Diseases and Procedures

Crohn's Disease

Introduction

Crohn's disease is an inflammatory disease of the gastrointestinal (GI) tract, sometimes called ileitis or enteritis. It usually occurs in the small intestine (primarily in the ileum, the lowest segment) and the large intestine (colon) but may occur in any section of the GI tract. Crohn's disease usually causes cramps, abdominal pain, diarrhea, fever, and rectal bleeding. Loss of appetite and weight loss may also occur. Although these symptoms range from mild to severe, most people with Crohn's disease lead active. normal lives.

Crohn's disease is a chronic (long lasting) condition; we don't know what causes it. Medication currently available is able to decrease the inflammation and control the symptoms - but cannot provide a cure.

Crohn's disease involves all layers of the intestine, yet sections of normal healthy bowel are often found between segments of diseases bowel. Ulcerative colitis attaks innermost lining of the colon in such a way that no healthy segments can exist between sections of dieased bowel. These two diseases are both forms of inflammatory bowel disease (IBD).

It is estimated that there are over one million Americans with IBM. Men and women seem to suffer equally from this disease. Crohn's disease is primarily a disease of the young, but it can affect people of all ages. The majority of cases are diagnosed before the age of 30, yet the disease can occur in people age 60 and above. Crohn's disease seems to run in families; about 20 percent of people with Crohn's disease have a brother, sister, parent or child who suffers from either Crohn's disease or ulerative colitis.

Treatment

There is no medical cure for Crohn's disease, so treatment is designed to decrease the inflammatory response, allow the involved tissue to heal, and decrease symptoms of diarrhea, fever and rectal bleeding.

Four different classes of drugs are used to treat Crohn's disease:

• Aminosalicylates: aspirin-like drugs, which include mesalmine and sulfasalazine
• Corticosteroids: including prednisone and hydrocortisone to reduce inflammation. These drugs must be used with great care, as they can cause serious side effects, which include increased suseptibility to infection
• Immune modifiers: to stop the inflammation by changing how the body regulates its immune system
• Antibiotics: to control infection

Nutrional supplements may be needed, especially for children whose growth has been affected by Crohn's disease. High-calorie liquid formulas are often given, while some more serious cases may need intravenous feeding.

Patients may experience long periods of remision, sometimes for years, during which they remain symptom-free. The disease, however, usually returns at various times in a person's life. It's important that treatment continue while the disease is in remission; this helps sustain the remission. Of the colon and rectum become seriously damaged, an ileostomy (creating an opening in the abdomen to remove waste) may be required. Most of these patients will continue to live normal, active lives. If medication can no longer control the symptoms, ot if there is intestinal blokage or some other complication, surgery may become necessary. In most cases, the diseased segment of the bowel is removed, while the two healthy ends are joined together. This procedure may allow a patient to be symptom-free for years, but can't be considered a cure, since the disease can still recur.

Good nutrition is especially important in the management of Crohn's disease, where the body often loses fluids, nutrients, vitamins, and minerals. Restoring and maintaining proper nutrition is an essential part of medical management.

Possible Complication

Crohn's disease may cause thickening and swelling of the intestinal wall, as well as scar tissue. This can narrow the opening, and result in bloackage - the most common complication of Crohn's disease.

Crohn's disease often causes nutritional problems due to poor diet, intestinal protein loss, and poor absorption of nutrient.

Quality of Life

Crohn's is a serious, but by no means fatal disease. Most people with Crohn's continue to lead useful and productive lives, even though they may need hospitalization from time to time, and may continue to need medication. Between occasional flare-ups, most people feel well and symptom-free.

Causes and Symptoms

The cause of Crohn's disease is not clear, although there are numerous unproven theories. Many researchers believe that the body's immune system reacts to the invasion of a virus or bacterium by causing continuous inflammation in the intestine.

The earliest symptoms of Crohn's disease are usually abdominal pain and diarrhea. The pain is usually below the navel, and often follows a meal. Decreased appetite, weight loss, joint pain, and fever are common early signs. Other symptoms include anal sores, including skin tags (often mistaken for hemorrhoids), fissures (cracks), fistulas (abnormal openings connecting the bowel to the skin surface near the anus), and abscesses.

Diagnosis

The most important diagnostic tool is a thorough patient history (signs and symptoms). The doctor is alert to the cluster of symptoms that point to a diagnosis of Crohn's disease. A physical exam and additional testing will confirm the diagnosis. These tests may include barium x-rays of the upper and lower GI tract, flexible sigmoidoscopy, and possibly colonoscopy. (These last two tests involove a direct examination of the colon with a lighted tube inserted through the anus.) The patient's blood is tested for anemia (a sign of intestinal bleeding), and a high white blood cell count(a sign of inflammation somewhere in the body). Laboratory examination of a stool sample will determine if there is bleeding or infection in the intestines.