Crohn's Disease: Difference between revisions

No edit summary
mNo edit summary
 
(124 intermediate revisions by 12 users not shown)
Line 1: Line 1:
<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox">
<div class="editorbox">
'''Original Editors '''- [http://www.physio-pedia.com/index.php5?title=User:Sarah_Bailey Sarah Bailey] [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  
'''Original Editors '''- [[User:Sarah Bailey|Sarah Bailey]] from [[Pathophysiology of Complex Patient Problems|Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  


'''Lead Editors''' - Your name will be added here if you are a lead editor on this page.&nbsp; [[Physiopedia:Editors|Read more.]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
</div>  
</div>  
== Definition/Description  ==
== Introduction ==
[[File:Crohn's Disease.png|thumb|CD chronic inflammation GI tract]]
Crohn disease (CD) and ulcerative colitis (UC) are both conditions commonly referred to as [[Irritable Bowel Syndrome|inflammatory bowel disease]] (IBD). CD causes chronic inflammation of the gastrointestinal tract. In Crohn disease, the inflammation extends through the entire thickness of the bowel wall from the mucosa to the serosa.


Crohn’s disease is a form of inflammatory bowel disease (IBD) that causes inflammation to the lining of the digestive or gastrointestinal (GI) tract <ref name="NDDIC">National Digestive Diseases Information Clearinghouse (NDDIC). Crohn’s disease. http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ (accessed 4 March 2010).</ref> and may be a result of an immune system malfunction. The immune system sees the bacteria and organisms that lie within the GI tract and intestines and mistakes them for outside invaders to the body. In response to this, the body produces extra white blood cells to the GI tract to fight off the invaders, which creates inflammation within the lining of the tract. Chronic inflammation may result in ulcerations within the layers of the tract <ref name="Living with Crohn's">Living with Crohn’s Disease. Inside Crohn’s disease. https://www.livingwithcrohnsdisease.com/livingwithcrohnsdisease/crohns_disease/inside_crohns.html (accessed 4 March 2010)</ref>. The inflammation can occur to any portion of the GI tract, from mouth to anus and can affect all layers of the intestinal tract while healthy bowel layers may be interspaced between the diseased portions of the bowel.
CD is a serious chronic inflammatory disorder that is difficult to diagnose and manage. The disease has a relapsing and remitting course. Many relapses can cause Crohn disease to progress from mild to moderate to severe penetrating (fistulization) or stricturing disease. There is no cure and most patients experience a poor quality of life..<ref name=":0">Ranasinghe IR, Hsu R. Crohn disease. Available: https://www.ncbi.nlm.nih.gov/books/NBK436021/<nowiki/>(accessed 1.10.2022)</ref>


The most commonly affected portion of GI tract affected is the lower portion of the small intestine, or ileum <ref name="NDDIC" />.&nbsp; Due to the inflammation, abdominal pain, diarrhea and malnutrition can be a result <ref name="mayo">MayoClinic.  Crohn’s Disease.  http://mayoclinic.com/health/crohns-disease/DS00104/DSECTION=causes (accessed 4 March 2010)</ref>.&nbsp; Crohn’s disease is also referred to as granulomatous enteritis or colitis, ileitis, regional enteritis, or terminal ileitis. This disease is similar in some aspects to ulcerative colitis, but the difference lies in the fact that ulcerative colitis produces inflammation only within the colon or rectum while Crohn’s disease produces inflammation within the colon, rectum, small intestine, stomach, mouth and esophagus. The inflammation caused by Crohn’s disease has the potential to affect the deeper layers more than ulcerative colitis <ref name="MedicineNet">MedicineNet.  Crohn’s Disease.  http://www.medicinenet.com/crohns_disease/page2.htm (accessed 4 March 2010)</ref>.&nbsp; While these two conditions are very similar, approximately 10 percent of individuals are unable to pinpoint whether the disease process is ulcerative colitis or Crohn’s disease. For these individuals, they are then diagnosed with indeterminate colitis <ref name="CCFA">Crohn’s and Colitis Foundation of America (CCFA).  About Crohn’s Disease.  http://ccfa.org/info/about/crohns (accessed 4 March 2010)</ref>.<br>
== Etiology ==
The cause of CD is not known but genetics seem to play a role as does the environmental affects on the immune system.


