Crohn's Disease - Research Paper Example

In the early 1930s, Dr. Burrill B. Crohn, together with two colleagues—Dr. Ginzburg and Dr. Oppenheimer, described a chronic inflammatory disorder, now known as Crohns disease, most commonly affecting, but not limited to, the intestines, which, together with ulcerative colitis, are characterized by a hyperactive immune system and collectively called inflammatory bowel disease (IBD). These two main categories of IBD have very similar symptoms, and definite diagnosis is hard to establish at times, with approximately 10 percent of colitis cases referred as indeterminate colitis, being unable to distinguish which is which. (Crohns & Colitis Foundation of America) Ulcerative colitis only involves the colon and affects only the superficial layers of its inner lining (mucosa) in a uniform distribution, starting from the anus. Conversely, Crohns disease may appear at any part of the digestive tract—from the mouth down to the anus, but most commonly at the lower part of the small intestine (ileum), involving perhaps all layers of the intestine, with normal healthy bowel between sections of diseased bowel. (National Digestive Diseases Information Clearinghouse 1) Although the exact root of Crohns disease is still a mystery, the condition is associated with a problem in the reaction of the bodys immune system called an autoimmune disorder, where the immune system is unable to distinguish between normal and foreign bodies. (Longstreth) According to Dr. Schoenfeld and Dr. Wu, the cells and proteins composing the immune system, normally defend the body against foreign invaders, such as harmful bacteria, viruses, fungi, etc. by being launched, causing inflammation—an important defense mechanism of the system, within the tissues where activation occurs, and triggered only in the presence of harmful invaders; furthermore, continued and abnormal activation of the immune system in the absence of the said foreign bodies results to chronic inflammation and ulceration. Whether this abnormality in the immune system response is a cause or a consequence of Crohns disease is yet to be determined by scientists, but research shows that a number of factors—genetic inheritance, the immune system itself, and the environment, have to with the aforementioned inflammation in the digestive tract. (NDDIC 2) NDDIC (2) has affirmed that it was found out that people with Crohns disease have high levels of tumor necrosis factor (TNF), a protein produced by the immune system. Additionally, a gene called NOD2 has been recently identified as an important determining factor of the body’s response to some bacteria, and mutations of which increases a person’s susceptibility to the disease; other genes essential in the understanding of the pathogenesis of Crohns disease—such as autophagy related 16-like 1 gene (ATG 16L1) and IRGM, both having a role to play in macrophage defects, are continually being studied. (Schoenfeld & Wu) Incidentally, there have been studies showing higher levels of E. coli bacteria in the intestines of those suffering from Crohn’s disease—probably resulting from a genetically determined defect with intestinal mucosal macrophages in eliminating E. coli, as well as speculations that infection by certain bacteria—such as strains of mycobacterium, causes the disease, but still no substantial evidence supporting it, added Dr. Schoenfeld and Dr. Wu. Crohn’s disease may occur at any age, but more often at ages between 15 and 35; other risk factors include: (1) family history of the disease, (2) Jewish ancestry, and (3) smoking. (Longstreth) Nevertheless, the exact relationship between the factors, possible causes and the disease, have not been proven and remains unknown, to date. According to Dr. Paul Klenerman, the symptoms of Crohn’s disease vary depending on its severity and location—many only have mild symptoms like periods of mild fever, at times, accompanied with blood in the stool and abdominal pain; loss of appetite, unintentional weight loss, general malaise, and boils, may also appear. But it does not end there, complications could develop, the most common is blockage of the intestine caused by the tendency of the disease to thicken the intestinal walls with inflammation and scar tissue buildup; additionally, fistulas—sores or ulcers tunneling through the diseased area into the tissues that surround it (i.e. bladder, vagina or skin) which frequently get infected, as well as fissures developing in the mucus membrane lining of the anus, are common complications. (NDDIC 3) NDDIC (3) pointed that nutritional complications—proteins, calories and vitamin deficiencies, which are possibly caused by malabsorption, or explicitly the insufficient nutritional intake, intestinal loss of proteins, or simply poor absorption, are also common in Crohn’s disease; other related complications include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, and other diseases of the liver and the biliary system. Furthermore, Crohn’s disease may result to impaired growth and sexual development in children. (Longstreth) To diagnose Crohn’s disease, thorough physical exam, as well as, a succession of tests may be necessary, such as: (1) blood tests to check for anemia (indicates intestinal bleeding) and white blood cell count (where a high WBC count indicates inflammation in the body); (2) upper GI series to look for inflammation and other abnormalities in the intestine, as well as in other parts of the GI tract, by barium ingestion prior to x-ray; (3) visual exam of the colon via a computer and TV monitor after inserting a lighted tube into the anus, in both sigmoidoscopy—which examines the lining in the lower part of the colon, and colonoscopy—for the entire large intestine, and; (4) examination of a sample tissue of the intestines lining in a microscope, referred as biopsy. (NDDIC 2-3) Tests for Albumin, C-reactive protein, Erythrocyte sedimentation rate, fecal fat, Hemoglobin, and Liver function, may also produce altered results with Crohn’s disease; CT scan and an MRI of the abdomen, may also be used for the diagnosis of the disease. (Longstreth) Once diagnosed, treatments which include: drug therapy—anti-inflammation drugs (mesalamine-containing drugs, most commonly Sulfasalazine, and 5-ASA agents like Asacol, Dipentum, or Pentasa), Corticosteroids (commonly Prednisone, prescribed in large dosage at the start, then lowered once symptoms are controlled; it is very effective, but causes serious side effects, greater susceptibility to infection included), immunosuppressive drugs (most commonly prescribed are 6-mercaptopurine and azathioprine, which, as studies suggest, enhance efficacy of corticosteroids), Infliximab (or Remicade, an anti-TNF substance, the first treatment approved by U.S. FDA for Crohn’s disease that is non-responsive to standard therapies), antibiotics (i.e. ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole, which are used to treat bacterial overgrowth), anti-diarrheal (i.e. diphenoxylate, loperamide or codeine) and fluid replacements (i.e. fluids and electrolytes to prevent dehydration); nutrition supplements—include special high-calorie liquid formulas for children with slowed growth development, also, food that may increase diarrhea and cramping, such as bulky grains, hot spices, alcohol and milk products should be avoided; surgery—either to relieve symptoms non-responsive to drug therapy or to correct complications, but disease often recurs after surgery, and may be inappropriate to some, hence, its risks and benefits should be carefully weighed; or, a combination, are available, but only to help control symptoms, complications, and recurrence. (NDDIC 3-5) Additionally, extra vitamins and minerals such as iron supplements and vitamin B12 for anemia, as well as, calcium and vitamin D supplements to keep the bones strong. (Longstreth) While Crohn’s disease has no known cure, with symptoms ranging from mild to severe, its periods of remission, generally let patients to lead full, active, and productive lives. (NDDIC 5) References: "What is Crohns Disease?" Crohns & Colitis Foundation of America. (n.d) 24 May 2011 "Crohn’s Disease." National Digestive Diseases Information Clearinghouse. USA: National Institutes of Health, 2006. 24 May 2011 Schoenfeld, A., and Wu, A. "Crohn’s Disease." MedicineNet.com. 17 November 2010. 24 May 2011 Longstreth, G. "Crohn’s Disease." MedlinePlus Trusted Health Informtion for You. USA: National Library of Medicine. 13 December 2010. 24 May 2011 Klenerman, P. "Crohn’s Disease." NetDoctor.co.uk. 04 January 2005. 24 May 2011 Read More