Crohn's Disease Patient Education
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Crohn’s Disease – Patient Education Overview
Crohn’s disease is an inflammatory disorder of the digestive tract (gastrointestinal/GI tract), typically in the lower part of the small intestine or ileum. The swelling penetrates into the intestinal lining. The irritation causes pain and diarrhea from frequent emptying.
Whereas ulcerative colitis has inflammation and ulcers limited to the top-lining layer of the colon, all layers in Crohn’s disease may be affected.
The cause of this disorder is unknown but a well accepted theory is that this is an autoimmune condition where the body’s immune cells mistakenly consider bacteria, foods and lining cells as being foreign invaders and attack them, causing extensive inflammation. High levels of Tumor Necrosis Factor have been identified with this condition.
Symptoms include:
- Diarrhea
- Abdominal pain
- Possible fever
- Possible skin problems
- Possible arthritis
- Bleeding
- Anemia
- Delayed development and stunted growth in children
The most common complication of Crohn’s disease is an intestinal blockage from swelling and scar tissue causing a narrowing of the intestinal passage. Nutritional deficiencies are also common.
Doctors Who Treat Crohn’s Disease – Patient Education
As Crohn’s Disease is diagnosed, treated and managed, you may encounter the following team of doctors and specialists listed in this patient education guide.
- Gastroenterologists - A physician who specializes in the health and conditions of the digestive system and digestive organs. Gastroenterologists are the main doctor you will see for your Crohn’s Disease.
Review our Crohn’s patient information guide about other physicians you may encounter including:
- Nutritionists - Devise diet plans to maximize the health of the individual along with the appropriate vitamins and supplements.
- Psychologists - Provide therapy for patients through counseling and psychotherapy.
- Psychiatrists - Medical doctor focusing on health and disorders of the mind and mood; may prescribe medications in addition to the psychotherapy needed.
- Holistic Practitioners - View the body as a whole, considering physical, mental and spiritual components; herbs and nutritional supplements are considered in addition to meditation, cleansing, diet and exercise programs.
Crohn’s Disease Doctor Visit – Patient Education
Having made your appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your Crohn’s disease visit which are listed in this patient education guide:
- Bring a list of symptoms with date of onset and foods consumed at that time, what makes the symptoms worse, what improves them.
- Record any personal life changes (lost job, stresses, and relationship problems).
- Bring an inventory of all medications being taken.
- Record all past medical history and family history.
- Take along a friend or family member to act as an advocate.
- Bring a list of questions to ask the healthcare provider.
Inform the doctor if you might be pregnant or have latex allergies.
Preparation for Barium Enema
- For 1-3 days prior to the test, follow a clear liquid diet.
- Drink large quantities of noncarbonated clear liquids.
- Laxatives will be advised for intestinal emptying – this may include suppositories or enemas.
Preparation for Barium Swallow
- Eat a low-fiber diet for 2-3 days prior.
- No food, drink or tobacco use after midnight on day of exam.
Questions to Ask Your Doctor About Crohn’s Disease
From your initial diagnosis throughout your treatment and care, you will have questions about your Crohn’s disease. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition.
Question About My Diagnosis
- Are there any other conditions causing my symptoms?
- Can this be Irritable Bowel Syndrome? What’s the difference?
- Can my medication or other conditions be causing these symptoms?
- Does this make me prone to cancer?
Questions About My Treatment
- Are there medications that I can take for relief? How soon after starting the drugs will they start working?
- Why did you choose this particular medication? What are the side effects of this medication?
- If I do not take the medication, what will happen to me?
- Is this condition progressive? Can it be cured?
- Will I need surgery for this in the future?
- Are there medications that I should avoid?
- Is there a clinical trial that I am eligible for?
Questions About My Lifestyle & Family
- Is this hereditary? Can my children get this?
- Is there a special diet that I should follow? Are there foods that I should avoid?
- Must I avoid drinking alcoholic beverages?
- Must I avoid all tobacco products?
- Are there special exercises that can help me?
- Is there a support group that I can join? Are there web forums?
Common Tests or Labs to Diagnose Crohn’s Disease
Three conditions that Crohn’s Disease must be distinguished from are:
- Irritable bowel syndrome (IBS)
- Colon/intestinal cancer
- Diverticulitis
The following tests may be performed to diagnose Crohn’s disease:
|
Test |
Why Test? |
What Happens? |
Normal Result |
|
Stool Sample |
Tests for blood in feces to see if there is bleeding in the intestinal tract |
Place a dab of your stool on a special card and send it to the lab, which adds chemical solutions to see the blood. Home test kits are available |
No blood found |
|
Colonoscopy |
Looks for polyps, abnormal growths, constrictions and ulcers or irregularities of the colon |
Your physician will request that you undergo colon prep 1-2 days prior to the test where you clean out your colon. (This causes frequent, loose stools or diarrhea until the colon is empty) For the test, one often receives a sedative or light general anesthesia after being placed on the exam table. A thin, flexible tube from 48-72 inches is passed up the rectum with a small video camera attached. Videos or pictures are taken of the colon during the procedure. |
Pinkish bowels with no growths, no obstructions or irregularities No inflammation is seen |
|
Sigmoido-scopy |
Lining of the rectum and lower colon (sigmoid) are examined visually. Any abnormal areas are biopsied |