== Prevalence  ==
The gut bacteria of people with Crohn’s disease changes but it still isn’t clear if the change is caused by inflammation.


Crohn’s disease affects approximately 500,000 to two million people in the United States, equally affecting men and women <ref name="MedicineNet" />.&nbsp; This disease may occur in individuals of all age, but has characteristically affected adolescents and young adults between 15-35 of age. It is estimated that 10 percent of individuals affected are under the age of 18. Crohn’s has been found to affect American Jews of European descent four to five times more than the general population. The prevalence among whites is 149 per 100,000 with a[[Image:CD map.jpeg|frame|right|100px|Geographic Distribution of Crohn's Disease||border|right|100px|Geographic Distribution of Crohn's Disease]] steady increase in incidence among African Americans. Hispanics and Asian have a lower prevalence than do African Americans and whites. There has been a potential link between living environment and the incidence of Crohn’s disease, where there are more reports amongst urban and northern climates than rural and southern climates. Similarly, this disease tends to be more predominant in the US and Europe <ref name="CCFA" />.<br>
Possibly a diet full of highly processed foods like sugary drinks and fast food, may increase the risk of developing Crohn’s. Crohn’s is not infectious. <ref name=":1">Crohns and Colitis Australia CD Available:https://crohnsandcolitis.org.au/about-crohns-colitis/crohns-disease/about-crohns-disease/ (accessed 1.10.2022)</ref>[[File:Crohn.png|thumb|531x531px|The 3 most common sites of intestinal involvement in CD (L) compared to the areas affected by ''ulcerative colitis'' (''R'').|alt=|center]]
== Epidemiology ==
[[Image:CD map.jpeg|World Distribution of CD|alt=|thumb]]
CD is most prevalent in the western developed world in North America, northern Europe, and New Zealand.


== Characteristics/Clinical Presentation  ==
The incidence of CD is bimodal with the onset occurring most frequently between ages 15 to 30 years and 40 to 60 years old.


There is no cure for this condition and Crohn’s disease alters between periods of remission and relapse. Crohn’s typically appears around adolescence and early adulthood and there is potential of Crohn’s disease to run in families <ref name="MedicineNet" />.&nbsp; About 20-25% of individuals affected with Crohn’s disease have a close relative who is affected with ulcerative colitis or Crohn’s disease. If an individual has a relative with Crohn’s, the risk of this individual is 10 times higher than the general population, while a brother or sister link increases the risk to 30 times higher than the general population. Current researchers have identified an abnormal genetic mutation on gene NOD2/CARD 15 which reduces the ability of the body to distinguish harmful bacteria. This mutation is found twice as often in individuals affected with Crohn’s versus the general population <ref name="CCFA" />.<br>  
It is more prominent in urban than rural areas.<ref name=":0" />
== Symptoms of Crohn’s Disease ==
[[File:Diarrhea.png|thumb|Diarrhea a symptom]]
While Crohn’s is a chronic disease, the patients will experience bouts of flare ups and remission with the absence of symptoms <ref name="CCFA">Crohn’s and Colitis Foundation of America (CCFA).  About Crohn’s Disease.  http://ccfa.org/info/about/crohns (accessed 4 March 2010)</ref>. 


