Crohn's disease

Overview

Living with Crohn's

Named for Burrill B. Crohn, a New York gastroenterologist who identified a pattern of intestinal inflammation in his patients, Crohn's disease is one of several chronic digestive tract aliments, including colitis. The cause of Crohn's, which most often makes its first appearance in young adults, has not yet been identified.

At the outset, Crohn's is marked by abdominal pain, cramping (usually on the right side), diarrhea, and often fever, fatigue, and weight loss. While some cases of Crohn's disappear on their own, the disease may progress, leading to intestinal blockage, ulceration, and infection. Between half and three quarters of people with Crohn's eventually require surgery to remove the affected portion of the intestine, usually more than five years after symptoms first appear.

Treatment focuses on relieving symptoms by changes in diet, stress reduction, drug therapy, and, as the last resort, surgery. Recent innovations in drug treatment include antibacterial medications (the same sort used to treat the ulcer-causing Helicobacter pylori), timed-release anti-inflammatory agents, which seem to produce fewer side effects than standard steroid therapies, and newer immunotherapeutic agents.

Detailed Description

In the early stages of Crohn's disease, tiny lesions called aphthoid ulcers form on the intestinal walls. Over time, the lesions grow together and the intestinal wall takes on a cobblestone appearance, with diseased areas separated by healthy segments.

Crohn's most often affects the ileum (where the large and small intestine join) though it can affect the any part of the digestive tract, from mouth to anus. As Crohn's progresses, the inflammation affects all layers of the intestinal walls, making them thick and inflexible, sometimes leading to strictures, obstructions, abscess formations, bowel perforations, and hemorrhage.

Surrounding tissues and lymph nodes can also become inflamed. If the perianal area is affected, there might be fissures (painful cracks in the anus). Inflamed pouches or tunnels, called fistulae, may also occur.

How Common Is Crohn's Disease?

An estimated one million Americans have Crohn's disease, and approximately 15,000 new cases are diagnosed each year. While the disease can develop at any age, symptoms most often appear in young adults in their 20s. Ninety percent of people who develop Crohn's will do so before the age of 40.

Some studies have suggested that women are more likely than men to develop Crohn's; others have shown that women tend to have more severe as well as more secondary symptoms.

Conventional Treatment

Goals of Treatment

Crohn's disease can often be managed with judicious use of appropriate medication. Specific goals for the treatment of Crohn's include:

• Inducing and maintaining remission during the active phase of the disease
• Managing discomfort caused by inflammation
• Managing other symptoms, such as diarrhea
• Protecting the bowel and avoiding complications that would require surgery
• Maintaining nutritional levels

Treatment Options

A range of medications and sometimes surgery are used to treat Crohn's disease.

Drug Therapy

Azulfidine
Asacol
Prednisone http://www.nmihi.com/p/prednisone.html
Imuran
Imodium
Principen
Flagyl http://www.nmihi.com/m/metronidazole.html
Tetracycline
Cipro http://www.nmihi.com/c/ciprofloxacin.html
Colazal
Topamax

Surgery

Between half and three quarters of people with Crohn's will undergo surgery at some point. But surgery, unfortunately, may not mean an end to symptoms; the disease can happen again next to the section of intestine that was removed. Involved sections of intestine can also develop scar tissue, causing an obstruction. Surgery may also be required to remove fistulae or treat a perforation or hemorrhage.

Managing Treatment

• For the initial mild treatment of the disease: sulfasalazine or mesalamine
• For moderate or severe disease: prednisone used concurrently with sulfasalazine or mesalamine
• Sulfasalazine or mesalamine are the maintenance drugs that you will use regularly
• Your physician will likely have other drug suggestions in treatment of the disease
• Immunosuppressant drugs (6MP/AZA) may be used as steroid-sparing agents
• Surgery, as a last resort

Possible Complications

Complications from Crohn's disease include:

• Intestinal malabsorption
• Intestinal obstruction
• Vitamin B-12 deficiency
• Formation of fistulae along intestine
• Risk of adenocarcinoma in ileum due to extensive colon disease
• Perforations along inflamed bowel/fistulae: perianal, enterocutaneous, entero-enteral
• Anemia and intestinal bleeding
• Risk of developing osteoporosis (especially when taking steroids)
• Short bowel syndrome (if too much intestine needs to be removed)

Healthcare Professionals Who May Be Involved in Treatment

Healthcare professionals involved in treating Crohn's may include:

• Family practitioners
• Internists
• Pediatricians
• Gastroenterologists
• General surgeons
• Colorectal surgeons
• Clinical immunologists

Activity and Diet Recommendations

Eating a balanced diet is especially important for people with Crohn's disease because some symptoms, including diarrhea and malabsorption caused by intestinal injury or surgery, leave people particularly prone to malnutrition. Eating small, frequent meals can reduce the severity of symptoms. Patients should also identify?-- and then eliminate?-- any foods that aggravate symptoms. Keeping a food diary, or written record of everything you eat, can help you figure out what triggers your discomfort. Many people find that high-fiber foods, such as salads, raw vegetables, and raw fruits, may be particularly problematic.

Avoiding alcohol, cigarettes, and foods high in saturated fats can also reduce the severity of symptoms.

Considerations

Pregnancy

Though Crohn's disease does not directly affect pregnancy, maintaining adequate nutrition is absolutely essential. You may want to ask your doctor about supplements. Discuss the safety of all your medications with your doctor prior to becoming pregnant.

Nursing mothers

Some drugs, like metronidazole, are excreted into breast milk. If it is taken while nursing, speak with your doctor about discontinuing breastfeeding for 12 to 24 hours to allow it to pass out of your system.

Considerations for Children and Adolescents

When children develop Crohn's disease, the primary symptoms are often joint inflammation, fever, anemia, and slow growth. Nutrition and dietary supplements are important to help children maintain normal growth.