Crohn's Disease
Crohn's disease is a chronic, recurrent inflammatory disease of
the intestinal tract. The intestinal tract has four major parts:
the esophagus, or food tube; the stomach, where food is churned
and digested; the long, small bowel, where nutrients, calories,
and vitamins are absorbed; and the colon and rectum, where water
is absorbed and stool is stored. The two primary sites for Crohn's
disease are the ileum, which is the last portion of the small bowel
(ileitis, regional enteritis), and the colon (Crohn's colitis).
The condition begins as small, microscopic nests of inflammation
which persist and smolder. The lining of the bowel can then become
ulcerated and the bowel wall thickened. Eventually, the bowel may
become narrowed or obstructed and surgery would be needed.
There is now evidence of a genetic link as Crohn's frequently shows
up in a family group. In addition, there is evidence that the normal
bacteria that grow in the lower gut may, in some manner, act to
promote inflammation. The body's immune system, which protects it
against many different infections, is known to be a factor. There
are still a number of unknowns about the cause of the disease.
The condition occurs in both sexes and among all age groups, although
it most frequently begins in young people. Jewish people are at
increased risk of developing Crohn's, while African Americans are
at decreased risk, which indicates the genetic link in this disease.
The symptoms of Crohn's disease depend on where in the intestinal
tract the disorder appears. When the ileum (ileitis) is involved,
recurrent pain may be experienced in the right lower abdomen. At
times, the pain mimics acute appendicitis. When the colon is the
site, diarrhea (sometimes bloody) may occur, along with fever and
weight loss. Crohn's disease often affects the anal area where there
may be a draining sinus tract called a fistula.
When the disease is active, fatigue and lethargy appear. In children
and adolescents there may be difficulty gaining or maintaining weight.
Certain blood and stool tests are performed to arrive at a diagnosis.
X-rays of the small intestine and colon (obtained through an upper
GI series and barium enema) are usually required. In addition, a
visual examination (sigmoidoscopy) of the lining of the rectum and
lower bowel is usually necessary. A more thorough exam of the entire
colon (colonoscopy) is often the best way of diagnosing the problem
when the disease is in the colon.
The disorder often remains quiet and easily controlled for long
periods of time.
Some problems, outside the bowel, can occur. Arthritis, eye and
skin problems, and - in rare instances - chronic liver conditions
may develop. As noted, the disease can occur around the anal canal.
Open sores called fissures can develop, which are often painful.
A fistula can also form. This is a tiny channel that burrows from
the rectum to the skin around the anus. In addition, when inflammation
persists in the ileum or colon, narrowing and partial obstruction
may occur. Surgery is usually required to treat this problem. When
Crohn's disease has been present for many years there is an increased
risk of cancer.
Effective medical and surgical treatment is available for Crohn's
disease. It is particularly important to maintain good nutrition
and health with a balanced diet, adequate exercise, and a positive,
upbeat attitude. Five types of medications are available to treat
this disease:
Cortisone or Steroids - These powerful
drugs provide highly effective results. A large dose is often used
initially to bring the disorder under quick control when the disease
is severe. The drug is then tapered to a low maintenance dose, perhaps
taken just every other day. Hopefully the drug may eventually be
stopped altogether. This medicine is administered by pill or enema.
Prednisone is a common generic name.
Anti-inflammation drugs - sulfasalazine
(Azulfidine), Dipentum, Asacol, Rowasa, and Pentasa belong to a
group of drugs called the 5-aminosalicylates. These drugs are most
useful in maintaining a remission, once the disease is brought under
control. They are most effective when the disease is present in
the colon. These are available in oral and enema preparations.
Immune System Suppressors - These medications
suppress the body's immune system, which appears to be overly active
and somehow aggravates the disease. The names of two of these commonly
used medications are azathioprine (trade name: Imuran) and 6 MP
(trade name: Purinethol). These drugs are particularly useful for
long-term care. There are other potent immune-suppressing drugs
that may be used in difficult cases.
Infliximab (trade name: Remicade) -
This drug is the first of a group of medications that blocks the
body's inflammation response. It is given by intravenous infusion
over several hours. These blocking antibody drugs are proving to
be very effective in many patients with severe disease.
Antibiotics - Since there is frequently
a bacterial infection along with Crohn's disease, antibiotics are
often used to treat this problem. Two that are commonly used are
ciprofloxacin (trade name: Cipro) and metronidazole (trade name:
Flagyl).
There are no foods known to actually injure the bowel. However,
during an acute phase of the disease, bulky foods, milk, and milk
products may increase diarrhea and cramping. Generally, the patient
is advised to eat a well-balanced diet, with adequate protein and
calories. A multivitamin and iron supplement may be recommended
by the doctor.
Stress, anxiety, and extreme emotions may aggravate symptoms of
the disorder, and any chronic disease can produce a serious emotional
reaction.
Surgery is commonly needed at some time during the course of Crohn's
disease. It may involve removing a portion of diseased bowel, or
simply the draining of an abscess or fistula. In all cases, the
guiding principle is to perform the least amount of surgery necessary
to correct the problem. Surgery does not cure Crohn's disease.
Most people with Crohn's disease lead active lives with few restrictions.
Although there is no known cure for the disorder, it can be managed
with present treatments. For a few patients, the course of the disease
can be more difficult and complicated, requiring extensive testing
and therapy. Surgery sometimes is required. In all cases, follow-up
care is essential to treat the disease and prevent or deal with
complications that may arise.
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