Tag Archives: Crohn’s disease

Viola yezoensis

Botanical Name: Viola yezoensis
Family: Violaceae
Genus: Viola
Species: Viola yezoensis
Kingdom:  Plantae
Phylum:  Magnoliophyta
Class: Angiospermae
Category: Fabids
Order: Malpighiales

Common Names: Arrowhead Herb, English Name : Chinese violet. Japanese: Hikage-sumire, Chinese Name: Zi Hua Di Ding
Habitat :Viola yezoensis is native to E. Asia – China, Japan, Korea. It grows on grassy fields in lowland, C. and S. Japan. Broad-leaved forests, montane thickets, grasslands on mountain slopes.
Description:
Viola yezoensis is a perennial herb growing to 0.2 m (0ft 8in) by 0.2 m (0ft 8in).

It is in flower from Apr to May, and the seeds ripen from May to June. The flowers are hermaphrodite (have both male and female organs) and are pollinated by Insects. CLICK & SEE THE PICTURES
Suitable for: light (sandy), medium (loamy) and heavy (clay)

soils and prefers well-drained soil. Suitable pH: acid and neutral soils. It can grow in semi-shade (light woodland) or no shade. It prefers moist

Cultivation:
Prefers a cool moist well-drained humus-rich soil in partial or dappled shade and protection from scorching winds. Tolerates sandstone and limestone soils but becomes chlorotic if the pH is too high. Prefers a pH between 6 and 6.5. Plants are hardy to at least -15°c. All members of this genus have more or less edible leaves and flower buds, though those species with yellow flowers can cause diarrhoea if eaten in large quantities.

Propagation:
Seed – best sown in the autumn in a cold frame. Sow stored seed in early spring in a cold frame. Prick out the seedlings into individual pots when they are large enough to handle and plant them out in the summer. Division in the autumn or just after flowering. Larger divisions can be planted out direct into their permanent positions, though we have found that it is best to pot up smaller divisions and grow them on in light shade in a greenhouse or cold frame until they are growing away well. Plant them out in the summer or the following spring.
Edible Uses: Young leaves and flower buds – raw or cooked. When added to soup they thicken it in much the same way as okra. A tea can be made from the leaves.
Medicinal Uses:
Antiinflammatory; Antipyretic.

The whole plant is antibacterial, anti-inflammatory, antipyretic and depurative. It is used internally in the treatment of boils, carbuncles, snakebite, skin disorders, mumps etc. The plant is harvested when in flower and dried for later use.

The Chinese herb compound prescription Viola yedoensis Makino Anti-itching Compound (VYAC), which consists of Viola yedoensis Makino, herb, Sophora flavescens Aiton, root, and Dictamnus dasycarpus Turcz, root and rhizome, has been traditionally used to treat various skin allergic inflammatory diseases in clinic.

Clears toxins, reduces inflammation and is antibacterial. Internally for boils, carbuncles, snakebite, skin disorders (especially erysipelas), mumps, and hot disorders with inflammation of the eyes, throat, or ears.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.
Resources:
https://species.wikimedia.org/wiki/Viola_yezoensis
http://pfaf.org/user/Plant.aspx?LatinName=Viola+yezoensis
http://www.herbnet.com/Herb%20Uses_UZ.htm
http://www.sciencedirect.com/science/article/pii/S0378874116303026
https://gd.eppo.int/taxon/VIOYZ

..http://herbpathy.com/Uses-and-Benefits-of-Viola-Yedoensis-Cid5348

Sarcoidosis

Alternative Names : Sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease

Definition:
Sarcoidosis (from sarc meaning flesh, -oid, like, and -osis, process)  is a disease in which abnormal collections of chronic inflammatory cells (granulomas) form as nodules in multiple organs. The cause of sarcoidosis is unknown. Granulomas most often appear in the lungs or the lymph nodes, but virtually any organ can be affected. Normally the onset is gradual. Sarcoidosis may be asymptomatic or chronic. It commonly improves or clears up spontaneously. More than 2/3 of people with lung sarcoidosis have no symptoms after 9 years. About 50% have relapses. About 10% develop serious disability. Lung scarring or infection may lead to respiratory failure and death.

