Treating Isolated Lower-Small-Intestine Crohn's


Crohn’s disease can occur in any part of the gastrointestinal tract. In some patients, the inflammation is limited to the last part of the small intestine. Dr. Ghassan Wahbeh shows how inflammation in this area requires specialized treatment.

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0:05 As we know, Crohn's disease can happen in any part of the gastrointestinal tract. That's anywhere from the mouth, the esophagus--which is a swallowing tube--the stomach, the first part of the small intestine; and then all the way down to the colon, where we start with the rectum, the left colon, the middle colon, the right colon. This is where the appendix usually is. And then the last part of the small intestine, and anywhere in between here. And we have feet and feet and feet of small intestine.

0:37 Now, in one out of six, to one out of eight of our patients, the inflammation could be very limited to this part of the bowel--which is the very last part of the small intestine--and possibly part of the right colon. And we can confirm that the inflammation is limited to these areas by doing our camera testing and biopsies--that's the upper endoscopy, and the colonoscopy. We can also get a lot of information about the areas that we cannot reach by doing images, like CT scans, MRIs. And we have to focus on really avoiding using, repeatedly, studies that expose our patients to radiation. MRIs are very commonly used at our center.

1:22 If we confirm that the inflammation is very limited to that area, oftentimes this inflammation--instead of allowing things to pass without difficulty through the small intestine--the wall of the small intestine is very thickened, and becomes narrow. This makes it very difficult for things to pass through, and this may end up with a complete blockage. Sometimes the wall, being so inflamed, can actually leak contents outside of the bowel, and cause an infection.

1:58 For these patients, it would be an option to go ahead and get surgery done. With surgery, we can remove the diseased part, and for some patients this could mean years of having no active disease after the surgery is completed. It's very important to keep in mind that an expert surgeon, who has a lot of talent doing these types of surgery, would be the best individual to do that.

2:25 It's also important to keep in mind that we have to be certain with our tests that the disease is very limited, and even after surgery, because there is a risk of the inflammation coming back. We have to reexamine the bowel, generally three to six months after surgery, and if there is active inflammation, start our patients on a treatment plan to prevent the need for another surgery.