| Crohn's
Disease
What is Crohn's
Disease?
Crohn's Disease is a disease which causes inflammation of the
intestines - the colon (large intestine) and the small intestines. The exact cause of
Crohn's disease is still unknown but current theories revolve around a combination of an
autoimmune reaction of the body directed toward the intestinal tissue, perhaps triggered
by one or more infectious or environmental factors. Approximately 5 out of 100,000 (1)
Americans have the disease, which seems to be more frequent in younger people and five
times more common amongst Jewish populations (2) although the exact reasons for this are
still unknown.
Under the microscope, the inflammation of Crohn's Disease
is quite distinct, and resembles the body's reaction to certain types of infection such as
tuberculosis, although no such germs are thought to be associated. If the colon is the
main area affected, which is quite common , the microscopic picture may be the only way to
distinguish it from ulcerative colitis and other intestinal disorders as the symptoms are
common.
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Symptoms
Typically, a teenager or young adult experiences a period of
weeks or months of irritable bowels with fatigue, weight loss, and depression. This is
commonly followed by a progressive combination of abdominal cramping, usually in the lower
right abdomen, and diarrhoea. A low grade fever may accompany it and, eventually, medical
attention is sought.
Crohn's disease may also cause fistulae ( small tunnels or
tracts within the intestine) which may result in infections or abscesses between areas of
intestine, or even between intestine and bladder, skin, or other organs. Extra-intestinal
symptoms of the disease include joint pains, rashes, eye inflammation, as well as kidney
and gall stones.
The disease may occur at any age, not rarely in the 40's
and 50's and often a confirmed diagnosis can take time because numerous intestinal
disorders cause similar symptoms.
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Diagnosis
Diagnosis is usually confirmed with upper and lower digestive
x-rays, although occasionally a biopsy of tissue is necessary; this can sometimes be done
through a special viewing tube swallowed by the patient as an outpatient procedure
(endoscopy) or through the proctoscope if the colon is involved. The extent and
complications are usually evaluated by means of special blood tests.
In some cases, the inflammation in the small intestines
inhibits the absorbtion of certain nutrients (especially vitamin B 12) fats, and dairy
sugar. This can lead to anaemia, malnutrition, and calcium deficiency.
Special care must be taken to rule out alternative
diagnoses including intestinal lymph node cancers like Hodgkin's Disease, appendicitis (in
the acute cases), tuberculosis of the intestine, and other rare diseases.
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Conventional Treatment
The approach to conventional medical treatment of this disease
often includes a combination of medical and surgical procedures. General measures include
careful nutritional measures such as a high protein and ample calorie diet. Activity and
rest are advised because undue fatigue is thought to augment the symptoms of the disease.
Foods such as dairy products and concentrated fats are often poorly tolerated, and
patients are usually advised to eat them in moderation.
Sulfasalazine (Azulfidine and others) is a common
medication used for the treatment of mild flares and prevention of future attacks. It is
metabolized in the intestine to chemicals which have both anti-inflammatory and
anti-microbial actions, but the exact mechanism of this drug's action is still not known.
What is known is that there are several side effects associated with these medications
including nausea, diarrhea, abdominal pain, tinnitus (ringing in the ears), vertigo,
fever, headache, pancreatitis and skin rashes)
In severe cases, corticosteroids (cortisone-like drugs) are
commonly prescribed, despite their well-recognized side effects. It is questionable
whether these drugs alter the long-term outcome of the disease but they do seem to control
the severe symptoms of acute attacks, especially when organs outside the intestine are
involved (eg. eye, skin, and joints). It is commonly accepted that corticosteroids should
not be used for long periods because of the dangers of severe side effects which include
hypertension, water retention, diabetes, osteoporosis and even mental disorders. When
corticosteroids cannot help a seriously ill patient, immunosuppressive drugs, such as
those used in the treatment of some cancers, are sometimes used. However, these are
serious drugs with potentially fatal side effects.
Surgery is also quite commonly undertaken for patients
suffering with Crohn's disease but recurrences in regions adjacent to the surgery, or even
distant areas, is common. If extensive surgery is done, the patient may be left with
insufficient intestine to absorb nutrients.
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Medical Prognosis
There is no set pattern in Crohn's disease but for most
patients, the disease causes recurrent illness with periods of remission and the
consequent need for long-term medication, many of which, as stated above, can cause
numerous side effects.
(1) Inflammatory bowel disease: primary health care
management of ulcerative colitis and Crohn's disease Cooke DM St. Louis University School
of Nursing. Nurse Pract Aug 1991, 16 (8) p27-30, 35-6, 38-9 (2) ibid
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