Crohn's Disease

Crohn's Disease

Crohn's disease is a form of inflammatory bowel disease (IBD), which involves chronic inflammation of the gastrointestinal tract. Crohn's-related inflammation usually affects the small and large intestines but may occur anywhere from the mouth to the end of the rectum (anus).

There isn’t anything you or your parents did to get the disease, so you don’t have to feel guilty about it. It is not contagious, which means it can’t be “caught” by someone else.

Pediatric GI doctor
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The exact cause of Crohn's disease is unknown. The condition is linked to a problem with the body's immune system, which normally helps protect the body. In Crohn's disease, the immune system cannot tell the difference between good substances and foreign invaders. This means the body may overreact to normal bacteria in the intestines. The result is an overactive immune response that leads to chronic inflammation. This is called an autoimmune disorder.

A person's genes and environmental factors seem to play a role in the development of Crohn's disease. Inflammation related to Crohn's disease most often occurs at the end of the small intestine where it joins the large intestine, but it may occur in any area of the digestive tract. Healthy patches of tissue can exist between diseased areas. The ongoing inflammation causes the intestinal wall to thicken.

Symptoms of Crohn’s disease depend on the part of the gastrointestinal tract affected. Symptoms range from mild to severe and can come and go with periods of flare-ups. The most common symptoms of Crohn's disease are:

Other symptoms may include:

  • Abdominal fullness and gas
  • Clotting problems such as deep vein thrombosis
  • Constipation
  • Eye inflammation
  • Fistulas around the rectal area (may cause draining of pus, mucus or stool)
  • Gastrointestinal bleeding
  • Kidney stones
  • Liver inflammation
  • Loss of appetite
  • Pain with passing stool
  • Rectal bleeding
  • Skin rash
  • Swollen gums
  • Unintentional weight loss

Diagnosis of Crohn's Disease

If your child shows signs of Crohn’s disease, a pediatric gastroenterologist can perform the following exams and tests to make a diagnosis:

  • Physical exam. A physical examination may reveal an abdominal mass or tenderness, skin rash, swollen joints or mouth ulcers.
  • Blood tests. A pediatric specialist may order a variety of blood tests to check for Crohn’s disease. Examples of blood tests include:
    • Complete blood count (CBC)
    • Erythrocyte sedimentation rate (ESR)
    • C-reactive protein (CRP)
    • Chemistry panel
    • Inflammatory bowel disease antibody panel
  • Stool tests. A sample of your child's stool can be tested to search for the presence of blood and bacteria. Types of stool tests include:
    • Hemoccult
    • Calprotectin
    • Culture
    • Clostridium difficile (C. diff)
  • Endoscopy. All children being tested for Crohn's disease will require an upper endoscopy and a colonoscopy. These tests allow a pediatric gastroenterologist to see the lining of the intestine and take biopsy samples to study inflamed areas.
  • Capsule endoscopy. Capsule endoscopy may also be performed to examine areas that cannot be reached by an upper endoscopy or colonoscopy.
  • Imaging studies. A pediatric gastroenterologist may use several imaging studies to take pictures and X-rays of your child’s gastrointestinal tract. Imaging studies for Crohn’s disease include:

Treatments

Treatments for Crohn’s disease include:

  • Medicines. Medicines are the main treatment for Crohn's disease. The following medicines are the most common, but other medications may be prescribed as needed:
    • Aminosalicylates (5-ASAs). Aminosalicylates are medicines that help control mild to moderate inflammation. Some forms of the drug are taken by mouth; others must be given rectally.
    • Corticosteroids. Corticosteroids, including prednisone and methylprednisolone, are used to treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum. Entocort (budesonide) is an oral steroid that is not absorbed much into the circulation but works on the lining of the intestine.
    • Immunomodulators. Immunomodulators such as azathioprine, 6-mercaptopurine or methotrexate help reduce the need for corticosteroids and can help heal some fistulas (abnormal connections between organs).
    • Antibiotics. Antibiotics may be prescribed to treat abscesses (sores) or fistulas.
  • Biologic therapy. Biologic therapy is used to treat patients with severe Crohn's disease which does not respond to any other types of medicine. Infliximab (Remicade), adalimumab (Humira) and certolizumab (Cimzia) are used for Crohn's disease and sometimes for ulcerative colitis. They belong to a class of drugs called monoclonal antibodies which help block an immune system chemical called TNF-alpha that promotes inflammation. Other related drugs are being studied.
  • Surgery. Some children with inflammatory bowel disease will require surgery to remove part of their intestine. This is called a bowel resection. Pediatric surgeons perform bowel resection in patients who are unresponsive to all medications and still have symptoms of pain and diarrhea. Surgery is also used when a child develops a narrowing of their intestine that will not resolve with medication.
  • Nutrition. Eating a healthy amount of calories, vitamins and protein is important to avoid malnutrition and weight loss. Children with Crohn's disease frequently lose weight and stop getting taller before they are diagnosed. The pediatric gastroenterologists at Riley at IU Health believe growth is a critical outcome in treating pediatric patients with inflammatory bowel disease. To promote healthy growth, our doctors recommend:
    • Oral nutritional supplements. Oral nutritional supplements such as Pediasure®, Boost® or Ensure® provide excellent nutrition in addition to a regular diet. Modulen® is designed specifically for patients with Crohn’s disease. Any of these can be taken once or more daily with meals or as a snack.
    • Calcium and vitamin D. Crohn’s disease can lead to premature thinning of the bones. This can be made worse by steroids. It is critical that patients with Crohn’s disease receive an adequate amount (often above what a normal child would require) of calcium and vitamin D. Your child's pediatric gastroenterologist will recommend the right amount of calcium and vitamin D based on the age of your child. Each 8-ounce glass of milk contains 300 mg of calcium. Some children may require a calcium supplement such as Tums®, Viactiv® or Caltrate®.
    • Parenteral nutrition. Parenteral nutrition is sugar, fat and protein given through an IV. This is only required in rare cases when children with severe Crohn’s disease are unable to take enough nutrition by eating and drinking or have severe weight loss prior to their diagnosis. If parenteral nutrition is required, your physician will carefully manage the ingredients included in each feeding. Blood tests help ensure proper parenteral nutrition.
  • Coping. It is natural that some children may become overwhelmed with the thought of having a lifelong illness. They will need the support of family, friends and, sometimes, a professional counselor.

Key Points to Remember

  • Crohn's disease is a form of inflammatory bowel disease that can cause inflammation anywhere from the mouth to the anus.
  • Symptoms are varied and can come and go with periods of flare-ups. Some of the most common symptoms include abdominal pain, diarrhea, blood in the stool, weight loss and vomiting.
  • Crohn's disease is a lifelong condition but can often be treated with medicines.
  • Eating a healthy diet is important to avoid malnutrition and weight loss.

Support Services & Resources

Visit the websites below to find support groups and services and learn more about Crohn’s disease.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Crohn's and Colitis Foundation of America (CCFA)

The Crohn's and Colitis Foundation of America (CCFA) sponsors support groups and summer camps for children with Crohn's disease and provides extensive information about the condition on their website.

GIKids

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition provides patient outreach and education for children and families living with Crohn’s disease.

ImproveCareNow

ImproveCareNow is a network of care centers who are working to raise the standard of care of children with inflammatory bowel disease. The organization's official website provides useful resources for patients, families and care providers.

Crohn's Disease Research

The pediatric gastroenterologists at Riley at IU Health actively participate in a large variety of local and national research studies. These studies are examining new treatments and new tests to help with diagnosis. We participate in studies about the quality of life in children with inflammatory bowel disease as well as perform sophisticated studies about protein and calorie metabolism in children with inflammatory bowel disease. We are the recipients of several grants to continue this research. Your child's pediatric specialist may ask about your interest in participating in these studies.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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