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Wednesday, March 7, 2012

Crohn's Disease

Crohn's disease is an inflammatory bowel disease (IBD), so called because it causes swelling and inflammation in the digestive or gastrointestinal (GI) tract. It may affect any part of the GI tract, but it usually affects the ileum or lower part, inflammation leads to abdominal pain and diarrhea. It is similar to other inflammatory bowel diseases like ulcerative colitis, which causes inflammation and ulcers in the top layer of the large intestines. However, in Crohn's disease, the inflammation can extend deeper, involving all layers of the intestines.

The exact cause of Crohn's disease is unknown. Current theories suggest that in people with Crohn's disease, the body has an abnormal immune response which causes white blood cells to accumulate in the lining of the intestines, leading to chronic inflammation, ulcers, and bowel injury. There may be a hereditary component as well.

Symptoms of Crohn's disease range from the moderate to the severe. There may even be periods of remission when the symptoms subside completely. When the disease is active, symptoms may include the following:

- Diarrhea
- Abdominal pain and cramping
- Blood in the stool
- Ulcers in the intestine
- Reduced appetite and weight loss

Crohn's disease may lead to complications. The most common one is blockage of the intestine. Crohn's disease may also cause ulcers that tunnel through affected areas and surrounding tissue, creating fistulas (abnormal connections between organs) or anal fissures (cracks). Malnutrition and vitamin deficiencies may also occur due to inadequate dietary intake or poor absorption. Anemia may also be present in some due to intestinal bleeding. Other complications may include the following:

- Arthritis
- Eye inflammation
- Skin disorders
- Diseases of the liver or bile ducts
- Delayed growth or development in children

There is also evidence that Crohn's disease and other inflammatory bowel diseases may increase the risk of colon cancer.

There is no cure for Crohn's disease. The goals for treatment are to control the inflammation, thereby reducing the symptoms of pain, diarrhea, and rectal bleeding. Treatments may also be aimed at correcting nutritional deficiencies. To accomplish these goals, a combination of treatments may be necessary including medications and nutritional supplements; surgery; and lifestyle changes.

Anti-inflammatory drugs including corticosteroids are often the first step in the treatment of Crohn's disease. Medications called immune system suppressors may also be prescribed. Antibiotics are used to heal fistulas and abscesses. In addition to controlling inflammation, other drugs can be used to relieve the symptoms, including anti-diarrheals and pain relievers. Nutritional supplements may be needed including iron supplements to treat anemia; calcium and vitamin D to prevent osteoporosis: and vitamin B-12 shots. Additional nutritional therapies including high-calorie liquid formulas; enteral nutrition (diet given via feeding tube); or parenteral nutrition (nutrients injected into a vein) may sometimes be necessary.

When medications can no longer control the symptoms of Crohn's disease, surgery may be necessary. It has been estimated that nearly three-quarters of all people with Crohn's disease will need surgery at some point. The doctor may recommend surgery to close fistulas or drain abscesses. Another common surgery is a strictureplasty, a procedure that widens a segment of the intestine that has become narrowed by disease. Surgery is also performed to remove damaged parts of the intestine. Some people who have the disease in their large intestine must have the entire colon removed (colectomy). In these cases, a small opening or stoma is made in the abdominal wall and the tip of the ileum is brought to the skin's surface where waste is collected in a pouch. The majority of colectomy patients live normal, active lives.  Surgery is not a cure and it is not unusual for people with Crohn’s disease to have more than one operation.

Lifestyle changes can help the per­son with Crohn's disease feel more in control of their health, since they can help control the symp­toms and lengthen the time be­tween flare-ups. No special diet has been proven to treat or prevent Crohn's disease, but it is important that people with Crohn's disease eat a nutritious diet, avoiding foods that seem to worsen symp­toms. A food diary may help the patient track foods, which cause symptoms to flare. In addition, eat­ing 5 or 6 small meals throughout the day may be better than eating 2-3 larger ones. It is also very im­portant to drink plenty of fluids, particularly water, due to the fluid loss from diarrhea. Alcohol, caf­feine and carbonated drinks may worsen symptoms. Some people with Crohn's disease notice that signs and symptoms flare or worsen when they are under stress. Since stress is unavoidable, it is important for people with Crohn's disease to learn to manage it. With your doctor's approval, a moderate exercise program can reduce-stress, relieve depression, and help normalize bowel function. Other stress reduction techniques that may be helpful include biofeed­back and regular relaxation and breathing exercises like yoga or meditation. Classes, books, CDs or DVDs may assist in learning these techniques.

For more information and support, contact the following:

Crohn's and Colitis Foundation of America
1-800-932-2423 or 212-685-3440

National Digestive Diseases Information Clearinghouse

Written by C. Robeson

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