Crohn’s Disease Treatment in Indore

Overview of Crohn’s Disease

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract. It can involve any area from the mouth to the anus, but the most common sites are the last part of the small intestine, called the terminal ileum, and the beginning of the colon. The inflammation tends to be patchy (with healthy bowel in between) and can extend through the full thickness of the bowel wall. The depth explains the increased likelihood of Crohn’s disease, as opposed to ulcerative colitis, to cause narrowing, abscesses and abnormal tunnels, called fistulas.

Named for Dr. Burrill Crohn, who first described the condition in the 1930s. It typically begins in the late teens to thirties and has a relapsing course. People can feel well for months and then get a flare and the pattern varies a lot from person to person. If untreated, ongoing inflammation can lead to gradual injury to the bowel, which is why early diagnosis and ongoing care are so important.

Dr. Kriti Bansal is a Crohn’s Disease Specialist in Indore. She also focuses on mapping precisely where the disease is, choosing treatment early enough to protect the bowel, and checking nutrition and growth along the way. The management of Crohn’s disease includes assessing the site, extent and behavior of the disease before planning.

Patterns of Crohn’s Disease

Doctors describe Crohn’s disease by location and behavior, as this predicts what kind of treatment is needed.

• Ileocolonic disease: The most common pattern, affecting the end of the small bowel and the right side of the colon, with pain in the lower right abdomen.
• Small bowel disease: Inflammation of the upper small intestine can interfere with absorption of nutrients and cause significant weight loss.
• Colonic disease: Inflammation confined to the colon can mimic ulcerative colitis, with diarrhea and sometimes blood.
• Upper GI disease: Less often involves the food pipe, stomach or duodenum leading to nausea, vomiting or difficulty swallowing.
• Perianal disease: Fissures, abscesses and fistulas around the anus can occur with any of the above patterns.
• Inflammatory, stricturing and penetrating behavior: The disease may remain inflammatory, scar and narrow the bowel, or bore through the bowel wall. The behavior may change over the years.

Symptoms of Crohn’s Disease

Symptoms tend to develop slowly and often are attributed to other causes for months or years, such as acidity or infection.

• Chronic abdominal pain: Crampy pain, typically in the lower right abdomen, often after eating.
• Diarrhea: Frequent loose stools, which may or may not contain blood, are common and may be nocturnal.
• Weight loss and poor appetite: Fear of pain after eating and poor absorption and inflammation cause weight and muscle loss.
• Fever and fatigue: Active disease is characterized by low-grade fever, nite sweats and fatigue.
• Mouth ulcers: Recurrent painful ulcers in the mouth can be an early sign.
• Perianal symptoms: Pain, swelling, a boil or drainage near the anus may be the initial presentation in some patients.
• Obstruction: Cramping, bloating and vomiting after eating are suggestive of a narrowed segment of bowel.
• Growth problems in children: Short stature, delayed puberty, and poor weight gain can occur with few bowel symptoms.
• Extra-intestinal manifestations: Joint pains, red eyes, skin nodules and gallstones.

Causes and Risk Factors of Crohn’s Disease

What causes the disease is not known for sure. Research suggests a combination of genetic susceptibility, an overactive immune response to intestinal bacteria, and environmental triggers.

• Genes: Over 200 gene regions have been associated with Crohn’s disease. The risk increases if there is a relative with the illness.
• Immune response: The body’s defense mechanisms still attack intestinal bacteria that are normally to be tolerated.
• Smoking: Smoking raises the risk of developing Crohn’s disease, as well as the risk of having more severe disease and of relapse after surgery.
• Diet and lifestyle: Increasing rates are associated with diets high in processed food and low in fiber and urban living.
• Previous infections and medicines: Previous gut infections, repeated courses of antibiotics and regular use of anti-inflammatory painkillers may play a part in susceptible people.

Complications of Crohn’s Disease

If inflammation continues, scarring can constrict the bowel and cause a blockage. An ulcer can penetrate through the wall and create a fistula connecting the intestine to another bowel loop, the bladder, the vagina or the skin. An abscess is a collection of pus that can develop in the abdomen or near the anus and needs to be drained.

Absorption is poor, leading to deficiencies of iron, vitamin B12, folate, vitamin D, calcium and zinc. Gallstones and kidney stones are more frequent. Regular surveillance is part of care, as long-standing disease involving the colon or surrounding fistulas increases cancer risk. Delays in treatment increase the probability of needing surgery so early evaluation is encouraged.

How Crohn’s Disease is Diagnosed

The diagnosis is made on the basis of clinical features and results of tests. There is no one test. A Crohn’s disease specialist in Indore will generally use a combination of endoscopy, imaging and lab results to map out the disease.

• Markers in blood and stool: Low vitamin levels, anemia, raised CRP and low albumin are markers of activity and malnutrition. Fecal calprotectin is a marker of bowel inflammation.
• Ileocolonoscopy: The doctor looks at the colon and the last part of the small bowel and takes samples (biopsies). Findings are typically patchy ulcers, cobblestone appearance and narrowed segments.
• Upper endoscopy: This is done for children or if there are upper abdominal symptoms.
• CT or MR enterography: Extent of small bowel disease, wall thickening, strictures, fistulas and abscesses MR is preferred in young patients and for perianal disease (to avoid radiation).
• Capsule endoscopy: If other tests are normal and there is no narrowing, a camera capsule can be swallowed to examine the small bowel.
• Pelvic MRI: It defines the tracts of perianal fistulas.
  In India, intestinal tuberculosis is so similar to Crohn’s disease that tuberculosis tests are performed on almost all patients before an immune-suppressing drug.