The typical symptoms of Crohn’s disease include diarrhea, abdominal cramping generally in the right lower quadrant <ref name="NDDIC" />, fever and potential rectal bleeding. The rectal bleeding is potentially due to tears or fissures within the anus lining. Fistulas or tunnels leading from the intestines to the bladder, vagina or skin may also occur, while most occur around the anal area. The fistula has potential to produce drainage, pus, mucus or stool being excreted from the opening. These symptoms may vary between individuals and may not all be present at the same time. There is potential for weight loss and fatigue. <br>
Patients with flare-ups of CD usually present with abdominal pain (right lower quadrant), flatulence/bloating, diarrhea (can include mucus and blood), fever, weight loss, anemia. In acute cases, perianal abscess, perianal Crohn disease, and cutaneous fistulas can be seen.<ref name=":0" />


While Crohn’s is a chronic disease, the patients will experience bouts of flare ups and remission with the absence of symptoms <ref name="CCFA" />.<br>


== Associated Co-morbidities  ==
About 50% of individuals with Crohn’s Disease will have mild symptoms. The other half may experience more severe symptoms and pain that appears to come and go. These patients undergo painful exacerbations and potentially symptom free remissions. The remissions might last for months to years but the symptoms will eventually return<ref name="CCFA" />.&nbsp;


While commonly Crohn’s disease affects the GI tract, there have been instances where additional complications include arthritis, skin conditions, inflammation of the eyes and/or mouth, joints, kidney stones, gallstones and liver/biliary conditions were also reported. <br>
The below viewing is a 5 minute presentation from a clients viewpoint.
{| class="FCK__ShowTableBorders" width="40%" cellspacing="1" cellpadding="1" border="0" align="centre"
|-
| align="right" |
{{#ev:youtube|Npda8xr2G-Y|300}}<ref name="Thomas">Thomas Craig. A Frank discussion on Crohn's Disease. Available at http://www.youtube.com/watch?v=Npda8xr2G-Y (last accessed 4/510)</ref>
|}
== Types of Crohn's Disease ==
[[Image:Crohn's distribution.jpg|thumb|right|300x200px|Distribution of Crohn's Disease within the Gastrointestinal tract]][[Image:What is Crohn's disease.jpg|frame|right|200px|Gastrointestinal Tract in which Crohn's Disease affects]]There are different types of Crohn’s Disease dependent upon the location and disease pattern within the GI tract.  The different locations of Crohn’s Disease include:


The most common associated comorbidity is a blockage of the intestines. Continual blockage tends to thicken the walls of the intestine with scar tissue which further reduces the size of the passageway <ref name="NDDIC" />. Fistulas are also common due to sores or ulcers that develop into deep ulcers or tracts connecting<ref name="CCFA" /> into the bladder, vagina, skin or anal area. These fistulas are then exposed to infection<ref name="NDDIC" />. <br>
<ref name="John">Crohn’s Disease: Introduction. John Hopkins Medicine. Available at http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&amp;GDL_Disease_ID=291F2209-F8A9-4011-8094-11EC9BF3100E&amp;GDL_DC_ID=D03119D7-57A3-4890-A717-CF1E7426C8BA (accessed 5 April 2010).</ref>


It has been discovered that individuals with Crohn’s disease have referred pain to the low back. Approximately 25% of individuals with Crohn’s and/or irritable bowel disease have sacroilitis, polyarthritis, monarthritis of ankle, knee, elbows and/or wrists <ref name="Goodman">Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed. St. Louis, MO: Saunders-Elsevier; 2007</ref>, as well as migratory arthralgias. At times, these joint conditions may even present initially before the other GI related symptoms<ref name="Patho">Goodman CC, Fuller KS. Pathophysiology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders-Elsevier; 2009.</ref>.<br>
# '''Gastroduodenal Crohn’s Disease:''' Located in the upper gastrointenstinal tract and affects the stomach and first part of the small intestine (duodenum).  This is uncommon and symptoms occur in 5% of those diagnosed with Crohn’s. 
# '''Jejunoileitis''': This is also uncommon in the general population of those diagnosed with Crohn’s disease.  Inflammation is located in the Jejunum or Second part of small intestines.
# '''Ileitis:''' Inflammation located in the last part of small intestine or ileum and affects 30% of individuals diagnosed with Crohn’s disease. 
# '''Ileocolitis:''' This is the most common form of Crohn’s disease and affects 50% of those diagnosed with inflammation located in the ileum and colon.
# '''Crohn’s Colitis:''' This affects 20% of individuals diagnosed with Crohn’s disease with inflammation located in the colon. The perianal disease and extraintestinal complications are more commonly associated in these individuals.
# '''Perianal Disease:''' This occurs in 1/3 of individuals diagnosed with Crohn’s disease.  These individuals can have fistulae, fissures, abscesses or skin tags (fleshy growths outside the anus)&nbsp;<ref name="Knol">Cheifetz Adam, Moss Alan, Peppercorn Mark. Crohn’s Disease. Knol Beta. Available at http://knol.google.com/k/crohn-s-disease#. Accessed 5 April 2010.</ref>


