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Crohn's: A Full-Body Disease

Reviewed by Neha Pathak, MD on October 20, 2020

By Ryan Ungaro, MD, as told to Barbara Brody

Back when I was in medical school, I decided to specialize in gastroenterology because I thought it was a  fascinating field. I still do. Inflammatory bowel disease (IBD) patients, including those with Crohn's, are particularly rewarding to treat because I really get to know them and support them closely over many years. It's my job to usher them through difficult times and get them back to enjoying a good quality of life.

As director of the Comprehensive Care for the Recently Diagnosed IBD Patient (COMPASS-IBD) program at Mount Sinai in New York, I see many people who have only recently learned that they have Crohn's. Often these patients have classic symptoms, which include diarrhea, abdominal pain, and urgency. But many don't realize there are a number of Crohn's disease symptoms, and potential complications, that aren't so obviously tied to the digestive system

Body-wide Issues

Crohn's disease is an inflammatory condition. That inflammation primarily affects the intestines. But fever might be a sign of Crohn's, particularly when it happens in conjunction with other symptoms. Fever suggests systemic inflammation, which could be stemming from inflammation in the bowel.

Continued

Unexplained weight loss can also be a symptom of Crohn's because body-wide inflammation has the potential to speed up your metabolism. Meanwhile, people with Crohn's often lose weight if they aren’t absorbing nutrients like they should. That's most likely to happen when the bowel gets ulcerated or inflamed or because you have chronic diarrhea.

Inside the Visit: Crohn’s DiseaseLearn more about Crohn’s disease, its treatment, and its likelihood of being passed on to future generations in this talk between a patient and her doctor.263

[MUSIC PLAYING]

DAVID WEINSTEIN: Thanks



for coming.

AMANDA PHELPS: Thanks for having

me.



DAVID WEINSTEIN: I thought

we would start off by just

having you tell us how he met.



AMANDA PHELPS: So I had battled

with constipation for years,

and I had really bad stomach

pains off and on.

Didn't really think anything

of it until it was really

excruciating.

So I talked with a friend

and she recommended you.



DAVID WEINSTEIN: People, when

they think of Crohn's disease,

they often think that it

presents with diarrhea.

Your Crohn's, where it's located

in the small bowel,

you presented with constipation.

You have to categorize it.

It's important to know

and for you to know where

your Crohn's is located,

my stomach, or my upper GI

tract,

or is it located

in the small bowel.



AMANDA PHELPS: So how did I even

get Crohn's?



DAVID WEINSTEIN: It's actually

very hard to get Crohn's because

of the microbiome being

in balance.

Normal bacteria that are flowing

through you're small bowel that

normally would be eradicated,

it gets through the cell,

it triggers an immune response,

and that immune response,

for whatever reason,

doesn't turn off.

It becomes overreactive.



AMANDA PHELPS: Do you think

I had Crohn's for a really long

time?



DAVID WEINSTEIN: Your own story

that you told,

which is the most important

thing really, that I do.

I think it had been there

for several years.

You made the decision.

You understood, having had

the information

from the colonoscopy, surgery

was going to make you feel

better.



AMANDA PHELPS: It was really

beneficial.

I was at the point

where I was in so much pain

that it had to help.

It couldn't hurt anymore.



DAVID WEINSTEIN: And it was

helpful to meet the surgeon

before hand, right?



AMANDA PHELPS: Oh, it was

definitely helpful.

Having that relationship I think

is really important.



DAVID WEINSTEIN: The severity

of your Crohn's was significant.

That led me to begin

the discussion with you

about beginning biologics.



AMANDA PHELPS: I was a little

anxious

and apprehensive

about the possibility

of medication.



DAVID WEINSTEIN: And you wanted

to get pregnant too.



AMANDA PHELPS: Right,

and I decided that Remicade

would be a good option

because it is considered to be

safe during pregnancy.

Are my kids going to end up with

Crohn's?



DAVID WEINSTEIN:

There's certainly an increased

risk, but most likely, they

won't.



AMANDA PHELPS: I've been doing

really well overall.

I pretty much just manage

my disease with avoiding foods

that upset my stomach.

I have really good days

and I have not so good days.



DAVID WEINSTEIN: What foods have

you found

that upset your stomach?



AMANDA PHELPS: So I definitely

avoid corn.

Sometimes raw vegetables tend

to upset my stomach.

So if I'm going to eat

vegetables, I usually make

sure they're cooked because it

digests a little easier for me.

I also don't eat steak very

often.



DAVID WEINSTEIN: Fruits,

vegetables, and fiber.

They're obviously good for you,

but they will slow down

gastric emptying.

Those are foods you can still

eat, but I like what you're

doing by cooking them or eating

smaller, frequent meals.

Diet absolutely plays a role.

It affects the microbiome,

but no diet is going to control

the disease.

And my concern more

is that people begin to restrict

their diet so severely that they

begin to lose weight.

Have you got your pneumonia

vaccines?



AMANDA PHELPS: I have not gotten

my pneumonia vaccines.



