Crohn’s Disease

Definition:-
Crohn’s disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and even malnutrition.

The inflammation caused by Crohn’s disease often spreads deep into the layers of affected bowel tissue. Like ulcerative colitis, another common IBD, Crohn’s disease can be both painful and debilitating and sometimes may lead to life-threatening complications.
click & see the pictures
It  may affect any part of the gastrointestinal tract from anus to mouth, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody), vomiting, or weight loss, but may also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis and inflammation of the eye.

Crohn’s disease is an autoimmune disease, in which the body’s immune system attacks the gastrointestinal tract, causing inflammation; it is classified as a type of inflammatory bowel disease. There has been evidence of a genetic link to Crohn’s disease, putting individuals with siblings afflicted with the disease at higher risk. It is understood to have a large environmental component as evidenced by the higher number of cases in western industrialized nations. Males and females are equally affected. Smokers are three times more likely to develop Crohn’s disease. Crohn’s disease affects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age.

While there’s no known medical cure for Crohn’s disease, therapies can greatly reduce the signs and symptoms of Crohn’s disease and even bring about long-term remission. With these therapies, many people with Crohn’s disease are able to function well.

Symptoms :-
Many people with Crohn’s disease have symptoms for years prior to the diagnosis. The usual onset is between 15 and 30 years of age but can occur at any age. Because of the ‘patchy’ nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more vague than with ulcerative colitis. People with Crohn’s disease will go through periods of flare-ups and remission.

Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include:

#Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is the most common problem for people with Crohn’s.

#Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting.

#Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood)…..click & see

Endoscopy image of colon showing serpiginous ulcer

#Ulcers. Crohn’s disease can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.

#Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.
Erythema nodosum due to CD….…click & see

Other signs and symptoms :-
People with severe Crohn’s disease may also experience:

#Fever
#Fatigue
#Arthritis
#Eye inflammation
#Skin disorders
#Inflammation of the liver or bile ducts
#Delayed growth or sexual development, in children

When to see a doctor :-
See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn’s disease, such as:

#Abdominal pain
#Blood in your stool
#Ongoing bouts of diarrhea that don’t respond to over-the-counter (OTC) medications
#Unexplained fever lasting more than a day or two.

Cause:-
Although the exact cause of Crohn’s disease is still unknown.  Previously, diet and stress were suspect, but now doctors know that although these factors may aggravate existing Crohn’s disease, they don’t cause it. A combination of environmental factors and genetic predisposition seems cause the disease. The genetic risk factors have now more or less been comprehensively elucidated, making Crohn’s disease the first genetically complex disease of which the genetic background has been resolved. The relative risks of contracting the disease when one has a mutation in one of the risk genes, however, are actually very low (approximately 1:200). Broadly speaking, the genetic data indicate that innate immune systems in patients with Crohn’s disease malfunction, and direct assessment of patient immunity confirms this notion. This had led to the notion that Crohn’s disease should be viewed as innate immune deficiency, chronic inflammation being caused by adaptive immunity trying to compensate for the reduced function of the innate immune system.Now, researchers believe that a number of factors, such as heredity and a malfunctioning immune system, play a role in the development of Crohn’s disease.

#Immune system. It’s possible that a virus or bacterium may cause Crohn’s disease. When your immune system tries to fight off the invading microorganism, the digestive tract becomes inflamed. Currently, many investigators believe that some people with the disease develop it because of an abnormal immune response to bacteria that normally live in the intestine.

#Heredity. Mutations in a gene called NOD2 tend to occur frequently in people with Crohn’s disease and seem to be associated with a higher likelihood of needing surgery for the disease. Scientists continue to search for other genetic mutations that might play a role in Crohn’s.

Complications:
Crohn’s disease can lead to several mechanical complications within the intestines, including obstruction, fistulae, and abscesses. Obstruction typically occurs from strictures or adhesions which narrow the lumen, blocking the passage of the intestinal contents. Fistulae can develop between two loops of bowel, between the bowel and bladder, between the bowel and vagina, and between the bowel and skin. Abscesses are walled off collections of infection, which can occur in the abdomen or in the perianal area in Crohn’s disease sufferers.

