About Crohn's Disease

An estimated 500,000 people in the US are affected by Crohn's disease (1). Crohn's disease affects women slightly more often then men (1). It can occur at any age, but the majority of patients are diagnosed between the ages of 15 and 35 (2).

Crohn's disease is a chronic, idiopathic inflammatory disease of the intestinal tract characterized by episodes of acute flares and periods of remission. The hallmark symptoms of Crohn's disease are persistent diarrhea, abdominal pain (particularly in the lower right quadrant), low grade fever, and weight loss (3, 4). Depending upon the severity of the disease and site of the inflammation, these symptoms may also be accompanied by nausea, vomiting, abscesses, fistulas, anal fissures, strictures, obstructions, nutritional deficiencies, and extraintestinal complications (rheumatologic, dermatologic, ocular, hepatobiliary, and urologic) (4). As a result of unpredictable reoccurrence of sometimes insidious symptoms and variability in clinical presentation of Crohn's, diagnosis can be difficult. The five most common types of Crohn's disease named for the area of disease involvement include the following: ileocolitis (approx 45%), ileitis (approx 35%), Crohn's (granulomatous) colitis (approx 20%), gastroduodenal Crohn's disease, and jejunileitis (5).

Approximately one-third of patients with Crohn's disease will develop perianal disease (manifested by incontinence, anal strictures, anorectal fistulas and perirectal abscesses (4). Up to 75% of patients will require surgery to remove an obstruction or repair a fistula or fissure at some point in their lives (2). Surgery is not curative in Crohn's disease but is the reason for the majority of hospitalizations and high costs of overall treatment (6).

The quality of life in patents with Crohn's disease can be significantly impacted (4). Patients are frequently concerned about the uncertain nature of the disease, their energy level, the effects of medications, the possibility of surgery, and the use of an ostomy bag (4). Patients with Crohn's disease say that the symptoms of Crohn's have an impact on many aspects of their lives. In a survey conducted on behalf of the Crohn's and Colitis Foundation of America and the Digestive Disease National Coalition in 2004, many patients with Crohn's disease reported that the disease impacted work and school productivity, absenteeism, higher educational achievements, recreational habits, and relationships with family and friends (7). Over half of patients with Crohn's disease feel that exacerbations of their disease strain their professional and personal life and in study almost one-third of patients concealed their illness from employers (8-10). However, regardless of the physical, social, and emotional difficulties that patients with Crohn's disease report, the majority of patients can be expected to lead normal lives (8, 11).


References

  1. Hanauer SB. Inflammatory Bowel Disease: epidemiology, pathogenesis, and therapeutic opportunities. Harrison's Internal Medicine Online. 2006: The McGraw Hill Companies; 12 (Suppl 1): S3-S9. Available at: http://www.ccfaprofessionals.org/site/c.fqKLLSOvElH/b.1428201/k.58F4/
    Advances_in_Treatment.htm.
  2. About Crohn's Disease. Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/info/about/crohns. Accessed June 23, 2006.
  3. Forbes A. Clinical presentation and diagnosis of Crohn's disease. In: Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003:183-198.
  4. Friedman S, Blumberg RS. Inflammatory Bowel Disease. In: Harrison's Internal Medicine. McGraw Hill Access Medicine. 2006. The Mcgraw Hill Companies. Available at: http://www.accessmedicine.com/content.aspx?aID=90323.
  5. The Merck Manual of Diagnosis and Therapy. Inflammatory bowel diseases. Crohn's Disease. Available at: http://www.merck.com/mrkshared/mmanual/section3/chapter31/31b.jsp.
  6. Cohen RD, Larson LR, Roth JM, Becker RV, Mummert LL. The cost of hospitalization in Crohn's disease. Am J Gastroenterol 2000;95:524-530.
  7. The Voices of Crohn's. Available at: http://www.crohnsresource.com/voices/about.html. Accessed July 25, 2006.
  8. Moser G. Oberwalder M, Wexner SD. Quality of life issues for the inflammatory bowel patient. In: Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003:757-765.
  9. Sörensen VZ, Olsen BG, Binder V. Life prospects and quality of life in patients with Crohn's disease. Gut 1987;28:382-385.
  10. Mayberry MK, Probert C, Srivastava E, et al. Perceived discrimination in education and employment by people with Crohn's disease: a case control study of educational achievement and employment. Gut;1992;33:312-314.
  11. Cooke WT, Mallas E, Prior P, Allan RN. Crohn's disease: course, treatment and long term prognosis. Q J Med 1980;49:363-384.
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