Crohn’s Disease: An Expert Explains Signs, Treatments and More How to Manage Symptoms of Crohn’s Disease

How does Crohn’s disease start? Is it the same thing as ulcerative colitis? Do I have to change my diet permanently? If you or someone you know were recently diagnosed with Crohn’s, you have a lot of questions. We talked to a top gastroenterologist to get the answers about this inflammatory bowel disease... If you frequently suffer from chronic diarrhea, stomach cramping, nausea and fatigue, you may think you are just prone to tummy troubles. But you could have Crohn’s disease, an autoimmune disease that causes inflammation of the digestive or gastrointestinal (GI) tract. “Crohn’s disease can attack any part of the GI tract from the mouth to the anus, but usually affects the small intestine and/or colon,” says Armen Simonian, M.D., head of gastroenterology at Capital Health Systems in Trenton, N.J., and chairman of the Department of Medicine. “The disease can be mistaken for gut or parasitic infections, stomach flu, food poisoning, gluten allergy, irritable bowel syndrome, and even lupus or appendicitis,” he says. Also, because Crohn’s is a systemic disease, it can manifest anywhere in the body, causing skin conditions, joint problems, eye diseases, arthritis and even gallstones, says Simonian. Fortunately, with today’s treatments, which include anti-inflammatory drugs, antibiotics, corticosteroids, biologics, or immune suppressants and surgery, “some women have remissions that last years or the rest of their lives, although it’s more common for remissions to last months or a few years,” he says. In this exclusive Lifescript interview, Simonian discusses the causes and complications of Crohn’s disease and its impact on women. Is Crohn’s disease inherited? Scientists believe you may inherit a genetic predisposition to the disease. In fact, about 20% of my patients have a close relative with Crohn’s. If you have a relative with Crohn’s disease, you’re 10 times more likely to develop the disease. If a sibling has it, your risk jumps to 30%. If both parents have inflammatory bowel disease, your risk is 35%. Jewish people of European descent also have a greater risk. How long does it take to diagnose Crohn’s disease? In the past, most women had symptoms for two years before getting diagnosed because they went back and forth to their family physician and never saw a gastroenterologist. Since symptoms of Crohn’s disease — chronic diarrhea, stomach cramping and nausea — are present in hundreds of conditions, it’s easy to understand why it isn’t more quickly diagnosed. Today, with greater awareness of Crohn’s disease among family physicians and the public, and better access to diagnostic tests, like colonoscopy and CT [computerized axial tomography] scans, most women are diagnosed within six months. How do physicians diagnose Crohn’s disease? We use several tests and procedures, including endoscopy, colonoscopy, X-rays, CT scan and a biopsy to confirm results. Colonoscopy is the best approach to monitor Crohn’s because it provides direct visualization of the intestines, so we can detect polyps and growths before they cause trouble. Isn’t there an easier way than colonoscopy to monitor Crohn’s? Unfortunately not. While the pill camera, or capsule endoscopy, is less invasive (you swallow a vitamin-sized pill embedded with a tiny video camera that takes 60,000 photos in six hours while traveling down your intestinal tract), it isn’t as effective at detecting polyps and abnormal growths as colonoscopy. Also, because many patients with Crohn’s have narrowed intestines and stricture, the pill could get stuck and require an emergency procedure to remove it. Over the past few years, colonoscopies have become much more comfortable. The worst part is preparation, which entails fasting and drinking an electrolyte-based solution to purge [the bowels]. Besides genetics, does anything cause or trigger Crohn’s? There’s no specific trigger for Crohn’s, but certain environmental factors can predispose you to the disease. And some factors can protect you from the disease. For example, if you were breast-fed as a baby, you’re less likely to get Crohn's. You’re also less susceptible if you eat lots of fruits and vegetables and less refined sugars. On the flipside, oral contraceptives slightly increase the risk of Crohn’s, although it’s not clear why. Over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, aspirin, naproxen and prescription NSAIDs like Celebrex and Motrin also increase the risk – possibly because they weaken intestines and make them more vulnerable to inflammation. You’re also at higher risk if you smoke, because nicotine inflames and irritates the intestines. If you continue smoking after diagnosis, you’re likely to have more severe symptoms [of Crohn’s disease]. Do symptoms of Crohn’s disease differ from ulcerative colitis? These two types of inflammatory bowel disease (IBD) share many symptoms, [but] Crohn’s affects the entire intestinal tract while ulcerative colitis affects just the colon. In Crohn’s disease, the entire intestine is inflamed. In ulcerative colitis, the inflammation is on the surface. The biggest difference is that we can cure ulcerative colitis by surgically removing the colon. But we can’t cure Crohn’s. In Crohn’s, if we removed the affected segment of colon, the disease could grow back. If we removed the entire colon, the disease could spread to the small intestine. Once diagnosed, what should a woman do? Getting diagnosed with an incurable disease that [you’ll] have for the rest of your life is a huge psychological hit, so you should have a supportive community. The Crohn’s and Colitis Foundation of America offers many resources on how to get the help and support you need. What’s next? See your primary doctor and gynecologist regularly to troubleshoot problems or side effects of medications. If you have Crohn’s disease, your immune system is compromised and overworked, increasing the risk of infection. To stay protected, get vaccinated against flu, pneumonia and tetanus, and get treated early for colds, flu, viruses and infections. If you’re taking biologics, which are genetically engineered drugs made from human genes, avoid “live-virus” vaccines for measles-mumps-rubella or varicella. Biologics suppress the immune system, so you may develop a viral infection from these extremely potent vaccines. Instead, get ‘dead-virus’ vaccines, which are safe for women taking biologics. Fortunately, most