Crohn’s disease also increases the risk of cancer in the area of inflammation. For example, individuals with Crohn’s disease involving the small bowel are at higher risk for small intestinal cancer. Similarly, people with Crohn’s colitis have a relative risk of 5.6 for developing colon cancer.[26] Screening for colon cancer with colonoscopy is recommended for anyone who has had Crohn’s colitis for at least eight years. Some studies suggest that there is a role for chemoprotection in the prevention of colorectal cancer in Crohn’s involving the colon; two agents have been suggested, folate and mesalamine preparations.

Individuals with Crohn’s disease are at risk of malnutrition for many reasons, including decreased food intake and malabsorption. The risk increases following resection of the small bowel. Such individuals may require oral supplements to increase their caloric intake, or in severe cases, total parenteral nutrition (TPN). Most people with moderate or severe Crohn’s disease are referred to a dietitian for assistance in nutrition.

Crohn’s disease can cause significant complications including bowel obstruction, abscesses, free perforation and hemorrhage.

Crohn’s disease can be problematic during pregnancy, and some medications can cause adverse outcomes for the fetus or mother. Consultation with an obstetrician and gastroenterologist about Crohn’s disease and all medications allows preventative measures to be taken. In some cases, remission can occur during pregnancy. Certain medications can also impact sperm count or may otherwise adversely affect a man’s ability to conceive.

Risk factors:-
Risk factors for Crohn’s disease may include:

#Age. Crohn’s disease can occur at any age, but you’re likely to develop the condition when you’re young. Most people are diagnosed with Crohn’s between the ages of 20 and 30.

#Ethnicity. Although whites have the highest risk of the disease, it can affect any ethnic group. If you’re of Ashkenazi Jewish descent, your risk is even higher.

#Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn’s disease has a family member with the disease.

#Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. Smoking also leads to more severe disease and a greater risk of surgery. If you smoke, stop. Discuss this with your doctor and get help. There are many smoking-cessation programs available if you are unable to quit on your own.

#Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop Crohn’s disease. Because Crohn’s disease occurs more often among people living in cities and industrial nations, it may be that environmental factors, including a diet high in fat or refined foods, play a role in Crohn’s disease. People living in northern climates also seem to have a greater risk of the disease.

#Isotretinoin (Accutane) use. Isotretinoin (Accutane) is a powerful medication sometimes used to treat scarring cystic acne or acne that doesn’t respond to other treatments. Although cause and effect hasn’t been proved, studies have reported the development of inflammatory bowel disease with isotretinoin use.

#Nonsteroidal anti-inflammatory drugs (NSAIDs). Although these medications — ibuprofen (Advil, Motrin, others), naproxen (Aleve), diclofenac (Cataflam, Voltaren), piroxicam (Feldene), and others — haven’t been shown to cause Crohn’s disease, they can cause similar signs and symptoms. Additionally, theses medications can make existing Crohn’s disease worse.

Diagnosis:-
The diagnosis of Crohn’s disease can sometimes be challenging, and a number of tests are often required to assist the physician in making the diagnosis. Even with a full battery of tests it may not be possible to diagnose Crohn’s with complete certainty; a colonoscopy is approximately 70% effective in diagnosing the disease with further tests being less effective. Disease in the small bowel is particularly difficult to diagnose as a traditional colonoscopy only allows access to the colon and lower portions of the small intestines; introduction of the capsule endoscopy aids in endoscopic .

Your doctor will likely diagnose Crohn’s disease only after ruling out other possible causes for your signs and symptoms, including irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of Crohn’s disease, you may have one or more of the following tests and procedures:

#Blood tests. Your doctor may suggest blood tests to check for anemia — a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with Crohn’s disease or ulcerative colitis has these antibodies. While your doctor may order these tests, a positive finding doesn’t mean you have Crohn’s disease and a negative finding doesn’t mean that you’re free of the disease.

#Fecal occult blood test (FOBT). You may need to provide a stool sample so that your doctor can test for blood in your stool.

#Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Some people have clusters of inflammatory cells called granulomas, which help confirm the diagnosis of Crohn’s disease because granulomas don’t occur with ulcerative colitis. In the majority of people with Crohn’s, granulomas aren’t present and diagnosis is made through biopsy and the location of the disease. Risks of colonoscopy include perforation of the colon wall and bleeding.

#Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last section of your colon.

#Barium enema. This diagnostic test allows your doctor to evaluate your large intestine with an X-ray. Before the test, your receive an enema with a contrast dye containing barium. Sometimes, air also is added. The barium dye coats the lining of the bowel, creating a silhouette of your rectum, colon and a portion of your small intestine that’s visible on an X-ray.

#Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. After you drink a solution containing barium, X-ray, CT or MRI images are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn’s disease. The test can also help your doctor determine which type of inflammatory bowel disease you have.

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#Computerized tomography (CT). Sometimes you may have a CT scan, a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel that can’t be seen with other tests. Your doctor may order this scan to better understand the location and extent of your disease or to check for complications such as a partial blockages, abscesses or fistulas. Although not invasive, a CT scan exposes you to more radiation than a conventional X-ray does.

#Capsule endoscopy.
If you have signs and symptoms that suggest Crohn’s disease but other diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer that you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn’s disease. Once it’s made the trip through your digestive system, the camera exits your body painlessly in your stool. Capsule endoscopy is generally very safe, but if you have a partial blockage in the bowel, there’s a slight chance the capsule may become lodged in your intestine.

Treatments:-

Modern Treatment:-
The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.

Medication:-
Acute treatment uses medications to treat any infection (normally antibiotics) and to reduce inflammation (normally aminosalicylate anti-inflammatory drugs and corticosteroids). When symptoms are in remission, treatment enters maintenance with a goal of avoiding the recurrence of symptoms. Prolonged use of corticosteroids has significant side-effects; as a result they are generally not used for long-term treatment. Alternatives include aminosalicylates alone, though only a minority are able to maintain the treatment, and many require immunosuppressive drugs.[81]

Medications used to treat the symptoms of Crohn’s disease include 5-aminosalicylic acid (5-ASA) formulations, prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab[15], certolizumab  and natalizumab.[88][89] Hydrocortisone should be used in severe attacks of Crohn’s disease.[90]

Low doses of the opiate receptor antagonist Naltrexone (also Low dose naltrexone) have been found to be effective in inducing remission in 67% of patients with Crohn’s disease in a small study conducted at Pennsylvania State University. Dr. Jill Smith, Professor of Gastroenterology at Pennsylvania State University’s College of Medicine concluded that “LDN therapy appears effective and safe in subjects with active Crohn’s disease.”[91] Smith and her colleagues have since received a NIH grant and are proceeding with a definitive Phase II placebo-controlled clinical trial.

Lifestyle changes:-
Certain lifestyle changes can reduce symptoms, including dietary adjustments, proper hydration and smoking cessation. Eating small meals frequently instead of big meals may also help with a low appetite. To manage symptoms have a balanced diet with proper portion control. Fatigue can be helped with regular exercise, a healthy diet and enough sleep. A food diary may help with identifying foods that trigger symptoms. Some patients should follow a low dietary fiber diet to control symptoms especially if fiberous foods cause symptoms.[86]

Surgery:
Crohn’s cannot be cured by surgery, though it is used when partial or a full blockage of the intestine occurs. Surgery may also be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs. After the first surgery, Crohn’s usually shows up at the site of the resection though it can appear in other locations. After a resection, scar tissue builds up which can cause strictures. A stricture is when the intestines become too small to allow excrement to pass through easily which can lead to a blockage. After the first resection, another resection may be necessary within five years.[92] For patients with an obstruction due to a stricture, two options for treatment are strictureplasty and resection of that portion of bowel. There is no statistical significance between strictureplasty alone versus strictureplasty and resection in cases of duodenal involvement. In these cases, re-operation rates were 31% and 27%, respectively, indicating that strictureplasty is a safe and effective treatment for selected patients with duodenal involvement

Short bowel syndrome (SBS, also short gut syndrome or simply short gut) can be caused by the surgical removal of the small intestines. It usually develops if a person has had half or more of their small intestines removed.[94] Diarrhea is the main symptom of short bowel syndrome though other symptoms may include cramping, bloating and heartburn. Short bowel syndrome is treated with changes in diet, intravenous feeding, vitamin and mineral supplements and treatment with medications. Another complication following surgery for Crohn’s disease where the terminal ileum has been removed is the development of excessive watery diarrhea. This is due to an inability to reabsorb bile acids after resection of the terminal ileum.[citation needed]

