CROHN’S DISEASE

By: Ariana Estelle-Symons, Ph.D.
Copyright 1999



IBS

IBS (Irritable Bowel Syndrome), is the most common digestive disorder encountered by physicians. Gastroenterologists report that nearly half the patients they see suffer from a type of IBS. It is estimated that one in five adult Americans has symptoms of IBS, although fewer than half of them seek medical help. Also known as intestinal neurosis, nervous indigestion, mucous colitis, spastic colitis, or spastic colon, the condition affects twice as many women as it does men. This may not be a true figure, because women are more likely to seek treatment, and that may account for the 2 to 1 ratio.

In simple terms, IBS is a condition in which the large intestine fails to function as it should. Normally, regular muscular contractions of the large intestine move waste from the small intestine to the rectum, at which point it’s evacuated. But when IBS is present, excessive muscular contractions of the large intestine result in cramping and diarrhea, and the lack of contractions results in constipation and cramping. This interference with the normal movement of food and waste material leads to the accumulation of mucus and toxins in the intestine. The accumulated material sets up a partial obstruction of the digestive tract, trapping gas and stools, which in turn causes bloating, distention and constipation. IBS may affect the entire gastrointestinal tract, from the mouth all the way through the colon.

The symptoms are numerous and varied and may include constipation and/or diarrhea (often alternating), abdominal pain, frequent painful bowel movements, mucus in the stools, nausea, flatulence, bloating, anorexia, and intolerance to certain foods. Because of the pain & discomfort involved with IBS, a person that suffers from it may actually dread eating a meal. Eating often triggers the pain. Even when the patient does eat normally, they are usually undernourished because of malabsorption of nutrients. Because diarrhea can cause a depletion of minerals and trace elements, the body can become ‘run-own’ in a short period of time.

This is not a condition to be self-diagnosed.

The diagnostic procedure is usually of process of elimination. Your physician will diagnose IBS by tests & procedures, which rule out other disorders that frequently cause similar symptoms, such as Crohn’s disease, diverticulitis, lactose intolerance, Celiac disease, and ulcerative colitis. Most of these procedures are not particularly pleasant, but quite necessary to diagnose IBS; they may include barium enema, colonoscopy, rectal biopsy, sigmoidoscopy, and stool examination to check for the presence of bacteria, blood, and/or parasites. IBS symptoms can be related to, or mimic other more life threatening disorders, such as candidiasis, colon cancer, diabetes mellitus, gallbladder disease, malabsorption disorders, pancreatic insufficiency, ulcers, and protozoa disease (parasitic infections amebiasis and giardiasis). Over 100 different disorders may be linked to the systemic effects of IBS. One disorder that is linked in about 25 percent of adults with IBS is arthritis, usually peripheral arthritis, which affects the ankles, knees, wrists, and sometimes the spine. Some people with IBS have abnormalities in the levels of liver enzymes in their blood. There are no physical signs of the disease in bowel tissue with this disorder, and its cause or causes are not well understood.

One theory points to psychological disturbances as playing a role in IBS. Studies have shown that people with IBS have higher levels of anxiety than normal and also a greater tendency to depression. However, other follow-up studies pointed out that these very patients were assessed after the development of the disorder. IBS can be such a troubling and disruptive syndrome, it comes as no surprise that people who suffer from it would find that their mental health also suffers.

Another theory points a finger at the yeast Candida, which is always present in the intestinal tract. However, Candida overgrowth can exacerbate IBS symptoms. Other causes or triggers may be:

One of the first steps to control symptoms of IBS is to increase dietary fiber. There was a time when fiber was blamed for causing IBS, but it is now known that is not the case. Additional fiber in the diet will not only help people with constipation, but can be helpful for those who suffer from diarrhea.

 If you suffer from IBS, the following guidelines may help.

 

The natural approach – Herbs & Kombucha

 


CROHN’S DISEASE


 What are the symptoms of Crohn’s disease?

The most common symptom of Crohn’s disease is abdominal pain, often in the lower right area, plus diarrhea. Other symptoms may include loss of appetite, weight loss, rectal bleeding, fever, headaches and digestive problems. Bleeding may be serious and persistent, leading to severe anemia. Quite often Crohn’s disease is misdiagnosed and the symptoms are thought to be those of IBS. Children with Crohn’s disease may suffer delayed development and stunted growth. Although Crohn’s occurs usually between the ages of 13 and 32, there seems to be more and more cases reported in children – which can be extremely detrimental to their normal development. The disease may increase chances for cancer by perhaps as much as 20 times.