vaccines today are made from dead viruses, and there are many alternatives for live-virus vaccines. If your only option is a live-virus vaccine, stop taking biologics and wait a few months before getting the vaccine. Do women’s with Crohn’s disease face other health risks? During a Crohn’s flare, chronic diarrhea, nausea and malabsorption can lead to vitamin and mineral deficiencies that can undermine health and cause bone loss. Medications like corticosteroids also deplete vitamin-D reserves and further increase the risk of osteopenia and osteoporosis. Since women with Crohn’s have a high rate of hip and back fractures, according to the Osteoporosis and Related Bone Diseases National Resource Center in Washington, D.C., you should get an annual DEXA scan (dual Energy X-ray absorptiometry), a non-invasive test that measures bone mineral density and is one of the most accurate ways to diagnose osteopenia and osteoporosis. While Crohn’s carries no increased risk for cervical dysplasia, cervical cancer, ovarian cancer or breast cancer, you should get an annual pap smear and mammograms to protect yourself against infection and cancer. If you develop unusual symptoms like a skin rash, eye problems or sore joints, see your gastroenterologist to determine if the symptoms are caused by Crohn’s. What diagnostic tests should women with Crohn’s disease get? See your gastroenterologist twice a year for routine blood tests that detect common problems like anemia, dehydration and vitamin deficiencies. How does diet affect Crohn’s disease? If you’re having a flare, you want some degree of bowel rest. That means you should eat a bland, low-fiber diet that is easy to digest, and also eat smaller meals. If you’re having a severe flare, you may do better on liquid meal replacements (Ensure, Boost, Carnation Instant Breakfast). A 2006 study conducted at the University Medical Center Utrecht in The Netherlands found that spicy foods, cabbage and citrus fruits (or juice) were most likely to cause irritation, while potato products, bread and bananas were least likely to cause problems. If you’re not flaring, you should eat a high-calorie, high-protein diet. Your body needs a lot of energy to fight a chronic disease like Crohn’s. What vitamin deficiencies do Crohn’s patients face? Many women with Crohn’s have deficiencies in several vitamins and minerals, including B12, which is absorbed at the end of the small bowel, the most common site for Crohn’s. They may also be deficient in potassium and magnesium, due to diarrhea, vomiting and corticosteroids. They may have iron deficiency from blood loss caused by inflammation and ulceration of the colon. Medications like sulfasalazine and methotrexate deplete folic acid. And corticosteroids deplete vitamin D reserves. Women with Crohn’s may be deficient in calcium because many can’t digest dairy products, and corticosteroids interfere with calcium absorption. And they may be deficient in fat-soluble vitamins, including vitamins A, E and K, because of malabsorption problems. If blood tests indicate a deficiency, your physician can prescribe supplements to restore levels to normal. If you’re deficient in vitamin B12 because you’re not absorbing it, you can get vitamin B12 injections. Since Crohn’s can spread to your liver, it’s also important to get a liver enzyme test, a simple blood test that detects liver damage. Can supplements help with the symptoms of Crohn’s disease? Fish oil is an amino acid, and several studies have shown that it may ease pain and inflammation. However, for every 10 studies that say fish oil helps Crohn’s patients, there are 10 that say it harms them. Fish oil has side effects like bloating, diarrhea and stomach upset that are hard for many women with Crohn’s to tolerate. A 2011 study at Hebrew University of Jerusalem of more than 1,000 people with Crohn's found that neither omega-3 fatty acids nor fish oil helped relieve systems or put them in remission. Is it safe for a woman with Crohn’s disease to get pregnant? It’s very safe, but wait until your disease is in remission. Women with Crohn’s who aren’t in remission have a higher risk of giving birth prematurely, or having a spontaneous abortion or stillbirth. Most (but not all) Crohn’s medications don’t pass into breast milk, so breast-feeding probably won’t be a problem. Talk to your gastroenterologist to ensure your medications won’t affect your newborn. A 2007 study conducted at the University of Lausanne in Switzerland found that most women in remission with Crohn’s had healthy pregnancies even when they took medications. Methotrexate, an anti-inflammatory drug used in Crohn’s, was the only drug deemed unsafe to take during pregnancy and breastfeeding Some women with Crohn’s disease might have to undergo surgery to remove inflamed areas of the pelvic region. How would that affect fertility or pregnancy? If Crohn’s spreads to your reproductive organs, you may need surgery. A byproduct of surgery can be adhesions and scar tissues that trap the fallopian tubes and make it harder to conceive. But never avoid or postpone surgery because you want to get pregnant. Your condition could get worse and cause complications. If you’ve already had surgery, you can still try to get pregnant as long as you’re in remission, but it may take you longer to conceive. Does Crohn's disease affect libido and mood? If you’re having a flare, your libido could be low because you have chronic diarrhea and stomach cramping. But does the disease cause decreased libido, or is your libido reduced because of your symptoms? It’s a chicken-or-egg question. Some medications, including corticosteroids, can lower sex drive, while deficiencies in iron, folic acid and vitamin B12 may drain your energy, making you too tired for sex, according to the Merck Manual. The same can be said for depression. If you’re stranded in the bathroom and in pain, you are likely to become depressed. But I don’t think Crohn’s triggers the chemical imbalance that causes depression. A 2011 study by the Mayo Clinic conducted on 12,000 people found that young women with Crohn’s were more likely to develop anxiety and depression than women without the disease. For more information, visit our Crohn's Disease Health Center. How Well Do You Understand Crohn’s Disease? A diagnosis of Crohn’s disease comes as a shock for many people, some who never suspected their abdominal discomfort could be something serious. This inflammatory disorder has far-ranging – and often serious – symptoms.