| 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.
What Causes Crohn's Disease?
After many years of intense research, the cause of
Crohn's disease is still unknown. One theory is that the condition
is caused by an unidentified, slow-growing microorganism. The body's
immune system, which protects it against many different infections,
is also known to be a factor. In spite of the unknown cause,
enormous understanding and knowledge currently exists about the
disease and its treatment.
Who Develops Crohn's Disease?
The condition occurs in both sexes and among all
age groups, although it most frequently begins in young people. For
unknown reasons, Jewish people are at increased risk of developing
Crohn's, while African Americans are at decreased risk.
Symptoms
The symptoms of Crohn's disease depend on where in
the intestinal tract the disorder first 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 (which is sometimes bloody) may
occur, as well as fever and weight loss.
When the inflammation is active, fatigue and lethargy appear. In
children and young people there may be difficulty gaining or
maintaining weight.
Diagnosis
Usually there is no one conclusive diagnostic test
for Crohn's disease. The physician uses a series of tests to assess
the patient's overall condition and then makes a diagnosis. The
patient's medical history and physical exam are always helpful.
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 extensive exam
of the entire colon (colonoscopy) is often the best way of
diagnosing the problem when the disease is in the colon.
Course and Complications
The disorder often remains quiet and easily
controlled for long periods of time. Most people with Crohn's
disease continue to pursue their goals in life, go to school, marry,
have a family, and work with few limitations or inconveniences. Some
problems, outside the bowel, can occur. Arthritis, eye and skin
problems, and-in rare instances-chronic liver conditions may
develop. 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.
Often surgery is required to treat these problems. When Crohn's
disease has been present for many years there is an increased risk
of cancer.
Treatment
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.
Four types of medications are usually used in
treating this disease:
1. Cortisone or Steroids-These powerful drugs
provide highly effective results. Often, a high dose is used
initially to bring the disorder under control. 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.
2. Anti-inflammation Drugs-sulfasalazine (Azulfidine),
Dipentum, Asacol, Rowasa, and Pentasa belong to a group of drugs
called the 5-aminosalicylate group. These drugs are most useful in
maintaining a remission, once the disease is brought under control.
They are available in oral and enema preparations.
3. Immune System
Suppressors-These medications suppress the body's immune system,
which appears to be overly active and to perpetuate the disease in
Crohn's patients. The names of two of these commonly used
medications are azathioprine (trade name: Imuran) and 6 MP (trade
name: Purinethol). There are other potent immune-suppressing drugs
that may be used in difficult cases.
4. Antibiotics--Since there is
frequently a bacterial infection along with Crohn's disease, a wide
assortment of antibiotics is available to treat this problem. One
that is commonly used is metronidazole (trade name: Flagyl).
Diet and Emotions
There are no foods known to actually injure the
bowel. However, during an acute phase of the disease, bulky foods,
milk, and milk products can 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
physician.
Stress, anxiety, and extreme emotions may
aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic
disease can produce a serious emotional reaction, which can usually
be handled through discussion with the physician.
Surgery
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 to correct the problem. It should be understood that surgery
does not cure Crohn's disease.
Summary
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.
This material does not cover all information and is not intended
as a substitute for professional medical care.
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