DAVID WEINSTEIN: Have you gotten

your flu shot yet?



AMANDA PHELPS: I have not gotten

my flu shot either,

and I'm hesitant to add

any other medications

to my body.



DAVID WEINSTEIN: Everybody

understands there's opinions

on vaccines.

The benefit so far outweighs

the risk.

Part of preventive care

with Crohn's is we immunize

against things that we can

immunize against.

Have you had

your dermatology checkup?



AMANDA PHELPS: That I have had.

I'm good about that one.

DAVID WEINSTEIN: Biologics

increases the risk of skin

cancer.

It's important that you should

have an annual dermatology

evaluation as a part

of preventive care.



AMANDA PHELPS: We've been

through a lot together.

I've been seeing you for five

and 1/2, six years now.

I live a normal life, even with

Crohn's.



DAVID WEINSTEIN: Right,

and you should.



AMANDA PHELPS: It is

important for you

to have that good relationship

with your doctor.

And I appreciate you being here

to help me.



DAVID WEINSTEIN: I'm

lucky to have you.



AMANDA PHELPS: We make

a good team.



DAVID WEINSTEIN: Yeah.



[LAUGHS]

David Weinstein, MD<br> Gastroenterologist<br> Metro Atlanta Gastroenterology<br> Amanda Phelps<br> Patient<br> Metro Atlanta Gastroenterology/delivery/aws/ac/aa/acaa65c4-3dfe-416c-bb5a-454022a3cf86/608aada1-3802-4d00-af3e-d3b23f64f010_inside-the-visit-crohns_,4500k,2500k,1000k,750k,400k,.mp412/05/2020 12:00:0018001200photo of fresh vegetables/webmd/consumer_assets/site_images/article_thumbnails/video/inside_the_visit_crohns_video/1800x1200_inside_the_visit_crohns_video.jpg091e9c5e8209445d

For that reason, weight loss could indicate new disease (in someone who hasn't yet been diagnosed) or be a sign of a flare up in someone who's been living with Crohn's for some time. In other cases, patients lose weight simply because they're eating less in an effort to avoid triggering or worsening their GI symptoms.

Fatigue is another common complaint among people with Crohn's disease. It may be linked to inflammation, but we also see it in many patients who seem to have their disease well-controlled. This is an active area of research, so hopefully we'll know more about why this happens in the future.  

Non-GI Complications

When someone has severe Crohn's disease or is experiencing a flare, it isn’t only their digestive system that's in trouble. Some people with Crohn's develop eye problems such as episcleritis, scleritis, and uveitis, which are different types of eye inflammation. They can cause redness and vision trouble.

Inflammation associated with Crohn's can also lead to skin symptoms, like tiny red bumps (erythema nodosum) or sores (pyoderma gangrenosum) that appear on the arms or legs.

Another possible complication is a disease of the bile ducts called primary sclerosing cholangitis. It's more common in people with ulcerative colitis (the other type of IBD), but it does occur in some people with Crohn's.

Crohn's and Other Autoimmune Ailments

Crohn's disease is an autoimmune condition. It happens when your immune system mistakenly attacks itself or responds inappropriately to a perceived invader. If you have one autoimmune disorder, the risk of having another goes up. Crohn's disease frequently overlaps with inflammatory forms of arthritis, especially ankylosing spondylitis, a condition characterized by inflammation in the joints of the lower spine and pelvis.

Continued

Psoriasis, an autoimmune disorder known for causing skin scaly patches, is also fairly common among people with Crohn's.

When someone with Crohn's develops joint pain or skin problems, we often loop in a dermatologist or rheumatologist to tease out what's going on. Sometimes the symptom turns out to be a complication of Crohn's, but you can't always chalk it up to underlying GI disease. Someone who turns out to have inflammatory arthritis or psoriasis may need specific treatment for those issues, in addition to the treatment they're getting for Crohn's.

The Importance of Personalized Care

No two people with Crohn's are alike, so treatment needs to be individualized. One of the things we consider when figuring out how to treat someone is whether or not they have extraintestinal manifestations. That means symptoms or problems that aren't limited to the gut.

For instance, someone who has Crohn's as well as psoriasis might be able to take a medication with broad anti-inflammatory action that helps both conditions. Another person with Crohn's symptoms that are confined to the GI tract might be better off with a drug that specifically targets inflammation in the gut.

I'm particularly interested in learning more about how to match each patient with the best treatment for them. At the moment, I'm conducting research funded by the National Institutes of Health aimed to predicting which patients, from the time of diagnosis, are likely to have a mild disease course versus a more severe disease that’s likely to lead to serious complications or require surgery. Right now it's often a guessing game, but if we can figure that out early on (using blood or intestinal biopsy markers) it will help us determine who needs the most aggressive treatments to keep their entire body as healthy as possible

WebMD Feature

Sources

SOURCE:

Ryan Ungaro, MD, director, Comprehensive Care for the Recently Diagnosed IBD Patient (COMPASS-IBD) program, Mount Sinai, New York.

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