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Sarcoidosis most commonly affects young adults of both sexes, although studies have reported more cases in females. Incidence is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years; a second peak is observed for women over 50.

Sarcoidosis occurs throughout the world in all races with an average incidence of 16.5/100,000 in men and 19/100,000 in women. The disease is most prevalent in Northern European countries, and the highest annual incidence of 60/100,000 is found in Sweden and Iceland. In the United States, sarcoidosis is more common in people of African descent than Caucasians, with annual incidence reported as 35.5 and 10.9/100,000, respectively. Sarcoidosis is less commonly reported in South America, Spain, India, Canada, and the Philippines.

The differing incidence across the world may be at least partially attributable to the lack of screening programs in certain regions of the world and the overshadowing presence of other granulomatous diseases, such as tuberculosis, that may interfere with the diagnosis of sarcoidosis where they are prevalent. There may also be differences in the severity of the disease between people of different ethnicities. Several studies suggest that the presentation in people of African origin may be more severe and disseminated than for Caucasians, who are more likely to have asymptomatic disease.

Manifestation appears to be slightly different according to race and sex. Erythema nodosum is far more common in men than in women and in Caucasians than in other races. In Japanese patients, ophthalmologic and cardiac involvement are more common than in other races.

Sarcoidosis is one of the few pulmonary diseases with a higher prevalence in non-smokers

Classification:
Sarcoidosis may be divided into the following types:

*Annular sarcoidosis
*Erythrodermic sarcoidosis
*Ichthyosiform sarcoidosis
*Hypopigmented sarcoidosis
*Löfgren syndrome
*Lupus pernio
*Morpheaform sarcoidosis
*Mucosal sarcoidosis
*Neurosarcoidosis
*Papular sarcoid
*Scar sarcoid
*Subcutaneous sarcoidosis
*Systemic sarcoidosis
*Ulcerative sarcoidosis

Symptoms:
Sarcoidosis is a systemic disease that can affect any organ. Common symptoms are vague, such as fatigue unchanged by sleep, lack of energy, weight loss, aches and pains, arthritis, dry eyes, swelling of the knees, blurry vision, shortness of breath, a dry hacking cough or skin lesions. Sarcoidosis and cancer may mimic one another, making the distinction difficult.  The cutaneous symptoms vary, and range from rashes and noduli (small bumps) to erythema nodosum or lupus pernio. It is often asymptomatic.

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The combination of erythema nodosum, bilateral hilar lymphadenopathy and arthralgia is called Löfgren syndrome. This syndrome has a relatively good prognosis.

Renal, liver (including portal hypertension), heart or brain involvement may cause further symptoms and altered functioning. Sarcoidosis affecting the brain or nerves is known as neurosarcoidosis.

Cardiac sarcoidosis:
Although cardiac involvement is present in 20% to 30% of patients with sarcoidosis, only about 5% of patients with systemic sarcoidosis are symptomatic.

The presentation of cardiac sarcoidosis can range from asymptomatic conduction abnormalities to fatal ventricular arrhythmia. Myocardial sarcoidosis can be a rare cause of sudden cardiac death.

Eye:
Manifestations in the eye include uveitis, uveoparotitis, and retinal inflammation, which may result in loss of visual acuity or blindness. The combination of anterior uveitis, parotitis, VII cranial nerve paralysis and fever is called uveoparotid fever, and is associated with Heerfordt-Waldenstrom syndrome. (D86.8)

Nervous system:
The central nervous system is involved in fewer than 1% of patients with sarcoidosis. There is usually granulomatous involvement of the basal meninges that subsequently affects the cranial nerves. Myelopathy may be the initial clinical presentation of intramedullary neurosarcoidosis.