Since this disease affects the absorption of nutrients, chronic individuals commonly have deficiencies of protein, calories and vitamins. This may be due to the malabsorption or overall inadequate dietary intake secondary to the patient’s attempt to limit the pain produced with eating <ref name="NDDIC" />.<br>
<ref name="Knol" />  


There is a risk of colorectal cancer that tends to increase with an increased length of time with the disease. There is a 2% incidence of colorectal cancer after 10 years diagnosis, 9% incidence after 20 years diagnosis, and 19% incidence after 30 years of diagnosis of Crohn’s disease. A 20% mortality rate lies within the first 10 years of diagnosis in the presence of complications. Surgical removal of the Crohn’s bowel does not prevent colorectal cancer, thus putting importance on prevention and screening for early detection of colorectal cancer<ref name="patho" />.<br>
== Complications ==


== Medications  ==
[[Image:Body complications.jpg|thumb|right|300px|Extraintestinal manifestations of Crohn's disease]]CD is a systemic disease and has manifold intestinal and extra-intestinal complications. Examples include:


add text here <br>  
* Stricture formation, fistulae and abscesses
* Colorectal carcinoma
* Ankylosing spondylitis
* Erythema nodosum, pyoderma gangrenosum
* Kidney and gall stones
* Anemia
* Hypercoagulable state
* Osteoporosis
* Eye inflammation<ref name=":0" /><br>


== Diagnostic Tests/Lab Tests/Lab Values  ==
== Diagnosis ==


add text here <br>  
The diagnosis is made by ruling out other potential causes. Investigations include: blood tests, fecal occult blood test, colonoscopy, flexible sigmoidoscopy, barium enema or small bowel imaging, CT of the GI tract, or a capsule endoscopy.<ref name="Knol" />  


== Causes  ==
Many CD patients who develop complications require surgery and possibly multiple procedures in time. Once a patient has had surgery, surveillance endoscopy is recommended in six to 12 months. If there is no endoscopic recurrence, ileocolonoscopy should be repeated in 1 to 3 years.<ref name=":0" />


add text here <br>
== Treatment/Management ==
[[File:Methotrexate.jpg|thumb|Methotrexate]]
The medical treatment is roughly grouped into two classes:


== Systemic Involvement  ==
# Mild to moderate disease can be treated by oral mesalamine, [[DMARDs in the Management of Rheumatoid Arthritis|immunomodulators]], methotrexate, and [[Corticosteroid Medication|steroids]].
# Moderate to severe disease will be best treated using a combination of immunomodulators and [[BDMARDs in the Management of Rheumatoid Arthritis|biologics]] or biologics alone.


add text here
* Dietician involvement is recommended and nutritional supplementation are highly recommended before and during the treatment of Crohn disease.
* Poor pregnancy outcomes are associated with active CD. Disease flares should be treated aggressively in pregnancy<ref>Kalla R, Ventham NT, Satsangi J, Arnott ID. Crohn’s disease. Bmj. 2014 Nov 19;349. Available:https://www.bmj.com/content/349/bmj.g6670 (accessed 1.10.2022)</ref>
* Mental health counseling for  may be needed depression
* Sound education about CD and best ways to live with the conditions, for example: Avoid NSAIDs as they may exacerbate disease; Manage mild diarrhea with antidiarrheals; Avoid smoking; heed dietician advice.<ref name=":0" />


