Crohn's Disease

Crohn's disease is a type of inflammatory bowel disease (IBD). It causes patchy inflammation of the lining of the intestines, leading to abdominal pain and diarrhea. Approximately 500,000 to 2 million people in the U.S. suffer from Crohn's disease.

The doctors at the UVM Medical Center use effective, research-based techniques to diagnose and treat Crohn's disease.

Crohn's Disease Care at UVM Medical Center

Our goal is to reduce your inflammation and painful symptoms. When you come to UVM Medical Center, you can expect:

• Expert diagnosis - Crohn's disease can be difficult to diagnose because it can cause symptoms similar to other gastrointestinal conditions. At The UVM Medical Center, our gastroenterologists have years of experience diagnosing and treating Crohn's disease. We use the most advanced diagnostic techniques to provide a precise diagnosis.
• Individualized treatment plan - Treatment for Crohn's disease could include medication, dietary changes, and surgery. Your doctor and a team of specialists will help develop a plan that works for you.
• Accredited surgical facilities - If you and your doctor decide that surgery is needed to relieve your symptoms, your procedure will take place in our surgical center. Our facilities are comfortable, safe, and fully accredited by the State of Vermont.

Risk Factors for Crohn's Disease

Crohn's disease causes the lining of your digestive tract to become inflamed, leading to pain, diarrhea and even malnutrition. People often experience different symptoms depending on which part of the digestive tract the disease affects. Crohn's disease can be painful and severely affect your quality of life.

Risk factors for Crohn's disease include:

• Age - Most people develop the disease before 30 years of age.
• Ethnicity - Jews of Eastern European (Ashkenazi) descent have the highest risk of developing the disease.
• Family history - If you have a close relative with Crohn's disease, your risk increases.
• Smoking cigarettes - While many risk factors are not in your control, quitting smoking is. Talk to your doctor about smoking-cessation programs.
• Location - People living in cities or industrialized areas are at higher risk.

Crohn's Disease Diagnosis

If you or a loved one experience unexplained abdominal symptoms such as diarrhea, pain, blood in the stool or weight loss, make an appointment with your doctor. Crohn's disease can be tricky to diagnose since it has similar symptoms to other conditions. It is important to receive an expert diagnosis from a doctor experienced in diagnosing different types of gastrointestinal conditions.

Our physicians use a combination of imaging scans, laboratory tests and endoscopy to obtain an accurate diagnosis. Doctors often diagnose Crohn's disease by first ruling out other possible conditions.

Your doctor will begin the diagnosis by asking you about your symptoms and your medical and family history. We will also perform a thorough physical examination.

Other diagnostic procedures include:

• Laboratory tests - We may order two types of laboratory tests:
• Blood test - to check if you have anemia or for signs of infection
• Fecal occult blood test - which tests a stool sample to look for signs of blood
• Imaging tests - We use the most advanced imaging technology available. These procedures provide us with a detailed picture of the inside of your body. Imaging tests include:
  • Computed tomography (CT) scan, which provides images of the entire bowel as well as surrounding tissue. A CT scan can help us pinpoint the location of the disease and check for complications.
  • Magnetic resonance imaging (MRI) scan, which is helpful in diagnosing Crohn's disease and determining the best way to manage it.
  • Small bowel imaging, which locates areas that are inflamed or narrowed. You drink a solution containing barium, then undergo an imaging scan. The solution highlights any abnormalities.
• Endoscopy - Your physician may order a number of different types of endoscopic procedures. Endoscopy uses a special flexible, lighted tube that your doctor inserts in you to examine the inside of your body. Endoscopic procedures include:
  • Colonoscopy, a procedure to examine your entire colon. Your doctor may also take tissue samples to examine under a microscope.
  • Flexible sigmoidoscopy is similar to a colonoscopy, but examines only one section of the colon.
  • Capsule endoscopy is helpful if you have symptoms of Crohn's but previous tests were negative. You swallow a small capsule with a camera attached. The camera takes thousands of images of your digestive tract. Your doctor can view the images to help determine a diagnosis. You excrete the capsule naturally.
  • Double balloon endoscopy uses a longer scope in order to reach further into the small bowel.

Crohn's Disease Treatments

Unfortunately, there is no cure for Crohn's disease. Our doctors will discuss all of your treatment options with you and answer any questions you may have. Then, we will create a personalized treatment plan for you. The goal of treatment is to reduce the inflammation, which will reduce the symptoms and prevent complications.

The main treatment is medication, along with dietary changes.  People respond differently to the different treatment options. The University of Vermont Medical Center physicians work with you to find the right combination of medication and possibly surgery.

We also recommend that you undergo regular screening for colon cancer. People with Crohn's disease are at higher risk for developing cancer. We will discuss with you when you should begin screenings.

Treatment options include:

• Medication - There are different types of medication that doctors use to treat Crohn's disease. These include:
• Anti-inflammatory medications - often used as the first step in treating Crohn's disease. They can help reduce the inflammation in your digestive tract.
• Immune system suppressors - which also work by reducing inflammation. While anti-inflammatory drugs target the inflammation directly, these medications reduce inflammation by suppressing your immune system's response.
• Antibiotics - which are helpful in reducing drainage and healing abscesses.
• Other medications to relieve symptoms such as stomach pain and diarrhea.
• Surgery - Sometimes dietary changes and medication do not sufficiently relieve your symptoms. If that happens, we may recommend surgery. We may use a type of surgery called strictureplasty, which widens narrowed areas of the intestine.

Benefits of surgery are usually temporary, meaning you may need a second procedure. We will combine surgery with a medication regimen to reduce your need for multiple surgeries. During surgery for Crohn's disease:

• Your surgeon removes the damaged part of the digestive tract.
• He or she then reconnects the healthy sections.
• We may also close fistulas (abnormal openings).