Scalp:
Sarcoidosis of the scalp presents with diffuse or patchy hair loss.

Causes and pathophysiology:
The exact cause of sarcoidosis is not known. The current working hypothesis is that in genetically susceptible individuals sarcoidosis is caused through alteration in immune response after exposure to an environmental, occupational, or infectious agent.

Dysregulation of the immune system:
Granulomatous inflammation is characterized primarily by accumulation of monocytes, macrophages and activated T-lymphocytes, with increased production of key inflammatory mediators, TNF-alpha, IFN-gamma, IL-2 and IL-12, characteristic of a Th1-polarized response (T-helper lymphocyte-1 response). Sarcoidosis has paradoxical effects on inflammatory processes; it is characterized by increased macrophage and CD4 helper T-cell activation resulting in accelerated inflammation, however, immune response to antigen challenges such as tuberculin is suppressed. This paradoxic state of simultaneous hyper- and hypo- activity is suggestive of a state of anergy. The anergy may also be responsible for the increased risk of infections and cancer. It appears that regulatory T-lymphocytes in the periphery of sarcoid granulomas suppress IL-2 secretion which is hypothesized to cause the state of anergy by preventing antigen-specific memory responses.

While it is widely believed that TNF-alpha plays an important role in the formation of granulomas, it was observed that sarcoidosis can be triggered by treatment with the TNF-alpha antagonist etanercept.

Genetic associations:
Investigations of genetic susceptibility yielded many candidate genes but only few were confirmed by further investigations and no reliable genetic markers are known. Currently, the most interesting candidate gene is BTNL2; several HLA-DR risk alleles are also being investigated.  In persistent sarcoidosis the HLA haplotype HLA-B7-DR15 are either cooperating in disease or another gene between these two loci is associated. In non-persistent disease there is a strong genetic association with HLA DR3-DQ2.[19] Siblings have only a modestly increased risk (hazard ratio 5-6) of developing the disease, indicating that genetic susceptibility plays only a small role. The alternate hypothesis that family members share similar exposures to environmental pathogens is quite plausible to explain the apparent hereditary factor.

Infectious agents:
Several infectious agents appear to be significantly associated with sarcoidosis but none of the known associations is specific enough to suggest a direct causative role. Propionibacterium acnes can be found in bronchoalveolar lavage of approximately 70% patients and is associated with disease activity, however it can be also found in 23% of controls. A recent meta-analysis investigating the role of mycobacteria in sarcoidosis found it was present in 26.4% of cases, however the meta-analysis also detected a possible publication bias, so the results need further confirmation.

There have also been reports of transmission of sarcoidosis via organ transplants.

Vitamin D dysregulation:
Sarcoidosis frequently causes an increase in vitamin D production outside the kidney. Macrophages inside the granulomas convert vitamin D to its active form, resulting in elevated levels of the hormone 1,25-dihydroxyvitamin D and symptoms of hypervitaminosis D that may include fatigue, lack of strength or energy, irritability, metallic taste, temporary memory loss or cognitive problems. Physiological compensatory responses (e.g., suppression of the parathyroid hormone levels) may mean the patient does not develop frank hypercalcemia. This condition may be aggravated by high levels of estradiol and prolactin such as in pregnancy, leading to hypercalciuria and/or compensatory hypoparathyroidism.High levels of Vitamin D are also implicated in immune-system dysfunctions which tie into the sarcoid condition.

Hyperprolactinemia:
Prolactin is frequently increased in sarcoidosis, between 3–32% cases have hyperprolactinemia,  this frequently leads to amenorrhea, galactorrhea or nonpuerperal mastitis in women. Prolactin also has a broad spectrum of effects on the immune system and increased prolactin levels are associated with disease activity or may exacerbate symptoms in many autoimmune diseases and treatment with prolactin lowering medication has been shown effective in some cases. However it is unknown if this relation holds in sarcoidosis and the gender predilection in sarcoidosis is less pronounced than in some other autoimmune diseases where such relation has been established. In pregnancy, the effects of prolactin and estrogen counteract each other to some degree, with a slight trend to improve pulmonary manifestations of sarcoidosis while lupus, uveitis and arthralgia might slightly worsen.   Lupus, uveitis and arthralgia are known to be in some cases associated with increased prolactin levels and respond to bromocriptin treatment but so far this has not been investigated specifically for sarcoidosis. The reasons for increased prolactin levels in sarcoidosis are uncertain. It has been observed that prolactin is produced by T-lymphocytes in some autoimmune disorders in amounts high enough to affect the feedback by the hypothalamic dopaminergic system.

