What is crohn's disease?
Crohn's disease is a condition in which there is inflammation of the small intestine. It is a type of Inflammatory Bowel Disease (IBD), a name for conditions that include inflammation of the large and small intestines. The disease occurs commonly in people between the ages of 20-40 years and equally in both sexes. Crohn's disease is rare in India, but its incidence is increasing, unlike the Western countries where it is fairly common.

How is it caused?
The cause is not known. The most widely accepted explanation is that the body's immune system becomes self destructive and attacks its own cells. Another hypothesis is that the disease is caused by the reaction of the digestive system to a foreign organism like a bacterium or a virus.

What are the symptoms?
The symptoms of Crohn's disease are :
* Abdominal pain and discomfort
* Diarrhoea
* Fatigue
* Weight loss
* Bleeding from the rectum
* Mild to moderate anaemia
* Fever

In advanced diseases, the ulcers in the intestine may perforate resulting in stool leaking into the abdomen (peritonitis). There may be localized collection of pus (abscess) between loops of intestines.

How is it diagnosed?
The disease is diagnosed by a thorough physical examination and a detailed medical history. Some laboratory tests may also be required to confirm the diagnosis.

One method of detection is colonoscopy. In this procedure a flexible telescope or colonoscope is passed through the anus into the intestine to examine the inside of the intestine. This would point out any inflammation or bleeding in the organ. Biopsy may be taken from diseases areas. The laboratory tests may be done to check for anaemia. This would indicate loss of blood from the body and if rectal bleeding is present, the diagnosis can become easier. Laboratory tests may also reveal an increased white blood cell count which indicates infection.

An X-ray test called the Barium meal follow through is done. Barium, a chalky white solution is given to the patient to drink. This solution coats the lining of the intestine and makes any swelling stand out in the X-ray.

What is the treatment?
The treatment measures are temporary and the disease has to be treated according to the most disturbing symptom at that time. Combination treatment measures are used.

1. Drug therapy – corticosteroids are the most commonly used drugs case of the disease. They help in reducing the inflammation. But these drugs may have very serious side effects and may make an individual more susceptible to infection. Prednisolone and sulphasalazine are the most commonly prescribed drugs. They are stopped as soon as the symptoms settle.
2. Dietary modification – the diet may be modified to include less fibre to decrease intestinal movement. The diet should be low in fat and be supplemented with iron, folic acid, calcium and vitamins.
3. Surgery – in case the condition is recurring, which it usually is, surgery may be required. It may also be required because of abscess or fistula formation.

In some cases the drugs may cause various side-effects. There may be some weight gain, increased muscle weakness, increased blood sugar and bone loss in some cases. There may also be weakness and fatigue.

   Infliximab may prevent Crohn's disease recurrence

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