Crohn’s Disease occurs when there is substantial inflammation along the digestive tract, which can cause diarrhea, fever, abdominal pain, and more. This disease can occur at any location in the digestive tract but is more common where the colon and small intestines meet. Crohn’s Disease is a type of Inflammatory Bowel Disease (IBD).
Who Can Have Crohn’s Disease
Crohn’s disease has a genetic component. Individuals with a familial history of Crohn’s disease are at a higher risk. European Jewish ancestry (Ashkenazi) increases the risk of Crohn’s Disease. Research has found that 15% of individuals affected have an immediate family member with the disease.
This disease can begin at any age, but symptoms most commonly appear in individuals in their late teens or twenties. Ironically, having an incredibly sanitary childhood can lead to a positive diagnosis. Because the body does not have experience attacking antigens, the body’s survival instinct will overreact and create more inflammation.
What Crohn’s Disease Does
Crohn’s disease (CD) is a type of Inflammatory Bowel Disease that occurs anywhere in the digestive tract (from mouth to anus) but is most frequently found in the small intestines. The classic appearance of CD is a transmural or complete ulcer formation through the bowel. These ulcers can penetrate all the way through the intestines and cause fissures, fistulas, granulomas, and other secondary issues including leaky gut, a.k.a. intestinal permeability. The ulcers/lesions are often present in multiple different locations at the same time and can skip healthy sections of the bowel altogether.
Symptoms of Crohn’s Disease
Digestive symptoms are common with Crohn’s Disease, including diarrhea, abdominal pain, and the possibility of either mucus or blood in stools. However, other symptoms include weight loss, nausea, vomiting, fatigue, and fever. In rare cases, symptoms can include inflammation affecting the joints, the skin, and the eyes.
Diagnosis
One of the most common methods of diagnosing Crohn’s disease is a colonoscopy. This is by far the most effective way to attain a definitive diagnosis. Imaging studies such as CT scans are also used but a biopsy from an endoscopy or colonoscopy is usually attained as well. There are other tests that can offer insight/increase your risk of having CD and these include different blood tests (a positive ASCA, a negative pANCA, and high ESR) and stool tests (high levels of lactoferrin and/or calprotectin). These blood and stool tests are only to access the progression and likely hood of active disease. Having a family member with a diagnosis of IBD or Crohn’s will make a diagnosis more likely.
DDX
In order to diagnose Crohn’s disease, we must first rule out other possibilities. Crohn’s disease and ulcerative colitis are incredibly similar, as they make up the two main facets of Inflammatory Bowel Disorder (IBD). The key difference between the two is that ulcerative colitis stays in the rectum/sigmoid/colon and progresses up, and Crohn’s can occur throughout the entire digestive tract but usually not in the rectum or sigmoid colon. Other conditions such as bacteria, viral, fungal, or parasitic infections need to be ruled out. Physicians must also rule out cancer, Celiac disease, diverticulitis, and peritonitis.
Allopathic Treatment
Most allopathic drugs are necessary when there is an acute flare of symptoms and work in conjunction with naturopathic medical care to prevent a flare. The common drugs usually prescribed can include budesonide, mesalamine, metronidazole, ciprofloxacin, azathioprine, 6-MP, and natalizumab to name a few. These medications will vary on serval different factors including genetics, cause of infection the severity of the disease, and prevention. In the most extreme cases, parts of the intestines might have to be removed through surgery. Staging is important to know what course of treatment is needed for acute care. It is always recommended to follow allopathic treatment strategies when there is an acute flare of Crohn’s Disease.
Naturopathic Treatment
You can discuss many naturopathic medication treatments from CD with your naturopathic physician. The common ones prescribed include Zinc, Vitamin D, and Folic Acid, which can all help with malabsorption. Both glutamine and the short-chain fatty acid called butyrate have been shown to help heal the inflamed tissues in CD patients. Different probiotics, herbs, and basic dietary and lifestyle changes are often necessary to help with remission.
Potential Complications
Due to the nature of the disease, there are quite a few complications that can arise from Crohn’s disease. The inflammation can lead to both obstructions, fissures (tearing of tissue), fistulas (tunnels connecting one organ to another organ, and perforation of the digestive tract. This can cause additional constipation, toxic megacolon, and increases the risk of colorectal cancer as well.
Related Bacteria
Patients with severe cases of CD commonly have low quantities of Faecalibacterium prausnitzii. This is most likely due to this bacteria’s ability to help reduce inflammation in the bowels.
Kluyvera spp. has been shown to be elevated in people who have severely inflamed guts. This is an opportunistic bacteria line that we are still learning about. Dr. D’Adamo’s Utopia program found this excellent government research study on the Kluyvera spp. strain.
Government researchers found in a study that patients with CD tend to have a lower number of Roseburia and Faecalibacterium, and a higher number of the Enterobacteriaceae family and Ruminococcus gnavus. Credit goes to Dr. D’Adamo for finding the study.
Related Genes
Government research has found that our genetics play a role in our risk of having Crohn’s Disease. The presence of gene NOD2 increases the risk of CD, and the presence of gene IL23R reduces the risk of both CD and Ulcerative Colitis, the other form of IBD.
The gene MUC2 encodes a protein that helps form a mucous, insoluble barrier that helps protect the gut lumen. The genetic variations that can affect the normal expression of the gene IRGM are often associated with susceptibility to CD. The gene SLC22A4 has been associated with both CD and autoimmune diseases such as rheumatoid arthritis. Genomewide association studies have found an association between both the gene LRRK2 and CD as well.
Scientists have long associated the HLA region of genes with IBD. Recent research has shown that the HLA region can contribute between 10-33% of the total genetic risk of CD, as well as 64-100% of the genetic risk of Ulcerative Colitis. The most extensively studied gene in the HLA region is HLA-DRB1. Genetic research has found that different alleles in HLA-DRB1 can play a role in determining – if present- not just a patient’s susceptibility, but also the potential location of CD, the level of severity, and the potential level of protection.
Scientists are studying the role of other genes, including ATG16L1, IL10, JAK2, SLC22A5, TYK2, and more.