Treatment for Crohn’s Disease

Treatment is aimed at controlling inflammation, healing the lining of the bowel, keeping the patient steroid free, preventing complications and restoring normal growth and nutrition. The decision to pursue a gradual step-up or early-intensive strategy depends on the risk of disease.

Inducing remission

Budesonide is useful in mild disease affecting the ileum and right colon due to its local activity and fewer systemic effects. Prednisolone – for moderate to severe flares for a few weeks then tapered off gradually. In children and some adults, 6 to 8 weeks of exclusive enteral nutrition can induce remission without steroids. Antibiotics are used for infections, abscesses and some perianal disease.

Maintaining remission

Azathioprine, mercaptopurine and methotrexate are used to keep the immune system under control in the long term. Biologic drugs are often offered early to those with features that predict a difficult course such as young age, extensive small bowel disease, perianal involvement or the need for steroids at the start. Anti-TNF agents such as infliximab and adalimumab, vedolizumab and ustekinumab are used, sometimes in combination with an immunomodulator. therapeutic drug levels and antibodies can be measured to adjust dosing.

Perianal Crohn’s disease

Perianal abscesses are drained and a seton, a soft thread placed in the tract of the fistula, may be placed to keep the tract open and draining. Next are antibiotics and biologic therapy, and then MRI to confirm healing.

Nutritional support

Weight is regained on high-calorie, high-protein diets supervised by a dietitian. Supplements of iron, B12, vitamin D, calcium and zinc are administered as needed. Those with narrowing are advised a low residue diet.

Surgical Management

About half of Crohn’s patients will need surgery at some point. It is indicated for strictures causing obstruction, abscesses, fistulas, perforation or disease not responding to medicines. The surgeon removes only the diseased segment or enlarges the narrowed segment (stricturoplasty) in an effort to preserve as much bowel as possible. To prevent the disease from coming back near the connection site, medicines and a follow-up colonoscopy about six months after surgery are scheduled.

Monitoring and Day-to-Day Care

Regular follow-up allows the doctor to review symptoms, weight, blood counts, inflammatory markers and calprotectin, and to arrange repeat endoscopy or imaging to confirm healing. One of the most helpful things a patient can do is stop smoking. If you are feeling fine, take medicines as per schedule as self-stopped treatment often leads to relapse.

Recovery is supported by eating small, frequent, nutritious meals, drinking enough fluids and being physically active. Patients with strictures should chew food well and avoid taking seeds, skins and tough fibers. Vaccinations and bone health are reviewed periodically and new anal pain, swelling or persistent vomiting should be reported straight away. Crohn’s disease management in Indore is based on regular follow-up, not just treatment during flares.

Nutrition Problems Unique to Crohn’s Disease

Crohn’s disease commonly affects the small bowel which is where nutrients get absorbed, so even patients who eat well often have deficiencies. If the terminal ileum is inflamed or removed, vitamin B12 cannot be absorbed from food and may need to be given by regular injection. Iron deficiency can be caused by slow blood loss and poor absorption and an iron infusion may be needed if tablets are not tolerated or not effective. Low vitamin D and calcium cause weak bones. Low zinc slows wound healing and decreases taste and appetite.

The dietitian can tailor meals to the stage of the disease. During flares, easily digestible, high-calorie options such as milk-based shakes, eggs, soft rice preparations, and well-cooked vegetables help maintain weight. Oral nutritional supplements are used to fill the gaps . Tube feeding or intravenous nutrition is reserved for situations where the gut cannot be used . The blood is tested for important nutrients once or twice a year.

Fertility, Pregnancy and Women’s Health

When Crohn’s disease is quiescent, it generally doesn’t affect fertility, but active inflammation or prior surgery in the pelvis can decrease the ability to become pregnant. Women are encouraged to try for pregnancy during remission, as active disease in pregnancy increases the risk of premature birth and low birth weight. Many medicines such as mesalamine, azathioprine and a number of biologics can be continued under supervision, while methotrexate has to be stopped months before trying to conceive. Women with Crohn’s disease may also be at increased risk of bone loss and their bone health should be reviewed Cervical screening is still important if on immune-modifying medicines.

Preventive Care & Cancer Screening

Having Crohn’s disease of the colon for eight or more years moderately increases the risk of colorectal cancer, so surveillance colonoscopy is advised at intervals recommended by the doctor. Patients on immunomodulators or biologics have a slightly increased risk of some skin cancers and require sun protection and an annual skin check. Ideally, routine vaccinations, including influenza, pneumococcal, hepatitis B and, in eligible people, HPV and shingles vaccines, should be given before the start of immune-suppressing therapy.

Why Choose Dr. Kriti Bansal

Dr. Kriti Bansal carefully distinguishes between Crohn’s disease and intestinal tuberculosis, which are often similar in many Indian patients. Getting the right diagnosis first can prevent misdiagnosis and unnecessary delay.

Her next visit will focus not only on symptoms but also on nutrition, bone health, vitamin levels and growth, because Crohn’s disease can affect the way the body absorbs nutrients. Early recognition of patients with signs of a difficult course is important and she works with colorectal surgeons and radiologists when interventions are needed.

Patients coming for treatment of Crohn’s disease in Indore are given a clear explanation of disease pattern, written treatment plan and fixed dates for review.

Book a Consultation

Phone: +91-7610102710
Email: drkritigastro@gmail.com