== Medical Management (current best evidence)  ==
== Physical Therapy Management   ==
Individuals may need physiotherapy to treat the following.


add text here
# Crohn’s disease is associated with [[arthritis]], notably arthritis of the [[Spondyloarthritis|lumbar spine]] and [[Sacroiliac Joint Syndrome|sacroiliac joints]]. Though arthritis usually affects [[Older People - An Introduction|older people]], Crohn's-related arthritis is common in young people with the disease.<ref>Enzine articles The Link Between Crohn's Disease And Lower Back Pain  Available:https://ezinearticles.com/?The-Link-Between-Crohns-Disease-And-Lower-Back-Pain&id=7654760 (accessed 1.10.2022)</ref> When a patient presents to physical therapy with low back, sacroiliac or hip pain, it is vital for the therapist to screen for potential organic sources of the pain and for a history of inflammatory bowel disease. See links re treatment.
# CD prevents correct absorption of [[Nutrition|nutrient]]<nowiki/>s through the intestines into the body. [[Vitamin D Deficiency|Vitamin D]] and calcium are key nutrients for bone health, and deficiency can lead to [[osteoporosis]]. Osteoporosis often leads to [[Insufficiency Fracture|insufficiency fractures]] eg in the vertebrae. Vertebral fractures can cause changes in [[Thoracic Hyperkyphosis|spinal curvature]], leaving other vertebrae more susceptible to fracture. Pain may result from the fracture itself, inflammation and/or [[Biomechanics|biomechanical]] changes. Educate clients regarding osteoporosis.
# Hydration is very important in patient’s with Crohn’s disease so the therapist should be aware of signs of dehydration when exercising, for example headache, dry lips, disorientation. 
# Exercise prescriptions have the ability to boost the immune system, reduce depression, and improve the body image of the patient. In addition to providing this exercise program, therapists can better create coping mechanisms as well as techniques to manage the unexpectedness of Crohn’s Disease<ref name="Patho">Goodman CC, Fuller KS. Pathophysiology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders-Elsevier; 2009.</ref>.


== Physical Therapy Management (current best evidence) ==
== Outcome Measures ==
An outcome measure has been created to track the progress or lack of progress for individuals affected with Crohn’s disease called Crohn’s Disease Activity Index (CDAI). A score below 150 indicates a better prognosis than higher scores. This measure helps to track an individual’s progress from week to week to determine if the symptoms are better or worse. This is more of a gauge of progress and not a prognosis tool<ref name="CDAI">Crohn’s Disease Activity Index (CDAI) calculator. CDAI Online Calculator. &amp;lt;ref="http://www.ibdjohn.com/cdai/"Crohn's Disease Activity Index, CDAI (accessed 4 March 2010)</ref>.<br>


add text here
== Dietary Management  ==
 
Diet is a confusing topic with a lot of conflicting information. Patients need talk with an accredited dietitian to find what’s right for them and their CD.<ref name=":1" />
== Alternative/Holistic Management (current best evidence) ==
 
add text here


== Differential Diagnosis  ==
== Differential Diagnosis  ==


add text here
The symptoms above are not specific to Crohn’s disease and have potential to be seen in other conditions. Differential diagnoses can include the following:
 
== Case Reports  ==
 
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>


== Resources <br>  ==
* Infection with amoebas


add appropriate resources here
* [[Behcet Disease|Behcet disease]]
* [[Celiac Disease (Coeliac Disease)|Celiac]] disease
* Intestinal carcinoid
* Intestinal [[tuberculosis]]
* Mesenteric ischemia
* Ulcerative colitis
== Viewing ==
<div class="coursebox">
14 minutes of informative viewing below
{| class="FCK__ShowTableBorders" width="100%" cellspacing="4" cellpadding="4" border="0"
|-
| align="center" | <imagemap>
Image:Crohn's presentation Pt 1.png |200px|border|left|
rect 0 0 830 452 [http://www.youtube.com/watch?v=EeAmYqn81PQ]
desc none
</imagemap>
| [http://www.youtube.com/watch?v=EeAmYqn81PQ '''Crohn's Disease Pt 1 of 2''']
[http://www.youtube.com/watch?v=EeAmYqn81PQ View the presentation]