In some cases of SBS, intestinal transplant surgery may be considered; though the number of transplant centres offering this procedure is quite small and it comes with a high risk due to the chance of infection and rejection of the transplanted intestine

Prospective treatments:
Researchers at University College London have questioned the wisdom of suppressing the immune system in Crohn’s, as the problem may be an under-active rather than an over-active immune system: their study found that Crohn’s patients showed an abnormally low response to an introduced infection, marked by a poor flow of blood to the wound, and the response improved when the patients were given sildenafil citrate.[34]

Recent studies using helminthic therapy or hookworms to treat Crohn’s Disease and other (non-viral) auto-immune diseases seem to yield promising results.

Complementary and alternative medicine:-
More than half of Crohn’s disease sufferers have tried complementary or alternative therapy.[97] These include diets, probiotics, fish oil and other herbal and nutritional supplements. The benefit of these medications is uncertain.

#Acupuncture is used to treat inflammatory bowel disease in China, and is being used more frequently in Western society. However, there is no evidence that acupuncture has benefits beyond the placebo effect.

#Methotrexate is a folate anti-metabolite drug which is also used for chemotherapy. It is useful in maintenance of remission for those no longer taking corticosteroids.

#Metronidazole and ciprofloxacin are antibiotics which are used to treat Crohn’s that have colonic or perianal involvement, although, in the United States, this use has not been approved by the Food and Drug Administration. They are also used for treatment of complications, including abscesses and other infections accompanying Crohn’s disease.

#Thalidomide has shown response in reversing endoscopic evidence of disease.

#Cannabis-derived drugs may be used to treat Crohn’s Disease with its anti-inflammatory properties. Cannabis-derived drugs may also help to heal the gut lining.

#Soluble Fiber has been used by some to treat symptoms.^ a b c Tungland BC, Meyer D, Nondigestible oligo- and polysaccharides (dietary fiber): their physiology and role in human health and food, Comp Rev Food Sci Food Safety, 3:73-92, 2002 (Table 3)

#Probiotics include Sacchromyces boulardii   and E. coli Nissle 1917.

#Boswellia is an ayurvedic (Indian traditional medicine) herb, used as a natural alternative to drugs. One study has found that the effectiveness of H-15 extract is not inferior to mesalazinesimilar, and suggests it that its safety makes it superior in benefit-risk evaluations.

Lifestyle and home remedies:-
Sometimes you may feel helpless when facing Crohn’s disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet
There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up in your condition. If you think there are foods that make your condition worse, try keeping a food diary to keep track of what you’re eating as well as how you feel. If you discover certain foods are causing your symptoms to flare, it’s a good idea to try eliminating those foods. Here are some suggestions that may help:

#Limit dairy products. Like many people with inflammatory bowel disease, you may find that problems, such as diarrhea, abdominal pain and gas, improve when you limit or eliminate dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. If so, limiting dairy or using an enzyme product, such as Lactaid, will help break down lactose.

#Try low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Foods that may be especially troublesome include butter, margarine, cream sauces and fried foods.

#Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. You may also find that you can tolerate some fruits and vegetables, but not others. In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. Consult your doctor prior to starting a high-fiber diet.

#Avoid problem foods. Eliminate any other foods that seem to make your signs and symptoms worse. These may include “gassy” foods such as beans, cabbage and broccoli, raw fruit juices and fruits — especially citrus fruits, spicy food, popcorn, alcohol, and foods and drinks that contain caffeine, such as chocolate and soda.

#Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.

#Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.

#Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.

#Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Stress :-
Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.

When you’re stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.

Although it’s not always possible to avoid stress, you can learn ways to help manage it. Some of these include:

#Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.

#Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. You’re then taught how to produce these changes without feedback from the machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.

#Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax. You can take classes in yoga and meditation or use books, CDs or DVDs at home.

You may click to see this article :-Banana Plantain and Broccoli Fibers for Crohn’s Disease Treatment

Prognosis:
Crohn’s disease is a chronic condition for which there is currently no cure. It is characterised by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is relatively low. However, Crohn’s disease is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Crohn’s_disease
http://www.mayoclinic.com/health/crohns-disease/DS00104

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