Crohn's Disease FAQ - Part 5

Surgery, risk of cancer, and pregnancy.

Surgery may also be used to treat CD, usually after all available drug treatments have failed. Anywhere from 40 to 60% of CD patients who have disease in the small bowel will have surgery in the first 10 years after diagnosis. Several different types of surgery are used to treat symptoms and complications of CD, yet none are a cure.

Resection. The most common type of surgery is the resection, during which surgeons remove a diseased piece of the intestine and reconnect the two healthy ends. Resections are common, and may be repeated as the disease recurs in different sections of the intestine.

Strictureplasty. Surgeons use stricturplasty to open up narrowed sections of the intestine (strictures) by making an incision lengthwise along the stricture and closing it in the opposite direction.

Ileostomy. An ileostomy is the complete removal of the colon and a creation of a stoma for eliminating waste. A stoma is the opening in the abdomen through which waste can leave the body from the small intestine. An ostomy bag must be worn on the abdomen to catch waste materials. Continent ostomies (j-pouch, etc.) are not appropriate for CD, as the disease may re-occur in the section of the intestine used to create the continent pouch.

For persons with CD, there are several factors that seem to affect the risk of developing colorectal cancer (CRC). These risks include: a young age at onset, 8 to 10 years of active disease, incidence of strictures and a history of primary sclerosing cholangitis. There are no current screening guidelines for long-standing CD as there are for UC (a colonoscopy every 1 or 2 years after 8 to 10 years of disease). However, physicians may recommend a colonoscopy every 2 to 3 years after 8 to 10 years of CD and every 1 to 2 years after 20 years of CD.

Small bowel cancer is extremely rare, but it appears to be associated with CD located in the ileum. However, more than 90% of IBD patients never develop cancer. A gastroenterologist can make an individualized assessment of cancer risk based on history, other risk factors, and the extent and duration of CD.

People who smoke, or who have smoked in the past, have a higher risk of developing CD. CD patients that smoke have an increased number of relapses, repeat surgeries, and aggressive immunosuppressive treatment. People with CD are generally encouraged to stop smoking by their physicians in order to prevent flare-ups of the disease.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen sodium can cause inflammation and worsen bleeding in the small intestine. They can even knock some people with IBD out of remission. People with IBD should consult with their gastroenterologist before taking NSAIDs, even those available over the counter.

A healthy pregnancy and baby are both possible. The course of IBD throughout the term of a pregnancy tends to remain similar to the condition of the disease at the time of conception.

For women with UC and CD in remission, the risk of miscarriage, stillbirth and congenital abnormality are the same as those for healthy women. A flare-up of CD at the time of conception or during the course of the pregnancy is associated with a higher risk of miscarriage and premature birth.

There seems to be a stronger risk of inheriting CD than UC, especially in Jewish families. However, children who have one parent with Crohn's disease have only a 7-9% lifetime risk of developing the condition, and just a 10% risk of developing some form of IBD. If both parents have IBD this risk is increased to about 35%.

With proper medical care, most people with CD lead long, productive lives. New medications and research into the causes of IBD continue to increase the quality of life for people with IBD.

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