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
|}
</div> <div class="coursebox">
{| class="FCK__ShowTableBorders" width="100%" cellspacing="4" cellpadding="4" border="0"
|-
| align="center" | <imagemap>
Image:Crohn's presentation Pt 2.png |200px|border|left|
rect 0 0 830 452 [http://www.youtube.com/watch?v=gnTZmSO5mqU]
desc none
</imagemap>
| [http://www.youtube.com/watch?v=gnTZmSO5mqU '''Crohn's Disease Pt 2 of 2''']
[http://www.youtube.com/watch?v=gnTZmSO5mqU View the presentation]  


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
|}
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
</div>  
</div>  
== References  ==
== References  ==


see [[Adding References|adding references tutorial]].
<references />


<references />
[[Category:Bellarmine_Student_Project]]


[[Category:Bellarmine_Student_Project]]
[[Category:Autoimmune Disorders]]
[[Category:Non Communicable Diseases]]
[[Category:Genetic Disorders]]
[[Category:Rheumatology]]

Latest revision as of 16:43, 9 September 2023

Original Editors - Sarah Bailey from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Sarah Bailey, Laura Ritchie, Lucinda hampton, Admin, Kim Jackson, Dave Pariser, Elaine Lonnemann, WikiSysop, Sehriban Ozmen, Wendy Walker, Manisha Shrestha and 127.0.0.1  

Introduction[edit | edit source]

CD chronic inflammation GI tract

Crohn disease (CD) and ulcerative colitis (UC) are both conditions commonly referred to as inflammatory bowel disease (IBD). CD causes chronic inflammation of the gastrointestinal tract. In Crohn disease, the inflammation extends through the entire thickness of the bowel wall from the mucosa to the serosa.

CD is a serious chronic inflammatory disorder that is difficult to diagnose and manage. The disease has a relapsing and remitting course. Many relapses can cause Crohn disease to progress from mild to moderate to severe penetrating (fistulization) or stricturing disease. There is no cure and most patients experience a poor quality of life..[1]

Etiology[edit | edit source]

The cause of CD is not known but genetics seem to play a role as does the environmental affects on the immune system.

The gut bacteria of people with Crohn’s disease changes but it still isn’t clear if the change is caused by inflammation.

Possibly a diet full of highly processed foods like sugary drinks and fast food, may increase the risk of developing Crohn’s. Crohn’s is not infectious. [2]

The 3 most common sites of intestinal involvement in CD (L) compared to the areas affected by ulcerative colitis (R).

Epidemiology[edit | edit source]

World Distribution of CD

CD is most prevalent in the western developed world in North America, northern Europe, and New Zealand.

The incidence of CD is bimodal with the onset occurring most frequently between ages 15 to 30 years and 40 to 60 years old.

It is more prominent in urban than rural areas.[1]

Symptoms of Crohn’s Disease[edit | edit source]

Diarrhea a symptom

While Crohn’s is a chronic disease, the patients will experience bouts of flare ups and remission with the absence of symptoms [3].

Patients with flare-ups of CD usually present with abdominal pain (right lower quadrant), flatulence/bloating, diarrhea (can include mucus and blood), fever, weight loss, anemia. In acute cases, perianal abscess, perianal Crohn disease, and cutaneous fistulas can be seen.[1]


About 50% of individuals with Crohn’s Disease will have mild symptoms. The other half may experience more severe symptoms and pain that appears to come and go. These patients undergo painful exacerbations and potentially symptom free remissions. The remissions might last for months to years but the symptoms will eventually return[3]. 

The below viewing is a 5 minute presentation from a clients viewpoint.

