Crohn's Disease

Crohn's disease is a type of inflammation that occurs anywhere (and sometimes multiple places) in the intestinal tract. The inflammation often shows up as ulcers. The ulcers seem to start as small mouth ulcer-like sores on the intestinal surface. They can become larger with swelling surrounding them, and deeper, indicating a more severe disease course. If the disease progresses, the swelling can become so tight, the inside of the bowel (another name for the intestine) narrows. The narrowed area is called a stenosis, and when it is there for a long time, it can form a scar (called a stricture).

These narrowings can block (obstruct) the flow. And then, as if the intestinal contents are trying to find another way out, they burrow through and penetrate the bowel, forming tracts, or fistulas, that go the skin or other tissues. When they can't exit to the skin, infections can develop and fester into an abscess.

Several classifications have helped us to understand the disease patterns in different age groups. They break out Crohn's disease by its location and behavior (stricturing, penetrating or just inflammatory) as well as by the patient's age and whether they've had growth problems. While that has not yet been linked to evidence on how each group will do with certain treatment regimens or with the genetics and triggers leading to each form of the disease, one day soon, it should.

Crohn's Disease And Other Issues

Crohn's disease can interfere with growth and / or puberty in as many as 25% of the kids who have it. They can also have problems develop in association with their bowel disease. These extra-intestinal manifestations can include the joints, the skin, the liver, and other tissues. Sometimes, they can even occur before intestinal symptoms develop.   

Symptoms of Crohn’s Disease

  • Abdominal pain
  • Diarrhea
  • Intestinal bleeding
  • Anemia or fatigue
  • Weight loss
  • Decreased growth
  • Delayed puberty
  • Sores or tissue thickening near or at the anus
  • Joint swelling or long-term pain
  • Particular rashes

The symptoms of Crohn's disease are similar to those of ulcerative colitis as well. Together, they are the two most common forms of Inflammatory Bowel Disease (IBD). Diarrhea and abdominal pain are also common symptoms of infections and Irritable Bowel Syndrome (IBS). Not all of the symptoms are present in all patients. Some will even have just growth problems or joint or skin complaints before they ever have any intestinal complaints.

Treatment For Crohn's Disease

Treatment is not just focused on relieving the complaints (clinical remission), but on trying to heal or improve the intestine itself. At the present time, there is no cure for Crohn's disease. Even removing the involved areas does not prevent Crohn's from returning. While surgery sometimes becomes necessary to get the disease under control, diet and one (or more) of the many medicines are usually preferred to lessen symptoms, to help heal the intestine, and, in children, to restore growth.

Nutrition and Crohn’s Disease

Nutrition is beginning to have an increasing role in the treatment and in furthering our understanding of Crohn's disease. The goals are to:

  • Prevent nutrient deficiency
  • Provide the additional protein, calories needed
  • Support the patient's growth
  • Return patients to healthful functioning
  • Bring the patients into remission
  • Help the intestine heal, when possible
  • Support a healthy intestinal flora (microbiome)
  • Maintain their health when all the other goals have been met

While these seem like a long list of difficult goals, they are sought as if they are a single goal, good health. It may be that they are achieved by encouraging a healthy microbiome, since many researchers feel that the overactive immune system in Crohn's disease is reacting to alterations in the intestinal flora.

There are a number of different nutritional strategies being used to pursue these goals

  • Standard nutrition with additional nutrients as needed
  • Enteral nutrition
  • Specific Carbohydrate Diet
  • Other restrictive diets
  • Herbal supplements

Irrespective of the nutritional and medical strategy, kids need to consume additional protein and calories, and adequate vitamins and minerals to compensate for the additional needs they have with IBD. They also need be monitored routinely in order to achieve the best results.

Frequent Monitoring Is Important

Those at increased risk

  • The child or teen whose growth or puberty is delayed
  • Those with deep ulcers
  • Those with strictures or penetrating disease
  • Those who have already had surgery
  • Those who can't get off of steroids

Those patients who aren't responding to dietary therapy or their current medicine should be re-evaluated. They often need to be placed on one of the more effective medications to get their Crohn's under control. Clinical symptoms often provide a useful guide if a child isn't doing well. Repeated abdominal pain, waking at night to have a loose bowel movement or passing blood usually indicates that either the child has an infection or needs to have their treatment redirected. For the child with few intestinal symptoms, blood or stool tests may suggest the need for a change or or re-evaluation of the intestine.