients.
  • Bowel blockage occurs.

Nutritional therapy may restore good nutrition to children who are growing more slowly than normal. It also can build strength if you need surgery or have been weakened because of severe diarrhea and poor nutrition.

Total parenteral nutrition allows the intestines to rest and heal. But it is common for symptoms to return when TPN is stopped and you go back to a regular diet. TPN does not change the long-term outcome of Crohn's disease.

Counselling for Crohn's disease

Crohn's disease can affect every aspect of your life. It may make you feel isolated or depressed. But you can take steps to improve your outlook and coping skills. You may want to seek professional counselling and social support from family, friends, or clergy.

Other Treatment Choices

Nutritional supplements

Complementary medicine

Many people with inflammatory bowel disease consider nontraditional or complementary medicine in addition to prescription medicines. They may turn to these alternatives because there is no cure for Crohn's disease. People may also use complementary medicine to help in coping with:

  • The difficult side effects from standard medicines.
  • The emotional strain of dealing with a chronic illness.
  • The negative impact of severe disease on daily life.

These therapies have not been proven effective for Crohn's disease, but they may improve your overall well-being.

The various complementary therapies include:

  • Special diets or nutritional supplements, such as probiotics, evening primrose, and fish oils.
  • Vitamin supplements, such as vitamins D and B12.
  • Herbs, such as aloe and ginseng.
  • Massage.
  • Stimulation of the feet, hands, and ears to try to affect parts of the body (reflexology).

What To Think About

Nutritional supplements can help people receive enough essential nutrients, but they are expensive.

TPN can cause metabolic imbalances. It also can raise the risk of a bloodstream infection from the catheter in the vein, which is needed to give TPN. Long-term use of TPN may raise the risk of liver problems or liver failure.

Other Places To Get Help

Organizations

American Society of Colon and Rectal Surgeons
85 West Algonquin Road
Suite 550
Arlington Heights, IL  60005
Phone: (847) 290-9184
Fax: (847) 290-9203
Email: ascrs@fascrs.org
Web Address: www.fascrs.org
 

The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1,000 board-certified colon and rectal surgeons and other surgeons dedicated to treating people with diseases and disorders affecting the colon, rectum, and anus.


Children's Digestive Health and Nutrition Foundation (CDHNF) (U.S.)
P.O. Box 6
Flourtown, PA  19031
Phone: (215) 233-0808
Email: cdhnf@cdhnf.org
Web Address: www.cdhnf.org
 

The Children's Digestive Health and Nutrition Foundation (CDHNF) Web site helps parents, children, and teens learn more about reflux and GERD, celiac disease, inflammatory bowel disease, and other digestive disorders in children.


Crohn's and Colitis Foundation of Canada (CCFC)
600-60 St. Clair Avenue East
Toronto, ON  M4T 1N5
Phone: (416) 920-5035
1-800-387-1479
Fax: (416) 929-0364
Email: ccfc@ccfc.ca
Web Address: www.ccfc.ca
 

The Crohn's and Colitis Foundation of Canada is a national not-for-profit voluntary medical research foundation. The CCFC raises funds for medical research, and provides educational and informational materials on inflammatory bowel disease (IBD) to patients, their families, health professionals, and the general public. The CCFC has many local chapters across Canada.


United Ostomy Association of Canada
P.O. Box 825-50 Charles Street East
Toronto, ON  M4Y 2N7
Phone: (416) 595-5452
1-888-969-9698
Fax: (416) 595-9924
Email: info@ostomycanada.ca
Web Address: www.ostomycanada.ca

Wound, Ostomy and Continence Nurses Society (WOCN)
15000 Commerce Parkway
Suite C
Mt. Laurel, NJ  08054
Phone: 1-888-224-WOCN (1-888-224-9626)
Web Address: www.wocn.org
 

The Wound, Ostomy and Continence Nurses Society (WOCN) is a professional, international nursing society of more than 4,200 health professionals who are experts in the care of people who have wounds, ostomies, and incontinence. The Web site offers a way to search for a Wound, Ostomy and Continence Nurse in your area. WOCN also publishes patient guides, lists other related Web sites, and has information about specialty clothing and accessories for people who have wounds, ostomies, and continence disorders.


References

Citations

  1. Sands BE (2006). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2459–2498. Philadelphia: Saunders Elsevier.

Other Works Consulted

  • Ali M, et al. (2004). Video capsule endoscopy: A voyage beyond the end of the scope. Cleveland Clinic Journal of Medicine, 71(5): 415–425.
  • American Gastroenterological Association (2006). American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology, 130(3): 935–939. Available online: http://www.gastro.org/practice/medical-position-statements.
  • American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738–745. Available online: http://www.gastro.org/practice/medical-position-statements.
  • Strong SA, et al. (2007). Practice parameters for the surgical management of Crohn's disease. Diseases of the Colon and Rectum, 50(11): 1735–1746.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Arvydas D. Vanagunas, MD - Gastroenterology
Last Revised December 8, 2010

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