Crohn’s disease is a long-term condition that causes inflammation in the digestive tract. Doctors do not categorize Crohn’s into different stages because symptoms can vary considerably over time, which can make it unpredictable.
Crohn’s disease is a type of inflammatory bowel disease. It is a progressive condition, which means that it tends to worsen gradually. But symptoms can sometimes disappear for weeks or even years.
In this article, we look at what Crohn’s disease is and its stages and progression. We also cover symptoms, complications, and treatment.
What is Crohn’s disease?
Crohn’s disease affects the gastrointestinal (GI) tract, which runs from the mouth to the anus and includes the stomach and intestines. The role of the GI tract is to break down the food a person eats and absorb the nutrients into the bloodstream. What remains at the end of this process is waste product, and the body passes it out as stool.
Crohn’s disease causes the GI tract to become inflamed. There are five different forms of Crohn’s disease, each affecting a different part of the GI tract:
- Gastroduodenal Crohn’s disease affects the stomach and the beginning of the small intestine.
- Jejunoileitis affects the upper half of the small intestine, usually in patches.
- Ileitis affects the end of the small intestine.
- Ileocolitis affects the end of the small intestine and the large intestine.
- Crohn’s colitis, or granulomatous colitis, affects the large intestine.
Symptoms vary, depending on the part of the GI tract that is affected and how severe the inflammation is. Ileocolitis is the most common form of Crohn’s disease.
Stages and progression
Crohn’s disease is chronic, which means that it is a long-term and often lifelong condition. It can also be progressive, which means that a person’s symptoms may become worse over time, but this is not always the case.
Crohn’s disease may get worse over time because long-term inflammation can damage the GI tract.
Doctors can treat and manage a person’s disease to stop or reduce inflammation. Early diagnosis and treatment of Crohn’s are vital to help slow progression and prevent more damage.
Crohn’s disease does not usually follow a set pattern. Typically, there are no recognizable stages that the condition moves through, and it is not always possible to predict how it will progress.
A person with Crohn’s disease will usually have flare-ups and periods of remission. A flare-up is when someone has a sudden increase or worsening of their symptoms. Remission is when they have few or no symptoms.
A doctor will help a person monitor their symptoms and offer advice on treatment and management, as needed.
Symptoms of Crohn’s diseases vary from person-to-person and can range from mild to severe. Symptoms also change over time and depend on the severity and location of the inflammation.
Common symptoms of Crohn’s disease include:
- abdominal pain and cramping
- unintentional weight loss
- bloody stools
Other possible symptoms may include:
- low energy and tiredness
- nausea and vomiting
- loss of appetite
- high temperature or fever
A person may not have all of these symptoms, but symptoms may increase or worsen, especially if left untreated. Crohn’s disease can also lead to complications.
Crohn’s disease can damage the GI tract over time, which can lead to:
- fistulas when two parts of the intestine connect to form a tunnel
- intestinal abscesses
- intestinal blockages
- internal bleeding from tears or holes in the bowel wall
In some cases, a person may need surgery to repair or remove a damaged section of the GI tract. According to a 2012 study, nearly 60 percent of people with Crohn’s disease needed surgery after 20 years of having the condition. Some people required surgery more than once.
Crohn’s disease can also affect how well a person’s body absorbs nutrients from the foods they eat, which may lead to a vitamin or mineral deficiency. Common deficiencies in people with Crohn’s disease include vitamin B-12, vitamin D, and iron. Taking supplements can help replace these nutrients.
Inflammation from Crohn’s disease can sometimes spread to other areas of the body, leading to:
- painful joints
- redness or pain in the eyes
- mouth ulcers
- blisters, ulcers, or swelling on the skin, often on the legs
- liver inflammation
Crohn’s disease increases a person’s risk of developing colon cancer. This risk starts after 8–10 years of having the disease and also depends on the severity of inflammation in the colon.
Early symptoms of colon cancer can be similar to Crohn’s and may include:
- blood in the stool
- a change in bowel habits that persists for more than a few days
- a lasting feeling of needing to have a bowel movement
- abdominal pain and cramping
- weight loss
- For people who have had Crohn’s for more than 8 years, a doctor may recommend yearly screening for colon cancer.
Treatment of Crohn’s disease is different for everyone and aims to:
- reduce inflammation in the intestines
- relieve symptoms
- prevent flare-ups
- achieve and maintain remission
Treatment may change over time, and it is essential to seek medical advice for flare-ups.
Different medications are available to treat people with Crohn’s disease. A doctor will prescribe drugs based on how severe a person’s symptoms are and what type of Crohn’s disease they have.
Drug treatments include:
- Aminosalicylates, which doctors use to treat people with mild to moderate symptoms. These drugs help reduce inflammation in the intestines.
- Corticosteroids reduce inflammation by suppressing the immune system. Doctors prescribe these drugs for moderate to severe symptoms.
