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Crohn's Disease

Crohn's disease is a type of chronic inflammatory bowel disease that can occur anywhere in the gastrointestinal tract, although it most commonly occurs in the ileum. Crohn's disease causes inflammation that extends deep into the intestinal walls, causing pain in the lower right abdominal area (where the small intestine and the large intestine meet) and chronic diarrhea. There may be blood, mucus, or pus in the stool. Symptoms also may include rectal bleeding, weight loss, and fever. In some people with Crohn's disease, abnormal connecting channels called fistulas develop between the intestines and the skin in the genital area. If this happens, intestinal contents may leak through the skin. For reasons that are not known, symptoms also can occur in areas outside the gastrointestinal tract. For example, inflammation and redness may occur in the irises of the eyes, and inflammation and swelling may occur in the joints. An abnormal immune response may be the cause of these symptoms. Crohn's disease increases the risk of cancer and makes it more difficult to screen for cancer due to disease-related tissue changes. The cause of Crohn's disease is unknown, although it appears to run in families.

A doctor can confirm a diagnosis of Crohn's disease by examining the ileum and the colon with an endoscope (viewing tube) in a procedure called colon-oscopy (see "Diagnostic Procedures," page 282). There is no cure for Crohn's disease. Medications such as cortisone and sulfasalazine are used to control the inflammation. Drugs also may be used to treat fistulas and the body's abnormal immune response. Your doctor may recommend that you avoid drinking milk or alcohol or eating spicy or high-fiber foods to help prevent worsening of your symptoms. If you are losing weight because your body is not absorbing enough nutrients, your doctor may recommend that you drink a high-calorie liquid nutritional supplement every day. This type of nutritional supplement is available in single-serving cans. In severe cases of weight loss, diarrhea, or bleeding, the doctor may recommend intravenous (directly into a vein) feeding in the hospital until the tissue has recovered sufficiently to permit normal absorption of nutrients. If treatment with medication is ineffective, surgery may be performed to repair a fistula or to remove severely damaged sections of the intestine. Surgery also may be required if the doctor finds precancerous changes in the cells in the intestine. However, surgery will not cure the disease or prevent recurrence of symptoms.

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