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Stanford Your Health: Crohn’s Disease


Crohn’s disease is one of two chronic inflammatory
bowel diseases. Usually, the immune system helps you fight
off infections, in inflammatory bowel disease, it attacks the digestive tract, and causes
inflammation. And, what happens is, is that your body is unable to get rid of the bacteria
and viruses that are helping with the inflammation. Basically, your immune system never turns
off. And because it doesn’t turn off, you perpetuate inflammation in the gut and form
ulcerations in the gut. The chronic inflammation is what leads to
symptoms in Crohn’s disease. The most common presenting symptoms are abdominal pain and
diarrhea. Other symptoms that patients may get is weight loss, appetite loss, fevers,
chills, fatigue, anemia. Crohn’s disease can also manifest in other
parts of the body. Symptoms that can occur in other organs include joint pains, joint
stiffness, eye pain, eye redness, skin lesions. People can get mouth ulcers as well as liver
problems. So, Crohn’s disease primarily affects people
in their twenty’s and again, in their fifty’s. It affects nearly one to two million Americans
in the United States, and there’s ten thousand new cases per year. Many of the patients have a family history
of Crohn’s disease, or they may have family history of other autoimmune diseases. There are also, environmental factors involved
with the development of Crohn’s disease, and those include, infections, non-steroidal and
anti-inflammatory medication, such as ibuprofen, stress, antibiotics, and so, some of these
things we can control, which may prevent triggering of the disease. We’re able to make an accurate diagnosis with
the history and physical exam, endoscopy with biopsies, lab tests, and imaging tests. There are three clinical patterns of Crohn’s
disease: inflammatory stricturing, fistulizing disease, and micro-perforations. Treatment options for Crohn’s disease fall
in three basic categories. Anti-inflammatory medications, immunomodulating medications,
and then we have the newer biologic agents. Steroids are very effective and work very
quickly, but, of course, it does come with side effects. Surgery may be effective and necessary in
some cases. The problem is that Crohn’s disease can come back. It is appropriate in certain
situations, especially if you develop a complication. It’s important for doctors to individualize
their treatment for each patient, and, our Stanford Inflammatory Bowel Disease program
does that. We have goals and management. And, those are to get people in remission quickly,
maintain them in steroid free remission, avoid complications, hospitalizations and improve
their overall quality of life. Having a multi-disciplinary approach to this
complex disease is very important. We involve our dedicated gastroenterologists,
colorectal surgeons, pathologists, radiologists, dermatologists, dieticians, as well as rheumatologists,
to help get the best care to our patients. Additionally, we collaborate very closely
with basic scientists so that we can bring newer therapies to the bedside. It would be great in the future if we would
be able to target therapies to certain parts of the gut. Also, be able to predict who’s
going to respond to which therapy so we don’t, use time, money, and the patient’s quality
of life that’s wasted on these sort of things., we are doing some of that research at Stanford,
and, we’re hoping to develop newer therapies that are safer, as well.

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