Crohn’s disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract. Small bowel Crohn’s disease specifically involves inflammation within the small intestine. This condition is characterized by periods of active disease, known as flares, interspersed with periods of remission where symptoms may lessen or disappear. Understanding this long-term condition is important for managing its effects on daily life.
Understanding Small Bowel Crohn’s Disease
Small bowel Crohn’s disease causes inflammation in the small intestine, where most nutrient absorption occurs. This inflammation can occur in any of its three sections: the duodenum, jejunum, or ileum. The ileum, the last and longest segment, is the most commonly affected area, often leading to ileitis or ileocolitis if the large intestine is also involved.
Unlike other forms of Crohn’s, small bowel Crohn’s can have unique impacts due to the small intestine’s role in digestion. The inflammation is transmural, extending through all layers of the bowel wall, which distinguishes it from superficial inflammation. The inflammation is often patchy, with segments of healthy tissue appearing between inflamed areas, a characteristic feature of Crohn’s disease. Patches can range from a few centimeters to longer stretches.
Recognizing the Symptoms
Symptoms of small bowel Crohn’s disease often reflect inflammation and impaired function. Abdominal pain is common, frequently experienced around the navel or in the lower right abdomen. This pain can be severe and is often accompanied by chronic diarrhea.
Unexplained weight loss is frequent, as inflammation interferes with nutrient absorption. Fatigue is common, resulting from inflammation, anemia, or poor nutrient absorption. Patients may also experience bloating and nutrient deficiencies like anemia.
Malabsorption can lead to specific deficiencies, such as iron or vitamin B12, further contributing to fatigue and other health concerns. In some cases, individuals might also develop mouth sores or experience nausea and vomiting, particularly if the upper small intestine is affected.
Diagnosing Small Bowel Crohn’s Disease
Diagnosis begins with a thorough medical history and physical examination. Blood tests check for inflammation markers and anemia. Stool samples are analyzed for blood, infection-causing bacteria, or specific inflammation markers like calprotectin.
Imaging studies visualize the small intestine and identify inflammation or damage. Magnetic Resonance Enterography (MRE) and Computed Tomography Enterography (CTE) provide detailed images, detecting complications like strictures or abscesses. A small bowel follow-through, using barium contrast, can also outline the intestine to reveal abnormalities.
Endoscopic procedures allow for direct visualization of the intestinal lining and tissue sampling. A colonoscopy with ileoscopy examines the large intestine and end of the ileum, allowing biopsies to confirm inflammation and rule out other conditions. For areas beyond standard colonoscopy, capsule endoscopy uses a swallowed camera, while double balloon enteroscopy uses a specialized scope for deeper segments.
Treatment Approaches
Treatment strategies aim to reduce inflammation, alleviate symptoms, and achieve remission. Medical therapies are the primary approach, using different medication classes. Anti-inflammatory drugs, like corticosteroids, are used for short-term flare relief. Immunosuppressants dampen the immune system’s overactive response.
Biologic therapies target specific inflammatory proteins (e.g., TNF inhibitors, IL-12/23 inhibitors, integrin inhibitors). They are used for moderate to severe disease or when other medications are ineffective. Antibiotics may treat complications like abscesses or fistulas. Symptom relief medications (e.g., anti-diarrhea agents, pain relievers) and nutritional therapy manage daily discomfort and deficiencies.
Surgery becomes necessary when medical treatments are insufficient or complications arise. Strictureplasty widens narrowed bowel sections without removal, preserving intestinal length. Bowel resection removes diseased segments and rejoins healthy ends. Surgery is considered for persistent blockages, fistulas, or abscesses unresponsive to medication. These treatments aim to control the disease and improve quality of life, though surgery does not cure Crohn’s disease.
Complications and Ongoing Care
Chronic inflammation can lead to several complications. Strictures, bowel narrowings from scar tissue, are common and can lead to partial or complete obstructions. These cause severe abdominal pain, nausea, and vomiting. Fistulas, abnormal tunnel-like connections between bowel loops or other organs/skin, are another significant complication. They can become infected and require treatment.
Abscesses, collections of pus, can develop in the abdomen or around the anus from deep inflammation. Malabsorption from small intestine damage can result in nutritional deficiencies (e.g., anemia from low iron or B12) and overall malnutrition, affecting energy and immune function. Anal fissures, small tears in the anus lining, can cause pain and bleeding. If the large intestine is also affected, there may be an increased risk of colon cancer.
Ongoing care is continuous. Regular monitoring with a gastroenterologist assesses disease activity and adjusts treatment plans. This involves periodic blood tests, stool tests, and imaging to track inflammation and detect complications early. Adherence to prescribed medications is essential to maintain remission and prevent flares, which can lead to further damage and complications.
Dietary considerations play a role in managing symptoms, though no universal diet exists. Patients may find certain foods trigger symptoms; a healthcare provider can help identify and manage these. Long-term management focuses on preventing disease progression, controlling symptoms, and addressing complications through medical therapies and surgical intervention when indicated.