Home >> Content >> What Are The Complications Of Crohn's Disease?
advertisement: 
Crohn's Disease

What Are The Complications Of Crohn's Disease?

Wednesday, March 21, 2012 - 13:35

Contributing Author: Guy Slowik FRCS

Because the inflammation in Crohn's disease affects the entire thickness of the intestinal wall (rather than only the inner mucosal layer, as in ulcerative colitis), particular complications can occur. These include:

In addition, individuals who live with Crohn's disease are at risk for malnutrition.

Fistulas

Fistulas are openings that breach the intestinal wall and connect diseased intestinal tissue with another loop of intestine, another internal organ such as the bladder, or the skin through the abdominal muscle wall or near the anus.

Fistulas are quite problematic. They drain bowel contents, which can lead to infection. They are painful and do not heal easily. Some medications, especially Infliximab, promote fistula healing. Sometimes fistulas must be corrected surgically, especially those that connect the diseased intestine to other internal organs.

Fissures

Fissures are deep crevices in the skin around the anus. They make bowel movements painful. Since they are, essentially, open wounds, they can become infected by bowel contents. Like fistulas, they are difficult to heal.

Other perianal complications include hemorrhoids and large external skin tags. Both can be painful and are easily irritated. Frequent bowel movements may cause them to bleed.

Strictures And Obstructions

Strictures are areas of the intestine (most often the small intestine) that have been severely narrowed due to disease. Each flare-up causes scarring in the affected area. Repeated cycles of flare-up and remission add to the scarring, causing the bowel wall to become thick and stenotic (lacking flexibility).

Strictures usually involve only a few centimeters of intestine. If they become so narrow that it is difficult for food to pass, however, they can cause pain after eating. Strictures can be corrected surgically through a procedure called strictureplasty.

When a longer segment of the intestine's inner passageway becomes so narrowed that food cannot passing through, the patient is said to have an obstruction. Obstructions can be caused by inflexible stenotic tissue, or by severe acute or chronic inflammation.

Sometimes obstructions can be relieved through treatment with medications and/or by following a soft or liquid diet for a few days or a few weeks. Occasionally, a prolonged period of complete bowel rest is prescribed, during which time the individual will be placed on total parenteral nutrition (TPN). TPN is a nutritionally complete intravenous feeding system, usually delivered into the major vein under the collarbone. If none of these treatments is effective in relieving the obstruction, the affected section of bowel must be removed surgically.

Abscesses

Abscesses are pockets of infection that form outside the bowel wall near a portion of diseased tissue, often causing a high fever and pain. Generally, they can be treated with medication. Occasionally, the patient must undergo a surgical procedure to drain them.

Malnutrition

Malnutrition is a greater risk for individuals with Crohn's disease than for those with ulcerative colitis, although both groups must deal with the nausea, pain, fatigue, and loss of appetite that often accompany the conditions. Because of chronic inflammation and the need for increased caloric intake, inflammatory bowel disease can lead to rapid weight loss and nutritional deficiency.

Individuals with Crohn's disease face the additional issue that their disease is often present in those portions of the small intestine where nutrients are absorbed. Diseased tissue does not properly absorb nutrients, so even those who are able to take in adequate calories may face nutritional deficiency. Therefore, individuals with Crohn's disease are generally treated with daily doses of folic acid and quarterly injections of vitamin B12.

Crohn's Disease