Crohn's Disease: Understanding Abdominal Cramps & Spasms
Abdominal pain in Crohn's disease arises from multiple mechanisms:
- Transmural Inflammation: Activates visceral afferents → cramping.
- Strictures/Fibrosis: Narrowed lumen → obstructive colicky pain, nausea, vomiting.
- Dysmotility: Inflammatory neuromuscular dysfunction → spasms.
- Complications: Abscess, fistula, perforation (acute severe pain).
- Visceral Hypersensitivity: Central sensitization amplifies pain.
Management
- Control inflammation: 5-ASA (mild colonic), corticosteroids (flares), immunomodulators (azathioprine), biologics (anti-TNF, anti-integrin, anti-IL12/23, JAK inhibitors).
- Stricture: Endoscopic dilation or resection.
- Symptomatic: Antispasmodics (hyoscyamine), low-dose tricyclics (neuromodulation), diet (low FODMAP if IBS overlap).
New/worsening pain → assess for complications (CT/MRE). Multidisciplinary IBD care optimizes outcomes.
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