- Antibiotics can treat infections or complications that arise from Crohn’s disease.
- Immunomodulators reduce inflammation by suppressing the immune system but can take several weeks or longer to start working. A doctor may prescribe these if a person’s symptoms do not respond to other medications.
- Biologics are drugs that target and suppress the immune system. Doctors usually only prescribe these drugs if other treatments have not been effective.
A person may require surgery to treat complications of Crohn’s disease. Types of surgery may include:
- Small bowel resection. This is where a surgeon removes part of the small intestine and then reconnect the two ends.
- Large bowel resection. Also known as a subtotal colectomy, this is where a surgeon removes part of the large intestine and then reconnect the two ends.
- Proctocolectomy. In this surgery, a surgeon removes the entire colon and rectum. Afterward, a person will need to use an ostomy pouch to collect stools through a small opening in the abdomen.
Over-the-counter medications, such as pain relievers and vitamin supplements, can also help with symptoms. A person should take these in addition to prescription medication.
Diet is an important way to manage Crohn’s disease symptoms. A person is often less able to absorb nutrients from their food and drink. A healthful diet has a good balance of protein, vitamins, minerals, fats, and fiber. This can help a person to get the nutrients they need and maintain good energy levels.
Some people may find that certain foods or drinks trigger or worsen their symptoms. Common examples include spicy foods or dairy products. Keeping a food diary may help a person to identify possible triggers.
People with Crohn’s disease should seek medical advice before making major changes to their diet.
COVID-19 will likely be with us forever. Here’s how we’ll live with it.
As COVID-19 continues to run its course, the likeliest long-term outcome is that the virus SARS-CoV-2 becomes endemic in large swaths of the world, constantly circulating among the human population but causing fewer cases of severe disease. Eventually—years or even decades in the future—COVID-19 could transition into a mild childhood illness, like the four endemic human coronaviruses that contribute to the common cold.
“My guess is, enough people will get it and enough people will get the vaccine to reduce person-to-person transmission,” says Paul Duplex, director of the University of Pittsburgh’s Center for Vaccine Research. “There will be pockets of people who won’t take [the vaccines], there will be localized outbreaks, but it will become one of the ‘regular’ coronaviruses.”
But this transition won’t happen overnight. Experts say that SARS-CoV-2’s exact post-pandemic trajectory will depend on three major factors: how long humans retain immunity to the virus, how quickly the virus evolves, and how widely older populations become immune during the pandemic itself.
Depending on how these three factors shake out, the world could be facing several years of a halting post-pandemic transition—one marked by continued viral evolution, localized outbreaks, and possibly multiple rounds of updated vaccinations.
“People have got to realize, this is not going to go away,” says Roy Anderson, an infectious disease epidemiologist at Imperial College London. “We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.”
The long road to another common cold
One of the essential factors governing the future of COVID-19 is our immunity to the illness. Immunity to any pathogen, including SARS-CoV-2, isn’t binary like a light switch. Instead, it’s more like a dimmer switch: The human immune system can confer varying degrees of partial protection from a pathogen, which can stave off severe illness without necessarily preventing infection or transmission.
In general, the partial protection effect is one of the reasons why the four known endemic human coronaviruses—the ones that cause a common cold—have such mild symptoms. A 2013 study in BMC Infectious Diseases shows that on average, humans are first exposed to all four of these coronaviruses between the ages of three and five-part of the first wave of infections that young children experience.
These initial infections lay the foundation for the body’s future immune response. As new variants of the endemic coronaviruses naturally evolve, the immune system has a head start in fighting them off—not enough to eradicate the virus instantly, but enough to ensure that symptoms don’t progress much beyond the sniffles.
“The virus is also its own enemy. Every time it infects you, it tops up your immunity,” says Marc Veldhoen, an immunologist at the Portugal’s University of Lisbon.
Past studies make clear that partial immunity can keep people from getting seriously ill, even as coronaviruses successfully enter their systems. Long-term, the same is likely to be true for the new coronavirus. Emory University postdoctoral fellow Jennie Lavine modeled SARS-CoV-2’s post-pandemic trajectory based on the 2013 study’s data, and her results—published in Science on January 12—suggest that if SARS-CoV-2 behaves like other coronaviruses, it will likely morph into mild nuisance years to decades from now.
This transition from pandemic to minor ailment, however, depends on how the immune response to SARS-CoV-2 holds up over time. Researchers are actively examining the body’s “immunological memory” of the virus. A study published in Science on January 6 tracked the immune response of 188 COVID-19 patients for five to eight months post-infection, and while individuals are varied, about 95 percent of patients had measurable levels of immunity.
“Immunity is waning, but certainly not gone, and I think this is key,” says Lavine, who wasn’t involved with the study.
