Frequently Asked Questions: Crohn's Disease

Here are some frequently asked questions related to Crohn's Disease.

Q: Is Crohn's disease an autoimmune disease?

A: A malfunction in the immune system is certainly a part of Crohn's disease. This may be an inability to "turn off" the immune system after it "turns on" for an appropriate reason. Or, the immune system may "turn on" for the wrong reason. Immunosuppressive medications used to keep individuals from rejecting transplanted organs have been shown to be effective in treating Crohn's disease. These factors have led many researchers to characterize Crohn's disease as autoimmune.

Q: Is Crohn's disease life-threatening?

A: Crohn's disease is very rarely life threatening. Normally, Crohn's disease is a chronic, lifelong illness characterized by sporadic flare-ups separated by periods of remission. Occasionally, a complication such as a severe abscess or a large fistula connecting the intestine to another internal organ can set the stage for a life-threatening infection. In addition, Crohn's disease may require surgery; all surgical procedures involve the risk of life-threatening complications.

Q: If both parents have Crohn's disease, what are the chances that their children will have Crohn's disease?

A: Inflammatory bowel disease (Crohn's disease and ulcerative colitis) is not strictly genetic. To date, scientists have found no specific gene in which a defect or mutation causes Crohn's disease. The chances of a child having Crohn's disease (or ulcerative colitis) if his or her parents do is only slightly greater than the chances of any other child having inflammatory bowel disease.

Q: If I need surgery, will I have to wear an ostomy bag?

A: The only surgery for Crohn's disease that may necessitate a temporary ostomy is a resection in which there is no totally healthy tissue to reconnect. Usually, within six to eight weeks after surgery, the tissue heals enough to close the ostomy and reconnect the two ends of the intestine. It is not the general practice to remove the entire colon in those with CD, because the disease often recurs "above" the most recent resection. This could create a situation in which the ostomy site or part of the gastrointestinal tract above the ostomy site becomes diseased.

Q: Should I be worried about steroid treatment?

A: Steroids have proved to be powerfully effective medications for thousands of people who live with inflammatory bowel disease. However, steroid use to treat Crohn's disease is increasingly controversial, given the many newer medications that are showing their usefulness. Additionally, steroids are toxic. Doctors today know that steroids are useful in inducing a remission, but not in maintaining a remission. This knowledge, and better understanding of the immunoregulating drugs such as 6-MP, has allowed doctors to get people off steroids much more quickly than in the past. Today, far fewer people are steroid dependent than years ago.

Q: Are the diagnostic tests used to find out if I have Crohn's disease painful?

A: The level of discomfort varies with the activity of the disease. For most people, both barium enema and sigmoidoscopy entail some discomfort, but little pain. These tests can be painful, however, for a person experiencing a flare-up. A colonoscopy is a more painful procedure. Because of that, doctors use a combination of a sedative and a painkiller, known as "conscious anesthesia," when performing this procedure.

Q: Should I be worried about colon cancer if I have Crohn's disease?

A: Statistical evidence does show that people with Crohn's disease have a slightly higher incidence of colon cancer than the general population does. For this reason, doctors begin regularly screening those with Crohn's disease about 12 years after diagnosis if the disease is confined to the small intestine, and eight years after diagnosis if there is disease in the colon.