Crohn’s disease, a chronic inflammation of the digestive tract, can appear at any age, but most Crohn’s disease patients are diagnosed as children or adolescents. It can affect the entire digestive system. The symptoms include frequent diarrhea, abdominal pain, and moderate to severe weight loss. Treatments can help patients live more normal lives, but there is no cure.
Scientists believe Crohn’s is caused when the body’s immune system mistakingly attacks food or friendly bacteria in the digestive system as hostile invaders and responds defensively by releasing chemicals that result in inflammation.
Because they cannot properly absorb food nutrients “the untreated patient with severe Crohn’s disease looks emaciated and weak from prolonged malnourishment,” says Dr. David Vargas, associate professor of surgery at the University of Kentucky College of Medicine and section head of colorectal surgery.
Another common inflammatory bowel disease, ulcerative colitis, has symptoms similar to Crohn’s disease. However, ulcerative colitis affects only the lower digestive tract, and causes patients to go to the bathroom 15 to 20 times a day, Vargas says.
Ulcerative colitis is very treatable using a well-established surgical procedure called the J-Pouch, created from the patient’s own healthy small intestine, that is more than 90 percent effective in curing the disease.
Patients with severe Crohn’s disease often benefit from bowel resection, the surgical removal of a damaged portion of the intestine. In many cases, the healthy ends of the intestine can be reattached.
If reattachment is not feasible, a surgical stoma—an artificial opening into the body—is created in the abdominal wall to allow wastes to drain from the intestine into a bag worn at the patient’s side. Surgery for Crohn’s does not necessarily mean patients will need a stoma their entire life.
“We have made tremendous advances in surgery, particularly in the use of minimally invasive techniques that have reduced the need for stoma creation in many patients,” Vargas says.
The key, though, has been a team approach to patient care. Gastroenterologists and surgeons work together to ensure patients benefit from advances in medical therapies before being offered surgery. In general, surgery should only be used when symptoms can no longer be controlled medically or if a patient has experienced a complication.
Some patients may be able to postpone surgery or avoid it altogether, says Dr. Willem de Villiers, chief of the Division of Digestive Diseases and Nutrition at UK College of Medicine.
Traditional medical therapies have involved treating symptoms through the use of anti-inflammatory drugs and steroids. But these drugs can have damaging side effects, especially with long-term use.
University of Kentucky has been at the forefront of using monoclonal antibody therapies (often called “biologic therapy”) that target various inflammatory molecules in active Crohn’s disease, de Villiers says.
“This avenue has resulted in many patients going into remission and remaining relatively symptom-free without the need for steroid medications,” he says.