In fact, it’s even possible that one of the cold-causing coronaviruses sparked a serious outbreak in the 1800s before fading into the litany of mild, commonplace human pathogens. Based on the spread of its family tree, researchers estimated in 2005 that the endemic coronavirus OC43 entered humans sometime in the late 19th century, likely the early 1890s. The timing has led some researchers to speculate that the original version of OC43 may have caused the “Russian flu” pandemic of 1890, which was noted for its unusually high rate of neurological symptoms—a noted effect of COVID-19.
“There’s no hard proof, but there are a lot of indications that this wasn’t an influenza pandemic but a corona-pandemic,” Veldhoen says.
The crucible of evolution
Though the carnage of past coronaviruses has faded over time, the road to a relatively painless coexistence between humans and SARS-CoV-2 will likely be bumpy. In the medium-term future, the impact of the virus will depend largely on its evolution.
SARS-CoV-2 is spreading uncontrollably around the world, and with every new replication, there’s a chance for mutations that could help the virus more effectively infect human hosts.
The human immune system, while protecting many of us from a serious illness, is also acting as an evolutionary crucible, putting pressure on the virus that selects for mutations that make it bind more effectively to human cells. The coming months and years will reveal how well our immune systems can keep up with these changes.
New SARS-CoV-2 variants also make widespread vaccination and other transmission-blocking measures, such as face masks and distancing, more crucial than ever. The less the virus spreads, the fewer opportunities it has to evolve.
We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.
ROY ANDERSONIMPERIAL COLLEGE LONDON
Current vaccines should still work well enough against emerging variants, such as the B.1.1.7 lineage first found in the United Kingdom, to prevent many cases of serious illness. Vaccines and natural infections create diverse swarms of antibodies that glom onto many different parts of SARS-CoV-2’s spike protein, which means that a single mutation can’t make the virus invisible to the human immune system.
Mutations may produce future variants of SARS-CoV-2 that partially resist current vaccines, however. In a preprint posted on November 19 and updated on January 19, Duplex and his colleagues show that mutations that delete parts of the SARS-CoV-2 genome’s spike protein region prevent certain human antibodies from binding.
“What I’ve learned from our own work is how deviously beautiful evolution is,” Duplex says.
Other labs have found that mutations in 501Y.V2, the variant first found in South Africa, are especially effective at helping the virus elude antibodies. Out of 44 recovered COVID-19 patients in South Africa, blood extracts from 21 of the patients didn’t effectively neutralize the 501Y.V2 variant, according to another preprint published on January 19. Those 21 people had mild to moderate cases of COVID-19, however, so their antibody levels were lower, to begin with, perhaps explaining why their blood did not neutralize the 501Y.V2 variant.
So far, currently authorized vaccines—which spur the production of high levels of antibodies—seem to be effective against the most concerning variants. In a third preprint published on January 19, researchers showed that antibodies from 20 people who had received the Pfizer-BioNTech or Moderna vaccines didn’t bind quite as well to viruses with the new mutations as they did to earlier variants—but they still bound, suggesting the vaccines will still protect against severe illness.
The new variants bring other threats as well. Some, such as B.1.1.7, appear to be more transmissible than earlier forms of SARS-CoV-2, and if left to spread uncontrollably, these variants could make many more people severely ill, which risks overwhelming healthcare systems around the world and even higher death tolls. Veldhoen adds that new variants also may pose a greater risk of reinfection to recovered COVID-19 patients.
Researchers are closely monitoring the new variants. If vaccines need to be updated in the future, Anderson says that it could be done quickly—in roughly six weeks for currently authorized mRNA vaccines, such as those made by Pfizer-BioNTech and Moderna. That timetable, though, doesn’t account for the regulatory approvals that updated vaccines would need to go through.
Anderson adds that depending on how the evolution of the virus progresses, lineages of SARS-CoV-2 may arise that are distinct enough that vaccines will need to be tailored to specific regions akin to vaccines for pneumococcus. To successfully guard against SARS-CoV-2 going forward, we will need a global monitoring network similar to the worldwide reference laboratories used to collect, sequence, and study variants of influenza.
“We’re going to have to live with it, we’re going to have to have constant vaccination, and we’re constantly going to have to have a very sophisticated molecular surveillance program to keep track of how the virus is evolving,” Anderson says.
The promise and challenge of widespread vaccination
Experts agree that transitioning beyond a pandemic depends on the prevalence of immunity, especially among older and more vulnerable populations. Younger people, especially children, will build up immunity to SARS-CoV-2 over a lifetime of exposure to the virus. Today’s adults have had no such luxury, leaving their immune systems naive and exposed.
The exact threshold for achieving population-wide immunity that slows down the virus’s spread will depend on how contagious future variants become. But so far, research of early variants of SARS-CoV-2 suggests at least 60 to 70 percent of the human population will need to become immune to end the pandemic phase.