[4]

Types of Crohn's Disease[edit | edit source]

Distribution of Crohn's Disease within the Gastrointestinal tract
Gastrointestinal Tract in which Crohn's Disease affects

There are different types of Crohn’s Disease dependent upon the location and disease pattern within the GI tract. The different locations of Crohn’s Disease include:

[5]

  1. Gastroduodenal Crohn’s Disease: Located in the upper gastrointenstinal tract and affects the stomach and first part of the small intestine (duodenum). This is uncommon and symptoms occur in 5% of those diagnosed with Crohn’s.
  2. Jejunoileitis: This is also uncommon in the general population of those diagnosed with Crohn’s disease. Inflammation is located in the Jejunum or Second part of small intestines.
  3. Ileitis: Inflammation located in the last part of small intestine or ileum and affects 30% of individuals diagnosed with Crohn’s disease.
  4. Ileocolitis: This is the most common form of Crohn’s disease and affects 50% of those diagnosed with inflammation located in the ileum and colon.
  5. Crohn’s Colitis: This affects 20% of individuals diagnosed with Crohn’s disease with inflammation located in the colon. The perianal disease and extraintestinal complications are more commonly associated in these individuals.
  6. Perianal Disease: This occurs in 1/3 of individuals diagnosed with Crohn’s disease. These individuals can have fistulae, fissures, abscesses or skin tags (fleshy growths outside the anus) [6]

[6]

Complications[edit | edit source]

Extraintestinal manifestations of Crohn's disease

CD is a systemic disease and has manifold intestinal and extra-intestinal complications. Examples include:

  • Stricture formation, fistulae and abscesses
  • Colorectal carcinoma
  • Ankylosing spondylitis
  • Erythema nodosum, pyoderma gangrenosum
  • Kidney and gall stones
  • Anemia
  • Hypercoagulable state
  • Osteoporosis
  • Eye inflammation[1]

Diagnosis[edit | edit source]

The diagnosis is made by ruling out other potential causes. Investigations include: blood tests, fecal occult blood test, colonoscopy, flexible sigmoidoscopy, barium enema or small bowel imaging, CT of the GI tract, or a capsule endoscopy.[6]

Many CD patients who develop complications require surgery and possibly multiple procedures in time. Once a patient has had surgery, surveillance endoscopy is recommended in six to 12 months. If there is no endoscopic recurrence, ileocolonoscopy should be repeated in 1 to 3 years.[1]

Treatment/Management[edit | edit source]

Methotrexate

The medical treatment is roughly grouped into two classes:

  1. Mild to moderate disease can be treated by oral mesalamine, immunomodulators, methotrexate, and steroids.
  2. Moderate to severe disease will be best treated using a combination of immunomodulators and biologics or biologics alone.
  • Dietician involvement is recommended and nutritional supplementation are highly recommended before and during the treatment of Crohn disease.
  • Poor pregnancy outcomes are associated with active CD. Disease flares should be treated aggressively in pregnancy[7]
  • Mental health counseling for may be needed depression
  • Sound education about CD and best ways to live with the conditions, for example: Avoid NSAIDs as they may exacerbate disease; Manage mild diarrhea with antidiarrheals; Avoid smoking; heed dietician advice.[1]

Physical Therapy Management[edit | edit source]

Individuals may need physiotherapy to treat the following.

  1. Crohn’s disease is associated with arthritis, notably arthritis of the lumbar spine and sacroiliac joints. Though arthritis usually affects older people, Crohn's-related arthritis is common in young people with the disease.[8] When a patient presents to physical therapy with low back, sacroiliac or hip pain, it is vital for the therapist to screen for potential organic sources of the pain and for a history of inflammatory bowel disease. See links re treatment.
  2. CD prevents correct absorption of nutrients through the intestines into the body. Vitamin D and calcium are key nutrients for bone health, and deficiency can lead to osteoporosis. Osteoporosis often leads to insufficiency fractures eg in the vertebrae. Vertebral fractures can cause changes in spinal curvature, leaving other vertebrae more susceptible to fracture. Pain may result from the fracture itself, inflammation and/or biomechanical changes. Educate clients regarding osteoporosis.
  3. Hydration is very important in patient’s with Crohn’s disease so the therapist should be aware of signs of dehydration when exercising, for example headache, dry lips, disorientation.
  4. Exercise prescriptions have the ability to boost the immune system, reduce depression, and improve the body image of the patient. In addition to providing this exercise program, therapists can better create coping mechanisms as well as techniques to manage the unexpectedness of Crohn’s Disease[9].

