Crohn’s Disease is one of two major inflammatory bowel diseases (aka IBD) along with Ulcerative Colitis and according to the Center for Disease Control and Prevention (aka the CDC), about 3 million adults in America report having either one. It is a chronic disease that is associated with a multitude of abdominal symptoms. While it is often times a life-long disease, there are ways to better manage it. Which is why patient education on what Crohn’s Disease and IBD is, its causes, symptoms, and treatment/management is so important.
What is Crohn’s Disease?
To fully understand what Crohn’s Disease is, we must first talk about Inflammatory Bowel Disease (aka IBD). IBD is pretty much what the name entails, inflammation of the gastrointestinal (aka GI) tract. IBD is chronic and can actually lead to internal GI damage if not managed and treated appropriately. Inflammatory Bowel Disease is broken into two major conditions primarily depending on the location of the inflammation: Crohn’s Disease and Ulcerative Colitis.
Now that we know what IBD is, we can take a closer look at what Crohn’s Disease is. The most distinctive difference between Crohn’s Disease and Ulcerative Colitis like previously stated is the location. With Crohn’s Disease, the inflammation can be anywhere in the GI tract, starting from the mouth and ending at the anus. On the other hand, Ulcerative Colitis inflammation is found in the large intestine and/or the rectum.
Causes
According to the CDC, the exact cause of IBD and therefore Crohn’s Disease is actually, “unknown, but IBD is the result of a weakened immune system.” Likely causes of a weakened immune system can be contributed to environmental triggers like bacterial or viral infections. There may also be a genetic connection, as “someone with a family history of IBD is more likely to develop this inappropriate immune response.”
Symptoms
Symptoms of Crohn’s disease can be divided into two sections, those of IBD, and those more specific to Crohn’s. Let’s take a look at IBD symptoms as defined by the CDC first:
- Persistent diarrhea
- Abdominal pain
- Rectal bleeding and bloody stools
- Weight loss
- Fatigue
Now that we know common IBD symptoms, we can take a deeper dive into Crohn’s specific symptoms. As mentioned, with Crohn’s Disease, any part of the GI tract can be affected, but it typically only affects certain spots or ‘patches’ and not the entire GI tract at once. With Crohn’s, the disease typically starts in the small intestine before working its way down to the large intestine. The inflammation also tends to penetrate deeper into the GI walls causing layers of inflammation. These layers can appear ‘cobblestone‘ like, see the American Gastroenterological Associations’ image below.
Labs and Imaging
To diagnose Irritable Bowel Disease, but more specifically Crohn’s Disease, there are multiple labs and imaging studies that can be done. To start with there are blood tests and stool samples that can be collected. With blood tests, we are looking for internal bleeding in the GI tract, indicated by anemia in labs. We are also looking for signs of inflammation. This can be seen with high white blood cell (aka WBC) counts and other inflammatory markers. With stool tests, we are looking for other possible causes for the patients’ symptoms. Like bacterial or viral infection or parasites.
As far as imaging goes, we can visualize the lining of the upper GI tract with an endoscopy. A thin flexible tube with a camera attached to the end that is inserted in the mouth and goes down the GI tract. We can also visualize the abdominal cavity through X-Rays with contrast dye, MRI’s (aka Magnetic Resonance Imaging), and CT (aka Computed Tomography) scans. We are specifically looking for the patchy, deep inflammation all throughout the GI tract and the aforementioned ‘cobblestoning‘.
Treatment – Medications
As previously mentioned, there is no cure for Irritable Bowel Disease or Crohn’s Disease but there are options to help manage the inflammation and ease the symptoms. As far as medications go, there are 5 major choices according to the American Gastroenterological Association.
Aminosalicylates
These drugs help, “control inflammation, especially in those who are newly diagnosed with mild symptoms.“
Corticosteroids
These drugs also help control inflammation but only for short term use. They, “are often given in large doses when the disease is at its worst, then lowered as symptoms get under control. They are given to people with moderate to severe symptoms.”
Immunosuppressants
These drugs take a while to begin seeing therapeutic effects so they are often paired with aminosalicylates or corticosteroids. They work by blocking, “the immune reaction that leads to inflammation, lessening swelling in the gastrointestinal (GI) tract.”
Biologic and Biosimilar Treatments
These drugs, “are used in people with moderate to severe ulcerative colitis who do not respond to other treatments.” They are administered via injection or infusion rather than the previosly mentioned treatments that are administered in the pill form.
Treatment – Non-Pharmaceuticals
In severe enough cases, parts of the GI tract are so damaged to the point where they cannot be repaired or saved. In these situations, surgical removal is the only answer. Patients may be left with resectioned intestines and possibly even an ostomy. This is where part of the intestine or ileum is brought through the abdominal wall and an exterior bag is placed to collect the waste product, aka stool.
Patient Education
Patient education and cooperation is key in treating and managing Crohn’s Disease. By teaching the patient about the disease, they have a better chance of understanding and managing it more independently. While we may not know the exact cause of the disease, we do know about ways to decrease inflammation and help manage the symptoms.
First off, smoking cessation is important as it worsens symptoms and can cause flare-ups. Recommend that your patients stay up to date with their vaccines as having IBD put them at a greater risk for developing infection. Having IBD can also cause bone weakening, so being aware of this and having regular bone density tests are important. Some patients with Irritable Bowel Disease needs more routine testing and additional screening for colorectal cancer and cervical cancer. It is important to remember that these patients are going to have a difficult time eating and digesting food which could put them at a higher risk for anxiety, for example when they need to run to the bathroom at unpredicted times, or depression. Because of this, talking about mental health with these patients along with physical health is vital.
If Left Untreated…
If left untreated, Crohn’s Disease can cause even more severe symptoms as the inflammation increases. It can penetrate deeper into the walls and surrounding tissues of the GI tract and result in perianal fistulas, or tunneling around the anus. Leading to deep wounds that need to be addressed. If these tunneling wounds are not addressed, they may lead to infection and if still let untreated, can lead to sepsis and eventually death. It can cause such damage to the GI tract to the point where it can permanently no longer function properly potentially causing strictures to form as well as bowel obstructions.
It can also lead to a myriad of other health concerns, some of them previously mentioned, such as pain, fatigue, infection, osteoporosis, colorectal cancer, cervical cancer, as well as mental health issues. Because of this, it is so important to educate our patients on recognition, treatment, and preventative management.
Do you treat patients with Crohn’s Disease? Comment below!
Plus be sure to check out the rest of the Patient Education Series here and the following posts as well:
- So I Passed the NCLEX… Now What?
- 10 Best Amazon Must Haves For New Grad Nurses
- How to Know if You Should Take the Job
- Gift Ideas for Your Nurse Preceptor
References pulled from the CDC, the American Gastroenterological Association, and Everyday Health.