This immunity can be achieved in one of two ways: large-scale vaccination, or recovery from natural infections. But achieving widespread immunity through uncontrolled spread comes at a terrible cost: hundreds of thousands more deaths and hospitalizations around the world. “If we don’t want to push forward vaccines and champion vaccines, we have to decide collectively how many old people we want to die—and I don’t want to be the one making that decision,” Duplex says.
Jeffrey Shaman, an infectious diseases expert at Columbia University, points out that the global push for vaccines also exposes existing inequities in global health. In a widely shared map from December, The Economist Intelligence Unit estimated that rich countries such as the U.S. will have widely accessible vaccines by early 2022, which may not happen for poorer countries in Africa and Asia until as late as 2023.
Efforts to vaccinate the developing world hinge, in part, on vaccines that can be stored with standard refrigeration, such as the vaccines under development by Oxford/AstraZeneca and Johnson & Johnson. (See the latest on COVID-19 vaccine development around the world.)
As of the week of January 18, according to a World Health Organization estimate, some 40 million COVID-19 vaccine doses have been administered around the world, mostly in high-income countries. In Africa, only two countries, Seychelles and Guinea, have started providing vaccines. And in Guinea, a low-income country, only 25 people have received doses.
Patients with IBD should receive COVID-19 vaccine, despite concerns
“For patients with IBD we would advocate, based on [International Organization for the Study of Inflammatory Bowel Disease (IOIBD)], that patients get vaccinated, acknowledging that there is a lack of data specifically in IBD patients,” Ryan C. Ungaro, MD, MS, gastroenterologist with Mount Sinai Hospital’s Feinstein IBD Center, told Healio Gastroenterology. “But we think the benefits outweigh the risks and based on prior experience with vaccinations in IBD patients.”
CDC and IOIBD recommend patients with IBD should receive the COVID-19 vaccine.
According to Ungaro, the CDC recommended immunocompromised patients should get the COVID-19 vaccine. Patients should be counseled that it is not yet known whether the safety and effectiveness of the vaccine in immunocompromised patients are the same compared with the general population.
“The major concern would be certain medications could lead to decreased response to the vaccine,” he said. “That is something that is going to need to be studied but right now the expert consensus is that IBD patients should get vaccinated against COVID-19.”
According to IOIBD recommendations, patients with IBD should receive the COVID-19 vaccine as soon as possible. Messenger RNA vaccines, replication vector vaccines, inactivated vaccines, and recombinant vaccines are safe to be administered in IBD patients, Ungaro said.
Additionally, the IOIBD said vaccines should not be deferred if an IBD patient is receiving immune-modifying therapies.
According to Ungaro, patients with IBD who take corticosteroids and get the vaccine should receive counseling that there may be a decreased systemic response. He said this needs to be studied further.
“Prospective studies are being planned to look at the real-world effectiveness and side effects of the COVID-19 vaccine in IBD patients,” Ungaro said. “This would require cohorts that are vaccinated and followed. Some studies are ongoing for that both in the United States and internationally. [Surveillance Epidemiology of Coronavirus Under Research Exclusion-IBD (SECURE-IBD)] is going to help support some of these efforts as well.”
Ungaro and his team at Mount Sinai in collaboration with the University of North Carolina developed the SECURE-IBD registry early in 2020 to monitor and report outcomes of COVID-19 in patients with IBD.
He said, “Physicians can encourage IBD patients to enroll in the Crohn’s and Colitis Foundation’s IBD Partners, they will be one of the sources for the prospective COVID-19 vaccine studies.”
Udo’s Choice® Super 8 Microbiotic
People liveing with crohns sisease can have a altered “microbiome” which means that the digestive bacteria thats in ther gut can be unbalanced ,that were takeing
Some experts maintain that using probiotics to restore the microbiome can allow a person with Crohn’s disease to reduce irregular immune responses and experience fewer symptoms.
They believe that adding healthful bacteria to the digestive tract, potentially by incorporating natural probiotic food sources to the diet, can reduce both intestinal inflammation and anomalies of the immune system. This could minimize symptoms of Crohn’s disease, such as gastrointestinal irritation, diarrhea, and stomach upset.
To see whether or not probiotics work for them, people with Crohn’s disease can keep a food diary and slowly incorporate some of these foods into their diet, noting any changes in their symptoms.
Probiotic foods include:
A person may also incorporate prebiotic foods into their diet. These are food sources that feed bacteria in the digestive tract and can promote their growth. These foods include onions, leeks, and asparagus.
Research has not proven that the probiotics in food can help reduce Crohn’s disease symptoms, so some people may wish to try taking a supplement first.
However, as long as someone does not have an allergy to foods that contain probiotics, incorporating them into the diet is a relatively risk-free method to try to improve overall health and help manage the disease.
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