Your physician will request that you undergo an enema one day prior to the test. Clear liquids only may also be advised. For the test, one will be awake, but light sedation may be given. You will lie on your side on the table, curled in a fetal position. As the tube is introduced through your rectum and advanced to the lower colon, air is injected to distend the passage. This may cause bloating, gassiness and cramping. Any abnormal growths are biopsied during this procedure, which takes 5-15 minutes. |
No inflammation, constriction or abnormal growths are visualized |
|
Capsule Endoscopy |
The small intestine is evaluated for polyps, inflammation, ulcers and tumors. (This part of the bowel is not properly visualized with colonoscopy or upper endoscopy |
A sensor device is applied to your abdomen with adhesive sleeves (like tape). The small camera is swallowed and travels naturally through the digestive tract during which time video images are transmitted to a data recorder worn on a belt. After the test is set up, you can go home. The procedure lasts 8 hours, after which you return to the office and the data recorder is removed. The transmitted images are then reviewed on a computer screen. |
No growths, ulcers or inflammation of the small intestine |
|
Double Balloon Endoscopy |
Visualizes the small intestine and allows for biopsies or cauterizations of abnormal areas. |
A prep and liquid diet is recommended for one-day prior and avoidance of aspirin for 10-14 days prior is prudent. After lying on the examination table, IV sedation is given. A flexible tube with two balloons attached to the tube in different sections can be introduced either orally or rectally. The test takes 1-3 hours. Cramping and bloating may be experienced postoperatively. |
No ulcers, growths or inflammation is visualized |
|
Barium Enema |
X-ray imaging of large intestine, seeking any abnormalities |
On the day prior to the test, diet is for clear liquids only and must drink 8 oz. every 2 hours from noon to midnight to be well hydrated. At 4 pm, drink one bottle of Magnesium Citrate and a suppository one hour before bedtime. For the test, you will be positioned on the table and an enema tip is introduced into the rectum whereupon a barium solution is infused. Air is pumped to inflate the bowel during the procedure. X-rays are taken during the procedure. When done, most of the barium is drained but plenty of fluids must be consumed postoperatively to rid the remaining barium from the system. Again, have a laxative prior to bedtime. |
No inflammation (which is seen in Crohn’s disease), no narrowing or strictures, ulcers or growths visualized. |
|
Small Bowel Imaging |
X-rays show narrowing or constriction of the small bowel or partial obstructions |
After cleansing the bowels and liquid only diet, the day before, you are asked to drink a barium liquid. Abdominal x-rays are then taken every 20-30 minutes in various positions once the barium reaches the right colon. |
Normal contour of the small bowel with no constriction, abnormal growths, obstructions, inflammation or ulcers seen on images. |
|
Computerized Tomography (CT scan) |
Looks for inflammation, strictures, abscesses, perforations and fistulas of the bowels |
A machine encircles the body like a tube whereby a series of x-rays are taken. |
No irregularities are visualized involving the stomach, small intestine and colon |
|
Magnetic Resonance Imaging (MRI) |
Looks for bowel obstructions, perianal fistulas, penetrating disease |
Prior to the test, you are asked to remove jewelry, eyeglasses, watches, wigs, dentures, hearing aids and hairpins. You lie down on a table that slides into the opening of a tunnel-like machine. (now open units just cover the body part to be examined). A sedative may be given prior to the examination. Loud thumping or rhythmic banging may be heard during the examination and so earplugs or music may be provided to block the noise. Monitoring of the heart and vital signs are also done during the test. |
No fistulas, inflammation, ulcers, growths seen. |
|
Complete Blood Count (CBC)
|
Tests for anemia or infection (patients with Crohn’s disease often have anemia due to Vitamin B12 or iron deficiency) |
While in a sitting position, after a tourniquet is applied to the arm, a nurse or technician will wipe the area to be punctured with an antiseptic. A needle is then inserted with syringe to draw a sample of blood from your vein- usually either at the inside of the elbow or back of hand. |
WBC=4.5-11 microliters Lymphocytes=25-33% Monocytes=3-7% Eosinophils=1-3% Basohils=0-.75% RBCs Female=4.1-5.1 Male=4.5-5.3 million/cubic mm Hemoglobin Female= 12-16 Male=13-16 g/dL Hematocrit Female=36-46% Male=37-49% |
|
Antibody Testing |
1) Anti-Saccharomyces cerevisiae antibody(ASCA) 2) Perinuclear anti-neutrophil cytoplasmic antibody (pANCA) |
While in a sitting position, a nurse or technician will draw a sample of blood from your arm. |
Tests are negative in normal results. Those with Crohn’s disease are +ASCA and negative for pANCA. Those with ulcerative colitis have the opposite result. |
Common Medications and Treatments for Crohn’s Disease
For severe symptoms of Crohn’s Disease, the following drugs may be administered.
|
Drug Category |
How it works |
|
Intravenous Corticosteroids |
Suppresses immune system to decrease flare-ups of Crohn’s Disease |
|
Biologics |
Target specific proteins that cause inflammation or block cells that lead to inflammation |
Supplements and herbs have had mixed results and can be found in treating the symptoms of Crohn’s Disease.
|
Drug Category |
How it works |
|
Omega-3 Fatty Acids |
Decrease Inflammation Enhance effect of medications taken |
|
Boswellia (frankincense) |
Decreases inflammation
Similar efficacy to mesalazine (drug used for Crohn’s disease) |
|
Slippery Elm |
Acts as an emollient to sooth mucous membranes and inflamed tissue Helps heal irritated tissue |
|
Bromelain (enzyme in pineapples) |
Decreases the secretions of enzymes that cause inflammation (cytokines) |
|
Marshmallow |
Soothes mucous membranes as an emollient |
|
Turmeric |
Anti-inflammatory agent that decreases inflammation |
Stress causes harmful effects on the body by:
- Increasing stomach acids
- Increasing acid reflux
- Decreasing proper digestive actions
By utilizing stress relievers, one helps to decrease the symptoms of diarrhea including abdominal pain, nausea and diarrhea associated with Crohn’s Disease and has been seen to be effective.
Stress relievers include:
• Yoga
• Biofeedback
• Deep breathing exercises
