What are the risk factors and complications of Crohn’s disease?

What are the risk factors for Crohn’s disease?

The below is a list of risk factors associated with Crohn's disease:

• Age – The condition is able to occur at any age, however, younger people seem to be more susceptible to the disease. The majority of people will develop Crohn’s disease when they are younger than 30 years old.
• Cigarette smoking – Smoking is one of the only risk factors that can be controlled. Smoking cigarettes also leads to a number of different diseases and conditions.
• Ethnicity – The disease is able to affect anyone regardless of their ethnic group, however, Caucasians from Eastern Europe with Jewish descent seem to have a higher risk of developing Crohn's disease, the reason for this is still unknown.
• Family history – If someone has a sibling or parent with the condition, then their risk may be increased. One in five people with Crohn's disease has a close relative with the condition.  
• Location – Living in an industrialised or urban area may increase one’s risks of developing the condition. This theory is based on the fact that various environmental factors such as diet, may have a significant role to play in the development of Crohn's disease. Those who live in the more northern climates have also been seen to have a higher risk.  
• Nonsteroidal anti-inflammatory medications –  Naproxen sodium (Anaprox, Aleve), ibuprofen (Advil, Motrin IB), diclofenac sodium (Solaraze, Voltaren), as well as a number of other medications have been known to lead to bowel inflammation and make Crohn's disease progress, although these medications are not a cause of the condition.

What are the complications of Crohn’s disease?

The following complications can be a direct result of Crohn’s disease:

• Inflammation – Inflammation is often confined to the lining of the bowel (bowel wall), this can lead to the narrowing of the bowel wall, known as stenosis, or scarring. The inflammation is also able to spread through the intestinal lining, this is known as an intestinal fistula (more on this below).
• Bowel obstruction – The thickness of the of the bowel wall can be affected by Crohn's disease. Over time, the parts of the intestine can narrow and thicken, which may result in the flow of the digestive content being blocked. This may require surgery in order to remove the infected area of the bowel.
• Ulcers – As a result of the chronic inflammation ulcers (open sores) are able to form anywhere in the digestive tract, this may include the anus and mouth as well as the person’s genital area, between the anus and scrotum or vulva, known as the perineum.
• Fistulas – In some cases, the ulcers are able to extend through the bowel (intestinal) wall entirely. This creates something known as a fistula which is an abnormal linking between the different parts of the body. Fistulas are able to develop between the intestine and the skin or between the intestine and an adjacent organ. A fistula forming near the anal area, known as a perianal fistula, is often the most common type of fistula associated with Crohn's disease. If a fistula develops in the patient’s abdomen, then the food digested may bypass the areas of the bowl that are needed to absorb the food. Fistulas can occur between the bladder or vagina and the loops of one’s bowel, or even through a person’s skin (as mentioned), this results in the continuous drainage of the bowel contents to the skin. In some patients, the fistulas may become infected and form a confined little pocket of pus that will collect in the tissue infected, this is known as an abscess. An abscess, if left untreated, can be life-threatening when it is in the bowels.  
• Anal fissure – An anal fissure is a tiny tear in the lining of the anus or skin tissue around the anus. It is often found where Crohn’s disease infections occur. These often cause bowel movements that are extremely painful and can even result in an infected tunnel between the anus and the skin, known as a perianal fistula.
• Malnutrition – Abdominal pain, cramping and diarrhoea can often make it hard for the patient to eat or for their intestine to be able to absorb the nutrients needed for nourishment. Anaemia is also a common complication associated with Crohn’s disease as a result of the low levels of iron or vitamin B-12 being absorbed.
• Colon cancer – If Crohn’s disease affects the colon, then the person’s risk of developing colon cancer is increased. The extent of the damage done from the infection and inflammation associated with the disease will influence the level of one’s risk. Cancer can develop from the changes in the colon that form from the inflammation, as well as the presence of excluded or bypassed segments as previously mentioned.
• Other health issues – A number of other health problems may develop as a result of Crohn’s disease in other areas of one’s body. Some of these issues include:
  • Liver or gallbladder disease - As a result of the inflammation affecting the small intestine’s ability to properly absorb the bile salts which are chemicals produced by the liver and then stored in the gallbladder (aiding in the digestion of fats and eliminating toxins from the body).
  • Osteoporosis – This is the softening of bones as a result of malnutrition and lack of calcium.
  • Anaemia – As a result of the lack of iron which is caused by malnutrition. Anaemia is a condition where the body suffers from a decrease in the number of red blood cells which results in the oxygen flow to vital organs being depleted.
• Medication risks – There are certain drugs used to treat Crohn’s disease that work through blocking the functions of the patient’s immune system that are responsible for the inflammation. These drugs are known to increase one’s risk of developing certain cancers such as skin cancers and lymphoma. Osteoporosis, diabetes and glaucoma have been linked to corticosteroids which aid in controlling inflammation. It is best to always speak to the doctor regarding the risks of medications that are prescribed.