The extrapituitary prolactin is believed to play a role as a cytokine like proinflammatory factor. Prolactin antibodies are believed to play a role in hyperprolactinemia in other autoimmune disorders and high prevalence endocrine autoimmunity has been observed in patients with sarcoidosis.[30] It may also be a consequence of renal disease or treatment with steroids. Neurosarcoidosis may occasionally cause hypopituiarism but has not been reported to cause hyperprolactinemia.

Thyroid disease:
In women, a substantial association of thyroid disease and sarcoidosis has been reported. The association is less marked but still significant for male patients. Female patients have a significantly elevated risk for hypothyroidism, hyperthyroidism and thyroid autoimmunity and it appears that autoimmunity is very important in the pathogenesis of thyroid disease in this population. Thyroid granulomatosis on the other hand is uncommon.

Hypersensitivity/autoimmune:
Association of autoimmune disorders has been frequently observed. The exact mechanism of this relation is not known but some evidence supports the hypothesis that this is a consequence of Th1 lymphokine prevalence.

Sarcoidosis has been associated with celiac disease. Celiac disease is a condition in which there is a chronic reaction to certain protein chains, commonly referred to as glutens, found in some cereal grains. This reaction causes destruction of the villi in the small intestine, with resulting malabsorption of nutrients.

An association with type IV hypersensitivity has been described. Tests of delayed cutaneous hypersensitivity have been used to measure progression.

Other:
While disputed, some cases have been associated with inhalation of the dust from the collapse of the World Trade Center after the September 11, 2001 attacks . Chicago comedian, Bernie Mac, suffered from sarcoidosis and died of pneumonia as a result of his compromised immune system. Reggie White, a former standout National Football League player, also suffered from sarcoidosis, and the disease played a major role in his death.

Risk Factors:
While anyone can develop sarcoidosis, factors that may increase your risk include:

*Age and sex. Sarcoidosis usually occurs between the ages of 20 and 40. Women are slightly more likely to develop the disease than are men.

*Race. Black Americans have a higher incidence of sarcoidosis than do white Americans. Also, sarcoidosis may be more severe in blacks and more likely to cause skin problems.

*Ethnicity. Worldwide, sarcoidosis is most commonly reported in people whose families originally came from Northern Europe — particularly Scandinavia and Britain. People with Japanese ancestry are more likely to develop eye or cardiac complications from sarcoidosis.

*Family history. If someone in your family has had sarcoidosis, you are more likely to develop the disease yourself.

Complications:
In about two-thirds of people with sarcoidosis, the condition resolves with no lasting consequences. But in some people, sarcoidosis can become chronic and lead to complications that may affect different parts of our body, such as : Lungs,Eyes,Kidneys,Heart, Nervous system  and Reproductive system.

Diagnosis:
Sarcoidosis can be difficult to diagnose, partly because the disease produces few signs and symptoms in its early stages. And when symptoms do occur, they vary by organ system affected and can mimic those of other disorders. A variety of diagnostic tests can narrow the possibilities and rule out other conditions.

Imaging tests
*X-ray. A simple chest X-ray can reveal evidence of lung damage or enlarged lymph nodes in your chest. In fact, some people have been diagnosed with sarcoidosis before they have any symptoms — from the evidence provided by chest X-rays taken for other reasons.