Crohn’s disease causes inflammation in the small intestine. Crohn’s usually occurs in the lower part of the small intestine, called the elium, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn’s disease is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. Crohn’s disease can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome (IBS) and to another type of IBD called ulcerative colitis. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine.

Sometimes referred to as ileitis or enteritis, Crohn’s disease affects males and females equally, and seems to run in some families. About 20 percent of people with Crohn’s disease have a blood relative with some form of IBD, most often a brother or sister, and sometimes a parent or child.

 What Causes Crohn’s Disease?

Theories about what causes Crohn’s disease abound, but none has been proven. The most popular theory is that the body’s immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine.

People with Crohn’s disease tend to have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause – or – result of the disease. According to current research, Crohn’s disease is not caused by emotional distress.

Some studies seem to indicate that free radical damage could be involved and lack of vitamins C and E could be a factor.

How is Crohn’s Disease Diagnosed?

A thorough physical exam and a series of tests may be required to diagnose Crohn’s disease.

Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.

The doctor may also do an upper gastrointestinal (GI) series to look at the small intestine. For this test, the patient drinks barium, a chalky solution that coats the lining of the small intestine, before x-rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine.

The doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope – a long, flexible, lighted tube linked to a computer and TV monitor – into the anus to see the inside of the large intestine. The doctor will be able to see any inflammation or bleeding. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope.

If these tests show Crohn’s disease, more x-rays of both the upper and lower digestive tract may be necessary to see how much is affected by the disease.


The Complications of Crohn’s Disease

The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohn’s disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery.

Nutritional complications are common in Crohn’s disease. Deficiencies of proteins, calories, and vitamins are well documented in Crohn’s disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption).

Other complications associated with Crohn’s disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.

What is the treatment for Crohn’s Disease?

Treatment for Crohn’s disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At their time, treatment can help control the disease, but there is no cure.

Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.

Someone with Crohn’s disease may need medical care for a long time, with regular doctor visits to monitor the condition.

 

Drug Therapy

Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.

Some patients take corticosteroids to control inflammation. These drugs are the most effective for active Crohn’s disease, but they can cause serious side effects, including greater susceptibility to infection.

Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteriods can eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.

The U.S. Food and Drug Administration (FDA) has approved the drug Infliximab (brand name, Remicade) for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open draining fistulas. Infliximab, the first treatment approved specifically for Crohn’s disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a protein produced by the immune system that may cause the inflammation associated with Crohn’s disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thereby preventing inflammation. Investigators will continue to study patients taking Infliximab to determine its long-tem safety and efficacy.

Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole. Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including dephenoxylate, loperaminde, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.


Nutrition Supplementation

The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.


Surgery

Surgery to remove part of the intestine can help Crohn’s disease – but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Many Crohn’s disease patients require surgery, either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine.

Some people who have Crohn’s disease in the large intestine need to have their entire colon removed in an operation called colectomy. A small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin’s surface. This opening, called a stoma, is where waste exits the body. The stoma is about the size of a quarter and is usually located in the right lower part of the abdomen near the belt line. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.

Sometimes only the diseased section of intestine is removed. In this operation, the intestine is cut above and below the diseased area and reconnected.

Because Crohn’s disease often recurs after surgery, people considering surgery should carefully weigh its benefits and risks compared with other treatments. Surgery may not be appropriate for everyone. People faced with this decision should get as much information as possible from doctors, nurses who work with colon surgery patients (enterostomal therapists), and other patients. Patient advocacy organizations can suggest support groups and other information resources.

People with Crohn’s disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn’s disease are able to hold jobs, raise families, and function successfully at home and in society.

 



Resources on Crohn’s Disease

Crohn’s & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: (800) 932-2423 or (212) 685-3440
Email:
info@ccfa.org
Webpage:
http://www.ccfa.org/


Pediatric Crohn’s & Colitis Association, Inc.
P.O.Box 188
Newton, MA 02168
Phone: (617) 244-6678


United Stormy Association
36 Executive Park, Suite 120
Irvine, CA 92714
Phone: (800)826-0826 or (714) 660-8624
Email:
uoz@deltanet.com
Webpage:
http://www.uoa.org/



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