Crohn's Disease - Diagnosis, Manifestations, and Treatment - Essay Example

CROHNS DISEASE Crohns Disease: In APA Style Arun Babu Academia Research INTRODUCTION Crohns Disease is d after the physician, Dr Crohn, who first described the disease in 1932. Crohns disease is an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohns disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea. Figure 1: showing the areas of GI Tract from mouth to anus. What is Crohns Disease Crohns disease is an inflammatory bowel disease, the general name for diseases that cause swelling in the intestines. Because the symptoms of Crohns disease are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis, it can be difficult to diagnose. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine. In Crohns disease, all layers of the intestine may be involved, and normal healthy bowel can be found between sections of diseased bowel. Crohns disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohns disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. Crohns disease can occur in people of all age groups, but it is more often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohns disease, and African Americans are at decreased risk for developing Crohns disease. Crohns disease may also be called ileitis or enteritis. What Causes Crohns Disease Several theories exist about what causes Crohns disease, but none have been proven. The human immune system is made from cells and different proteins that protect people from infection. The most popular theory is that the body's immune system reacts abnormally in people with Crohns disease, mistaking bacteria, foods, and other substances for being foreign. The immune system's response is to attack these "invaders." During this process, white blood cells accumulate in the lining of the intestines, producing chronic inflammation, which leads to ulcerations and bowel injury. Scientists do not know if the abnormality in the functioning of the immune system in people with Crohns disease is a cause, or a result, of the disease. Research shows that the inflammation seen in the GI tract of people with Crohns disease involves several factors: the genes the patient has inherited, the immune system itself, and the environment. Foreign substances, also referred to as antigens, are found in the environment. One possible cause for inflammation may be the body's reaction to these antigens, or that the antigens themselves are the cause for the inflammation. Some scientists think that a protein produced by the immune system, called anti-tumor necrosis factor (TNF), may be a possible cause for the inflammation associated with Crohns disease. What are the Symptoms The most common symptoms of Crohns disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohns disease may suffer delayed development and stunted growth. The range and severity of symptoms varies. How is Crohns Disease Diagnosed A thorough physical exam and a series of tests may be required to diagnose Crohns disease. Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines. The doctor may do an upper GI series to look at the small intestine. For this test, the person drinks barium, a chalky solution that coats the lining of the small intestine, before x rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine. If these tests show Crohns disease, more x rays of both the upper and lower digestive tract may be necessary to see how much of the GI tract is affected by the disease. The doctor may also do a visual exam of the colon by performing either a sigmoidoscopy or a colonoscopy. For both of these tests, the doctor inserts a long, flexible, lighted tube linked to a computer and TV monitor into the anus. A sigmoidoscopy allows the doctor to examine the lining of the lower part of the large intestine, while a colonoscopy allows the doctor to examine the lining of the entire large intestine. The doctor will be able to see any inflammation or bleeding during either of these exams, although a colonoscopy is usually a better test because the doctor can see the entire large intestine. The doctor may also do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope. What are the Complications of Crohns Disease The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohns disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues, such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery. In addition to fistulas, small tears called fissures may develop in the lining of the mucus membrane of the anus. Nutritional complications are common in Crohns disease. Deficiencies of proteins, calories, and vitamins are well documented. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption, also referred to as malabsorption. Other complications associated with Crohns disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately. What is the Treatment for Crohns Disease Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. At this time, treatment can help control the disease by lowering the number of times a person experiences a recurrence, but there is no cure. Treatment for Crohns disease depends on the location and severity of disease, complications, and the person's response to previous medical treatments when treated for reoccurring symptoms. Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible. Someone with Crohns disease may need medical care for a long time, with regular doctor visits to monitor the condition. Can Diet Control Crohns Disease People with Crohns disease often experience a decrease in appetite, which can affect their ability to receive the daily nutrition needed for good health and healing. In addition, Crohns disease is associated with diarrhea and poor absorption of necessary nutrients. No special diet has been proven effective for preventing or treating Crohns disease, but it is very important that people who have Crohns disease follow a nutritious diet and avoid any foods that seem to worsen symptoms. There are no consistent dietary rules to follow that will improve a person's symptoms. People should take vitamin supplements only on their doctor's advice. Dietary Changes That May Be Helpful Avoid sugar (including soft drinks and processed foods with added sugar): A person with Crohns disease might consume more sugar than the average healthy person. A high-fiber, low-sugar diet led to a 79% reduction in hospitalizations compared with no dietary change in one group of people with Crohns disease. Reduce animal protein and fat: Reduce animal protein and fat (from foods other than fish) in the diet. Eat fish (3.5 to 7 ounces per day) instead of chicken, beef, or pork: A two-year trial compared the effects of having people with Crohns eat fish high in omega-3 fatty acids (EPA and DHA) or a diet low in fish. The fish-eating group had a 20% relapse rate compared with 58% in those not eating fish. Avoid food allergens: Some people with Crohns disease have food allergies and have been reported to do better when they avoid foods to which they are allergic. Baker's yeast (found in bread and other bakery goods) is thought to be a possible trigger for Crohns disease. Yeast and some cheeses are high in histamine, which is secreted during an allergic response. People with Crohns lack the ability to break down histamine at a normal rate, so the link to yeast and dairy may not be coincidental. Avoid nuts, raw fruit, and tomatoes, in selected cases: Some people find that these foods aggravate Crohns symptoms; other foods may also cause problems. Elimination diets should be supervised by a qualified healthcare practitioner. Low Microparticle Diet Shows Promise in Management of Crohns Disease A study reported in the February 2001 issue of the European Journal of Gastroenterology and Hepatology found that a diet low in microparticles could be beneficial in the management of Crohns disease. Researchers in London have identified tiny bits of inorganic material in intestinal white blood cells known as phagocytes. The researchers believe this material may induce inflammation in susceptible individuals. For a 4 month period, 20 Crohns patients were chosen randomly to be part of a trial group or a control group to receive a low microparticle diet or a control diet. In addition, special care was taken to peel and wash fruits and vegetables, to avoid substances (including toothpaste and medications) that could contain trace particles of titanium dioxide, and to only use filtered water. Over the four months, those patients receiving the microparticle diet had a decreased Crohns activity index, and seven patients achieved remission as compared to none in the control group. This study, the first of its kind, indicates that there are certain agents that, when eliminated, may control the inflammation of Crohns disease. Recommended Vitamins, Supplements, Herbs & Other Nutritional Products Helpful: Cod Liver Oil 250 ml - lemon flavor (CODL4) - Cod Liver Oil Helpful: Digestive Enzymes - Digestive Enzymes-V 60 Vcaps Self Help: Key nutritional supplements Fish oil: A special enteric-coated, "free fatty acid" form of EPA/DHA (providing 2.7 grams per day of the omega-3 fatty acids EPA and DHA) taken from fish oil may decrease inflammation associated with Crohns disease. Vitamin D: Malabsorption of vitamin D is common in Crohns disease and can lead to a deficiency. Vitamin D has been shown to prevent bone loss in Crohns patients, while an unsupplemented control group experienced significant bone loss. A doctor should evaluate vitamin D status and suggest the right level of vitamin D supplements. Other Nutritional Supplements That May Be Helpful Multiple vitamin/mineral: Crohns disease often leads to malabsorption. As a result, inadequate levels of many nutrients are common. For this reason, it makes sense for people with Crohns disease to take a high-potency multivitamin/mineral supplement. In particular, deficiencies in zinc, folic acid, vitamin B12, vitamin D, and iron have been reported. Saccharomyces boulardii: Diarrhea caused by Crohns disease and other conditions has responded to Saccharomyces boulardii supplementation (250-500 mg two to three times per day) in double-blind research. Zinc: 25-50 mg per day, balanced with 2-4 mg per day of copper. Key herbs None Other Herbs That May Be Helpful Agrimony Aloe (Aloe Vera, Aloe barbadensis)* Chamomile (Matricaria recutita)* Cranesbill (Geranium maculatum)* Green tea (Camellia sinensis)* Licorice (Glycyrrhiza glabra)* Herb combination: Marshmallow (Althea officinalis), Slippery elm (Ulmus fulva), and Cranesbill (Geranium maculatum) combination* Oak (Quercus spp.)* Witch hazel (Hamamelis virginiana)* Yarrow (Achillea millefolium)* Lifestyle Changes That May Be Helpful Quit smoking: People with Crohns disease are more likely to smoke, and there is evidence that smoking worsens disease progression. Can Stress Make Crohns Disease Worse There is no evidence showing that stress causes Crohns disease. However, people with Crohns disease sometimes feel increased stress in their lives from having to live with a chronic illness. Some people with Crohns disease also report that they experience a flare in disease when they are experiencing a stressful event or situation. There is no type of person that is more likely to experience a flare in disease than another when under stress. For people who find there is a connection between their stress level and a worsening of their symptoms, using relaxation techniques, such as slow breathing, and taking special care to eat well and get enough sleep, may help them feel better. Conclusions Crohns disease is a chronic inflammatory disease involving predominantly the small intestine and colon. The symptoms and the activity of the disease can come and go. Even though many effective medications are available to control the activity of the disease, there is as yet no cure for Crohns disease. Surgery can significantly improve the quality of life in selected individuals, but recurrence of the disease after surgery is common. The disease can have complications, both within and outside of the intestine. Newer treatments are actively being evaluated. A better understanding of the role of genetics and environmental factors in the cause of Crohns disease may lead to improved treatments and prevention of the disease. References Thompson G. The Angry Gut. New York, NY: Perseus Publishing; 1993. Saibil F. Crohn's Disease & Ulcerative Colitis. Westport, CT: Firefly Books; 1997. Zonderman J, Vender R, Bertolucci, B. Understanding Crohn's Disease and Ulcerative Colitis. Jackson, MS: University Press of Mississippi; 2000. Gotschall EG. Breaking the Vicious Cycle: Intestinal Health Through Diet. Kirkton, Ontario: Kirkton Press; 1994. Banks PA, ed. Crohn's Disease and Ulcerative Colitis Fact Book. New York, NY: Hungry Minds, Inc.; 1984. Scala J. The New Eating Right for a Bad Gut: The Complete Nutritional Guide to Ileitis, Colitis, Crohn's Disease, and Inflammatory Bowel Disease. New York, NY: Plume Publishing; 2000. Stein S, Hanauer S, Rood R, eds. Inflammatory Bowel Disease: A Guide for Patients and Their Families. Philadelphia, PA: Lippincott Williams & Wilkins Publishers; 1998. Crohn's & Colitis Foundation. The Crohn's Disease and Ulcerative Colitis Fact Book. James Scala. The New Eating Right for a Bad Gut: The Complete Nutritional Guide to Ileitis, Colitis, Crohn's Disease, and Inflammatory Bowel Disease http://www.ccfa.org/advocacy/IBDResearchEnhancementAct http://www.crohns.net/Miva/education/aboutcrohns.shtml http://www.crohns.net/Miva/education/crohnsdiet.htm http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm http://www.healthcastle.com/ibd-diet.shtml http://www.medicinenet.com/crohns_disease http://www.naturaleyecare.com/diseases.aspd_num=48 Read More