Outcome Measures[edit | edit source]

An outcome measure has been created to track the progress or lack of progress for individuals affected with Crohn’s disease called Crohn’s Disease Activity Index (CDAI). A score below 150 indicates a better prognosis than higher scores. This measure helps to track an individual’s progress from week to week to determine if the symptoms are better or worse. This is more of a gauge of progress and not a prognosis tool[10].

Dietary Management[edit | edit source]

Diet is a confusing topic with a lot of conflicting information. Patients need talk with an accredited dietitian to find what’s right for them and their CD.[2]

Differential Diagnosis[edit | edit source]

The symptoms above are not specific to Crohn’s disease and have potential to be seen in other conditions. Differential diagnoses can include the following:

  • Infection with amoebas

Viewing[edit | edit source]

14 minutes of informative viewing below

http://www.youtube.com/watch?v=EeAmYqn81PQCrohn's presentation Pt 1.png
 Crohn's Disease Pt 1 of 2

View the presentation

http://www.youtube.com/watch?v=gnTZmSO5mqUCrohn's presentation Pt 2.png
 Crohn's Disease Pt 2 of 2

View the presentation

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Ranasinghe IR, Hsu R. Crohn disease. Available: https://www.ncbi.nlm.nih.gov/books/NBK436021/(accessed 1.10.2022)
  2. ↑ 2.0 2.1 Crohns and Colitis Australia CD Available:https://crohnsandcolitis.org.au/about-crohns-colitis/crohns-disease/about-crohns-disease/ (accessed 1.10.2022)
  3. ↑ 3.0 3.1 Crohn’s and Colitis Foundation of America (CCFA). About Crohn’s Disease. http://ccfa.org/info/about/crohns (accessed 4 March 2010)
  4. ↑ Thomas Craig. A Frank discussion on Crohn's Disease. Available at http://www.youtube.com/watch?v=Npda8xr2G-Y (last accessed 4/510)
  5. ↑ Crohn’s Disease: Introduction. John Hopkins Medicine. Available at http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Disease_ID=291F2209-F8A9-4011-8094-11EC9BF3100E&GDL_DC_ID=D03119D7-57A3-4890-A717-CF1E7426C8BA (accessed 5 April 2010).
  6. ↑ 6.0 6.1 6.2 Cheifetz Adam, Moss Alan, Peppercorn Mark. Crohn’s Disease. Knol Beta. Available at http://knol.google.com/k/crohn-s-disease#. Accessed 5 April 2010.
  7. ↑ Kalla R, Ventham NT, Satsangi J, Arnott ID. Crohn’s disease. Bmj. 2014 Nov 19;349. Available:https://www.bmj.com/content/349/bmj.g6670 (accessed 1.10.2022)
  8. ↑ Enzine articles The Link Between Crohn's Disease And Lower Back Pain Available:https://ezinearticles.com/?The-Link-Between-Crohns-Disease-And-Lower-Back-Pain&id=7654760 (accessed 1.10.2022)
  9. ↑ Goodman CC, Fuller KS. Pathophysiology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders-Elsevier; 2009.
  10. ↑ Crohn’s Disease Activity Index (CDAI) calculator. CDAI Online Calculator. &lt;ref="http://www.ibdjohn.com/cdai/"Crohn's Disease Activity Index, CDAI (accessed 4 March 2010)
Retrieved from "https://www.physio-pedia.com/index.php?title=Crohn%27s_Disease&oldid=341243"