Tyler James Williams’ Crohn’s Disease

In a recent interview in Men’s Health, actor Tyler James Williams, 30, revealed that he had nearly died 5 years ago from Crohn’s disease. Williams, who originally came to fame playing the adolescent Chris Rock in “Everybody Hates Chris,” went on to play roles in “Criminal Minds,” “Detroit,” and most recently “Abbott Elementary,” for which he earned an Emmy nomination and recently won a Golden Globe.

For years, William thought of himself as a “hard gainer,” finding it difficult to add muscle to his slight frame. Even 10 years after “Everybody Hates Chris,” Williams kept being offered roles for adolescents when he wanted more age-appropriate adult roles. This led him to hire personal trainers, lift heavy weights and force-feed himself in an attempt to bulk up. But his body said otherwise. He would vomit after drinking 1,600 calorie shakes, and he barely made it to 130 lb. Williams told Men’s Health: “I was really pushing my body to the limit. By the time December hit, it just crashed. Everything shut down.”

He experienced searing abdominal pain and was unable to hold down food. He was seen at NYU Langone Health in New York City, where a gastroenterologist found that his bowels were extremely inflamed and obstructed by scar tissue, with a less than a 1-cm gap in his terminal ileum. Williams was diagnosed as having a flare-up of Crohn’s disease, a disorder he had no idea he even had.

Williams underwent emergency surgery to remove 6 inches of his lower intestines. However, his intestines did not heal well, and he went into septic shock, requiring a second emergency procedure. Postop, he spent several months recuperating and required parenteral nutrition.

Since that time, Williams revealed that his brother Tyrel has also been diagnosed with Crohn’s disease, and the two have focused on living a healthier lifestyle. He now avoids alcohol, coffee, and red meat as potential triggers of his disease.

“I had to learn how to stop making a dramatic change happen really quickly and learn how to have a better relationship with my body,” he told Men’s Health. “The important thing for me, and those like me, to remember is that longevity is a big part of the game. If you can’t [stay strong] and be healthy, there really is no point.”

Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease (IBD), along with ulcerative colitis and microscopic colitis. It is a chronic disease that causes inflammation and irritation of the digestive tract. It can occur anywhere, from mouth to anus, but most commonly affects the small intestine, terminal ileum, and right colon.

It is estimated that about half a million people in the U.S. have Crohn’s disease. The incidence of Crohn’s disease in the U.S. and worldwide is increasing, although the reason for the increase is unclear.

Crohn’s disease can develop in people of any age but is more likely to develop in people between the ages of 20 and 29 who have a family member, most often a sibling or parent, with IBD and who smoke cigarettes.

Causes of Crohn’s Disease

Crohn’s disease is an autoimmune disease. There is substantial evidence to suggest that the disease results from an inappropriate immune response in the bowel from environmental factors such as drugs, toxins, infections, or intestinal microbes in a genetically susceptible host.

More than 100 genes have been associated with Crohn’s disease. Several genetic phenotypes have been studied and found to be highly linked to IBD. They include NOD2, ATG16L1, IRGM, LRRK2, IL23R, among others.

NOD2/CARD15 mutations were found to be associated with a phenotype of Crohn’s disease diagnosed at a younger age, with ileal involvement and increased severity of ileal disease requiring surgical intervention or reoperation.

The inflammation in Crohn’s disease is characteristically transmural. According to a review on StatPearls, “The initial lesion starts out as an infiltrate around an intestinal crypt. This goes on to develop ulceration first in the superficial mucosa and involves deeper layers. As the inflammation progresses, non-caseating granulomas form involving all layers of the intestinal wall. It can develop into the classic cobblestone mucosal appearance and skip lesions along the length of the intestine sparing areas with normal mucosa. As the flare of Crohn settles, scarring replaces the inflamed areas of the intestines.”

Symptoms of Crohn’s Disease

The most common symptoms of Crohn’s disease are diarrhea, abdominal cramping and pain, and weight loss. Other symptoms include:

• Anemia
• Eye redness or pain
• Feeling tired
• Fever
• Joint pain or soreness
• Nausea or loss of appetite
• Skin changes that involve red, tender bumps under the skin

Complications can include the following:

• Intestinal obstruction: Crohn’s disease can thicken the wall of the intestines; over time, the thickened areas can narrow, causing intestinal obstruction
• Fistulas: Inflammation can go through the wall of the intestines and create fistulas to other organs or to the outside of the body; fistulas may become infected
• Abscesses: Inflammation that goes through the wall of the intestines can also lead to abscesses
• Anal fissures: These small tears in the anus may cause itching, pain, or bleeding
• Ulcers: Inflammation anywhere along the digestive tract can lead to ulcers or open sores in the mouth, intestines, anus, or perineum
• Malnutrition: Crohn’s disease can reduce intake of vitamins, minerals, and nutrients needed to maintain healthy tissues and organ function
• Other inflammation: Inflammation in other areas of the body, including joints, eyes, and skin, may also occur

For patients with Crohn’s disease in the colon, there is an increased risk of colon cancer, and they should be screened like those at higher risk.

Management

There is currently no cure for Crohn’s disease, and no one single treatment works for everyone. Overall, the goal is to reduce inflammation that triggers symptoms. A long-term goal is to reduce complications.

Treatment and management will typically consist of medication, dietary adjustments, and occasionally surgical intervention.

Medical management with corticosteroids, including budesonide, hydrocortisone, methylprednisolone and prednisone, decreases inflammation and reduces the activity of the immune system.

Aminosalicylates contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. These include balsalazide, mesalamine, olsalazine (Dipentum), and sulfasalazine.

Immunomodulators also reduce inflammation by reducing immune system activity. They can take several weeks to 3 months to show signs of improvement. Immunomodulators include: 6-mercaptopurine (6-MP), azathioprine, cyclosporine, and methotrexate.

Biologic therapies target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies can put patients into remission, especially if they do not respond to other medicines. Biologic therapies include:

• Anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab (Cimzia), and infliximab
• Anti-integrin therapies, such as natalizumab (Tysabri) and vedolizumab (Entyvio)
• Anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab (Stelara)

If Crohn’s disease symptoms are severe, bowel rest may be necessary for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, patients may drink nutritive liquids by mouth or through a feeding tube inserted into the stomach or small intestine or be given IV nutrition.

Even with medication, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60% of people had surgery within 20 years of diagnosis with Crohn’s disease. Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat:

• Fistulas
• Bleeding that is life threatening
• Intestinal obstructions
• Symptoms, when medicines do not improve the patient’s condition

Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.