*CT scan. Computerized tomography (CT) uses a computer to combine a large number of X-rays views taken from many different directions into detailed, cross-sectional images of your internal structures.

Lab tests
Samples of your blood may be tested to check your general health and to see how well your kidneys and liver are functioning.

Lung function tests
These tests typically measure:

…#The volume of your lungs
…#How much air you can breathe in and out
…#How fast you can breathe air out
…#How well your lungs deliver oxygen to your blood

Biopsies
A biopsy is a small sample of tissue taken from a part of your body believed to be affected by sarcoidosis. The sample can be tested for the types of granulomas that are commonly seen in sarcoidosis. Biopsies can most easily be taken from your skin, from lymph nodes right under the skin, or from the outer membrane of your eye.

Lung biopsies can be obtained during a bronchoscopy (brong-KOS-kuh-pee). This procedure uses a thin, flexible tube that contains a fiber-optic camera and a grasping tool. After the tube is inserted down your throat, a doctor uses the grasping tool to remove a small sample of lung tissue — about the size of a grain of rice. The sample is sent to a microbiology laboratory to look for specific organisms.

Treatment :
Currently, there’s no cure for sarcoidosis. For one in ten people the disease slowly gets worse over time and for one in 50 it proves fatal. However, for the majority of those with the disorder – around eight out of every ten people, in fact – the condition resolves spontaneously after a few years and never comes back.

Relief from symptoms can be found with anti-inflammatory painkillers, and steroids can also prove extremely effective. When used to treat chronic sarcoidosis, steroids may need to be used at a low dose for many months, sometimes a year or more. During this time, regular blood and lung function tests and chest x-rays are performed to monitor how well the treatment is working. In more severe cases, immunosuppressive drugs such as methotrexate are used. Newer drugs such as infliximab may also be prescribed.

Prognosis:
The disease can remit spontaneously or become chronic, with exacerbations and remissions. In some patients, it can progress to pulmonary fibrosis and death. Approximately half of the cases resolve without treatment or can be cured within 12–36 months and most within 5 years. Some cases persist several decades.  Where the heart is involved, the prognosis is poor.   Patients with sarcoidosis appear to be at significantly increased risk for cancer, in particular lung cancer, malignant lymphomas,[40] and cancer in other organs known to be affected in sarcoidosis.   In sarcoidosis-lymphoma syndrome, sarcoidosis is followed by the development of a lymphoproliferative disorder such as non-Hodgkin lymphoma. This may be attributed to the underlying immunological abnormalities that occur during the sarcoidosis disease process.  Sarcoidosis can also follow cancer   or occur concurrently with cancer. There have been reports of hairy cell leukemia,  acute myeloid leukemia,  and acute myeloblastic leukemia   associated with sarcoidosis.
In pregnancy:
Sarcoidosis generally does not prevent successful pregnancy and delivery; the endogenous estrogen in pregnancy may even have a slightly beneficial immunomodulatory effect. In most cases the course of sarcoidosis is unaffected by pregnancy; there is improvement in a few cases and worsening of symptoms in very few cases.
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.

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Resources:
http://en.wikipedia.org/wiki/Sarcoidosis
http://www.bbc.co.uk/health/physical_health/conditions/sarcoidosis1.shtml
http://www.mayoclinic.com/health/sarcoidosis/DS00251

http://www.metrohealth.org/body.cfm?id=1554

Cup of Magic

 

Probiotics, prebiotics, antibiotics. The words often cause confusion because they sound similar. But, of course, they mean very different things, although all three are derived from the Greek word “bios”, meaning “life”.

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Most people would love a magic pill that would put an end to all their health problems. Preferably one that contains prebiotics (meaning “before life”) and probiotics (“helping life”), along with a few trace elements, minerals, antioxidants and vitamins.

Probiotics are defined by the World Health Organization as microorganisms, which when administered alive in adequate amounts, confer a health benefit to the host. They are advertised by the pharma industry as protective, anti-infection agents that give the body’s natural reserves a boost against disease. They are sold as capsules and powders containing organisms like Lactobacillus bulgaricus and Streptococcus thermophilus. The products are much hyped, and have fancy names and expensive packaging.

