Children's Hospital Colorado

Crohn's Disease

What is Crohn's disease?

Crohn's disease belongs to a group of conditions known as inflammatory bowel diseases (IBD). Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract (GI tract). It is important to know that Crohn's disease is not the same thing as ulcerative colitis, another type of IBD. The symptoms of these two illnesses are quite similar but the areas affected in the gastrointestinal tract are different.

Crohn's disease may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. In children it frequently affects the large intestine, which is also called the colon.

Crohn's disease can cause inflammation, scarring and infection in the gastrointestinal tract.  It can also affect other organs including skin, eyes, bones and liver. Crohn's disease can lead to chronic anal fissures, small tears in the inner lining of the rectum, and infections around the anus. Crohn's disease can also cause fistulas, which are small tunnels that emerge from the intestine to connect to other loops of intestine and can lead to other medical problems.

While both Crohn's disease and ulcerative colitis are types of inflammatory bowel diseases (IBD), they should not be confused with irritable bowel syndrome (IBS), a disorder that affects the muscle contractions of the colon. IBS is different from chronic intestinal inflammation.

Watch this video to learn more about Crohn's disease.

What causes Crohn's disease?

The causes of Crohn's disease are not well understood. Recent research suggests both hereditary and environmental factors contribute to the development of Crohn's disease.

The GI tract normally contains harmless bacteria, many of which help us digest food. In people with IBD, these bacteria are mistaken for harmful invaders and the body launches an immune system attack against them. Cells travel out of the blood to the intestines and produce inflammation, a normal immune system response to harmful bacteria. However, the inflammation does not subside, leading to persistent or chronic inflammation, ulceration, thickening of the intestinal wall and eventually causing symptoms. Diet and stress may aggravate Crohn's Disease, but they do not cause the disease on their own.

Who gets Crohn's disease?

Crohn's disease may affect as many as 1.4 million Americans. Men and women are equally likely to be affected. The disease can occur at any age, Crohn's disease is more prevalent among adolescents and young adults between the ages of 15 and 35. Although cases of Crohn's disease are rapidly on the rise in children under 10 years old and have been seen in children under 1 year old.

Crohn's disease tends to run in families, so if you or a close relative have the disease, your family members have a significantly increased chance of developing Crohn's. Studies have shown that 5% to 20% of affected individuals have a first  degree relative (parents, child or sibling) with one of the diseases. The risk is substantially higher when both parents have IBD.

The disease is most common among people of eastern European backgrounds, including Jews of European descent. In recent years, an increasing number of cases have been reported among African Americans.

Helpful resources

  • The Crohn's and Colitis Foundation of America has patient information, supports research and has community support programs for children and families who are affected by Crohn's Disease.
  • The Pediatric IBD Foundation explains more about IBD and Crohn's disease.
  • Take Steps is a fundraising and advocacy group supporting people with Crohn's disease and ulcerative colitis.

What are the signs and symptoms of Crohn's disease?

Crohn's disease can affect any part of the GI tract and symptoms may depend on which part of is affected. While symptoms vary from patient to patient and some may be more common than others, the symptoms of Crohn's disease include:

Symptoms related to inflammation of the GI tract:

  • Persistent diarrhea
  • Rectal bleeding/bloody diarrhea
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of incomplete evacuation

General symptoms that may also be associated with IBD:

  • Fever
  • Loss of appetite
  • Weight Loss or poor weight gain
  • Delay in puberty
  • Fatigue
  • Night sweats
  • Loss of normal menstrual cycle

If you think your child is showing signs of Crohn's Disease symptoms, a doctor will need to do some specific testing to make a diagnosis.

People suffering from Crohn's often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, Crohn's may delay growth and development.

Crohn's is a chronic disease, so this means patients will likely experience periods when the disease flares up and causes symptoms, followed by periods of remission when patients may not notices symptoms at all.

What tests are used to diagnose Crohn's disease?

The diagnosis of Crohn's disease is not dependent on one test or study. Diagnosis is dependent on the multiple studies put together. Normally Crohn's disease is diagnosed by a combination of:

  • History and physical exam: A doctor will examine your child and ask about his or her health in the past.  
  • Growth curves: a measurement of how children are growing compared to their peers.
  • Blood tests
  • Upper intestinal endoscopy and colonoscopy with biopsies: A surgeon will use a tiny camera to examine the insides of your child's GI tract, then take a small amount of tissue from the areas affected by Crohn's to look at the cells under a microscope.
  • MRI
  • CT Scan
  • Upper intestinal radiology
  • Video capsule endoscopy
  • Excluding infections and other immune disorders

How do doctors at Children's Hospital Colorado make a diagnosis?

The Doctors at Children's Colorado make a diagnosis by assessing a combination of information including history and physical exam, blood tests, upper intestinal endoscopy and colonoscopy with biopsies and some form of radiologic evaluation such as MRI or CT scan.

How is Crohn's treated?

Crohn's disease is treated in a variety of ways depending on the severity of the disease. In general the goal is to decrease inflammation. These therapies could include nutrition, medication or surgery.

At Children's Hospital Colorado the newest and most effective therapies are available. We are a leader in providing nutritional therapy (also called enteral therapy) for the treatment of Crohn's disease. In addition, we use oral as well as injectable anti-inflammatory medications to bring the disease under control. As Crohn's disease is a lifelong or chronic disease, frequently children stay on these medications for the rest of their lives and proper monitoring and dosing is crucial.

In addition to more traditional approaches for the treatment of Crohn's disease we also participate in clinical trials to evaluate new treatments and perform research to help define new therapies for the treatment of the inflammatory bowel diseases.

Why choose Children's Hospital Colorado for your child's Crohn's disease?

The Children's Hospital Inflammatory Bowel Diseases Center at the Digestive Health Institute is the only center in the region to provide comprehensive pediatric-specific multidisciplinary care in a team comprised of board certified pediatric gastroenterology physicians, advance practice nurses, a nurse coordinator, social worker, nutritionist, pediatric radiologists, pediatric surgeons. psychologists and child life specialists. The center provides a platform for a seamless continuum of care for children with IBD. Our focus on nutrition and its role in pediatric IBD stands out as an example for other practices in the treatment of IBD.

With a combined 50 years of experience caring for patients with IBD, our physicians treat children with IBD and are leaders in research, education and improving quality of care. Our program participates in the Improve Care Now network for collaborative work in continuous quality improvement, innovation and discovery to improve the health and well being of children and adolescents with IBD. Within this international consortium our center performs in the top for remission rates, nutrition and growth status.

Our physicians and support staff aim to provide compassionate, patient centered care including a comprehensive evaluation and diagnosis with transition to a complete care plan in order to provide children with IBD the opportunity to flourish without having to focus on their IBD. We also aim to provide the skills and understanding of their disease to make the transition to adulthood and adult medical care simple.

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