That’s why it’s so important to diagnose and treat Crohn’s disease as soon as possible. You can work with a gastroenterologist to manage and treat the condition, thereby helping reduce — or delay — your risk of developing some of the more severe complications.
Severe Complications of Crohn’s
When people start showing signs of Crohn’s inflammation, they usually have such telltale symptoms as diarrhea, abdominal cramping, and rectal bleeding. Over the course of months or years, the majority of people with Crohn’s go on to develop more serious symptoms. These include penetrating complications, like fistulas, in which abnormal connections are made between different sections of the bowel and between the bowel and other organs, as well as stricturing complications, which narrow the intestinal wall and eventually cause bowel obstructions, explains Adam Cheifetz, MD, a gastroenterologist and the director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, in Boston. The longer the disease goes untreated, the more dangerous symptoms become, heightening a person’s risk of numerous complications, hospitalizations, disability, time lost from work, surgery, and decreased quality of life. “This is why an early diagnosis of Crohn’s disease is essential,” says Michele Rubin, APN, CNS, an inflammatory-bowel-disease advanced practice nurse and associate director of the Inflammatory Bowel Disease Center at the University of Chicago Medicine. Once Crohn’s has progressed to the stage at which fistulas or strictures form, patients often need surgical resectioning procedures. “We know from natural history data that up to 75 percent of patients with Crohn’s will eventually require surgery,” says Dr. Cheifetz. Surgery, however, is not curative, he adds. Crohn’s disease can come back. “Five years after surgery,” Cheifetz says, “about 50 percent of patients already have clinical recurrence of Crohn’s.” “Medicine may work to heal inflammation, but it doesn’t work on scar tissue,” says Rubin.
Additional Crohn’s Complications
The inflammation caused by Crohn’s disease doesn’t occur in just one layer of the bowel. “It can spread throughout all the layers,” says Cheifetz. Up to a third of patients with Crohn’s can also experience perianal inflammation and complications, he adds, which, again, can progress if the disease is untreated. Untreated Crohn’s may also increase the risk for colorectal cancer, say experts at the Crohn’s and Colitis Foundation of America (CCFA). The link between the two conditions isn’t as strong as it is for ulcerative colitis and colorectal cancer, but Cheifetz explains that inflammation in the colon that’s left untreated poses one of the biggest risks for colon cancer. “We know,” he says “that patients with colonic inflammatory bowel disease are at a higher risk for colon cancer.” Malnutrition is another common complication of untreated Crohn’s. It may develop based on the “severity and location of bowel inflammation,” says Rubin. Your symptoms may make it difficult for you to eat or for your intestines to absorb nutrients. “Prolonged inflammation [also] leads to a loss of weight and muscle mass,” Rubin says. People with nutritional deficiencies resulting from Crohn’s may be advised to try a dietary change or to add nutritional supplements to their eating regimen. If malnutrition becomes severe, some patients may require enteral (by means of a tube) or parenteral (intravenous) feeding. CCFA experts also say that people with Crohn’s may lose bone mass as a result of prolonged inflammation, long-term corticosteroid use, or a vitamin D deficiency.
Avoiding the Dangers of Untreated Crohn’s
If you have symptoms of Crohn’s disease, getting diagnosed and following your prescribed treatment regimen is crucial to managing your condition — and avoiding the dangers of untreated inflammation. Some people with mild Crohn’s may do fine over a number of years without seeing their disease progress, but Cheifetz emphasizes that they, too, need to be monitored closely so any changes in their condition can be addressed quickly. Cheifetz says that it’s important for patients with moderate to severe Crohn’s to get treated and to be monitored closely to make sure the medication is working and that the disease isn’t progressing. “Part of our goal,” he says, “is to treat the disease while it’s inflammatory — when Crohn’s will respond to the medication and we can prevent these progressive changes and complications.” While some people with Crohn’s fear the potential risks of medications, particularly biologics, Cheifetz encourages them to keep things in perspective, saying “It’s really important to be aware that the complications of untreated Crohn’s disease are much more common than the complications of these medications.” A review of research data published in May 2015 in the journal Therapeutic Advances in Chronic Disease reports that tailored antitumor necrosis factor (anti-TCF) biologic therapy can induce remission and help improve long-term outcomes for people with Crohn’s. Cheifetz adds that while some risks are associated with it, biologic therapy has revolutionized the way Crohn’s disease is treated — and how well patients fare.