However, what advertisements do not mention is that to be effective, there should be at least 75 million live organisms in each capsule. Food and chlorine in water kill these organisms. They therefore have to be swallowed with non-chlorinated water on an empty stomach
.
The intestines need to be populated with these organisms. So initially, the capsules have to be swallowed four to six times a day. The minuscule numbers contained in commercially available capsules are insufficient and do not confer any real health benefit.

Probiotics are not new products; they have been around for centuries. Fermented dough and curd (yogurt) contain natural, healthy probiotics. Commercially available yogurt may not contain live lactobacillus (probiotics) unless specifically mentioned on the package.

Natural probiotics like curd have many medicinal properties that are being rediscovered now. Curd starts to act in the mouth itself. It reduces the number of plaque forming bacteria, and prevents bad breath, tooth decay and mouth ulcers.

In the stomach, curd helps neutralise gastric acidity, reducing belching, burning and dyspepsia. It prevents infections, particularly the growth and multiplication of H. pylori, which is implicated in gastric ulcers and stomach cancer.

In the intestine, probiotics live with other protective intestinal flora, reducing gas formation and diarrhoea. The immunological effects reduce the incidence and symptoms of Crohn’s disease (inflammatory condition of the intestines that may affect any part from the mouth to the anus) and ulcerative colitis. Bowel habits become regular and the incidence of colon cancer reduces in those who eat curd regularly.

The action of the probiotics on digested food results in the synthesis of B-complex vitamins. This reduces vitamin deficiencies. Children who are given curd in addition to milk have less diarrhoea than those given milk alone.

Many Indians are relatively lactose intolerant and develop bloating, abdominal pain and diarrhoea when given to drink milk. They thus tend to curtail their milk intake and in the absence of calcium supplementation become susceptible to osteoporosis. In curd, however, the milk is already partially digested, and this reduces the symptoms of intolerance. As little as one cup of curd a day is beneficial in the prevention of osteoporosis.

Studies have also shown that eating curd regularly prevents the development of candidiasis, a common vaginal fungal infection. Other studies have shown conflicting results with no real benefit. But this has not prevented pharmaceutical companies from advocating lactobacillus capsules and vaginal pessaries for candidial infection. Curd also boosts the immune system. Regular eaters swear by it, saying it reduces infections as well as the duration of illnesses.

Prebiotics, on the other hand, are soluble fibres and non-digestible food ingredients that remain in the colon. They selectively stimulate the growth and activity of beneficial microorganisms already present in the large intestine. Prebiotics are found in oats, wheat, onions and garlic. When probiotics and prebiotics are combined, they form “synbiotics”. This probably confers the best health benefits with probiotics acting in the small intestine and prebiotics in the large.

Antibiotics are used to kill harmful microorganisms in the intestine, bloodstream and the various organs. They should be used appropriately in the correct dosage and duration. Unlike probiotics and prebiotics, antibiotics are specific for a particular infection. They are not health supplements.

Antioxidants are found in coloured fruits and vegetables. Oxidation is essential for cell metabolism. During this process a few cells die releasing harmful free radicals. This is prevented by antioxidants.

All said and done, health does not come packaged as an expensive magic capsule containing probiotics and antioxidants to be drunk with a glass of artificial fibre. For good health,

Eat four to five helpings of fresh fruits and vegetables daily. The green, yellow, orange and red ones contain antioxidants

Curd reduces infections as well as the duration of illnesses

Eat one tablespoon of homemade curd first thing in the morning on an empty stomach

Eat chappatis four or five times a week

Give these health ingredients an extra boost by exercising one hour everyday.


Source
: The Telegraph (Kolkata)

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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.
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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.

#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.

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. Hydrocortisone should be used in severe attacks of Crohn’s disease.

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.”  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.

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.  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.  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.

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.

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. 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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