Crohn’s Disease is a condition that causes inflammation of the digestive system or gut. Crohn’s can affect any part of the gut, though the most common area affected is the end of the ileum (the last part of the small intestine), or the colon. It primarily affects the small and large bowel, but can occur anywhere in the digestive tract. The inflammation causes uncomfortable and bothersome symptoms and may result in serious damage to the digestive tract. Abdominal pain, diarrhea and weight loss are the most obvious symptoms. Making a definitive diagnosis is difficult, possibly requiring many different tests performed over a long period of time.
Crohn’s disease is one of the two major types of inflammatory bowel disease (IBD), the other being ulcerative colitis. The main difference between the two conditions is that, whereas Crohn’s disease can affect any part of the digestive tract, ulcerative colitis affects only the large bowel and the rectum.
Crohn’s disease is a disease where the body’s immune system begins attacking healthy cells in the GI tract, causing inflammation. Because it is a disease of the immune system, Crohn’s is classified medically as an autoimmune disorder. This means that the body is producing antibodies that work against itself.
What is GI Tract?
The GI tract actually starts at the mouth. It follows a twisting and turning course and ends, many yards later, at the rectum. In between are a number of organs that all play a part in processing and transporting food through the body The first is the esophagus, a narrow tube that connects the mouth to the stomach. Food passes through the stomach and enters the small intestine. This is the section where most of our nutrients are absorbed. The small intestine leads to the colon, or large intestine, which connects to the rectum. The principal function of the colon is to absorb excess water and salts from waste material (what’s left after food has been digested). It also stores solid waste, converting it to stool, and excretes it through the anus. When inflammation occurs, the primary functions are affected, including the absorption of water. As a result, diarrhea can be a very common symptom during flares of Crohn’s disease.
Approximately 1.6 million Americans have either Crohn’s disease or ulcerative colitis. Males and females appear to be affected equally. This illness usually appears early in life; about one-sixth of patients present before the age of 15 and often with severe disease. The average age at diagnosis is 27 years. The cause of Crohn’s disease is unknown, although strong genetic influences are suggested by the occurrence of this disease in families, with a higher incidence in Jews than in the general population. Genetic influences are more prominent in the younger onset subgroup of patients than those who present after the age of 40.
Causes
The exact cause of Crohn’s disease is unknown. Researchers believe the following factors may play a role in causing Crohn’s disease –
- Autoimmune reaction – Scientists believe one cause of Crohn’s disease may be an autoimmune reaction—when a person’s immune system attacks healthy cells in the body by mistake. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the intestines. This immune system response causes the inflammation, leading to symptoms.
- Genes – Crohn’s disease sometimes runs in families. Research has shown that people who have a parent or sibling with Crohn’s disease may be more likely to develop the disease. Researchers continue to study the link between genes and Crohn’s disease.
- Environment – Some studies suggest that certain things in the environment may increase the chance of a person getting Crohn’s disease, although the overall chance is low. Nonsteroidal anti-inflammatory drugs, antibiotics, and oral contraceptives may slightly increase the chance of developing Crohn’s disease. A high-fat diet may also slightly increase the chance of getting Crohn’s disease.
Symptoms
Most people with Crohn’s disease are diagnosed during late adolescence and early adulthood (15-30 years of age), with a second spike in numbers occurring between the ages of 60 and 70 years, mainly in women.
Symptoms depend on the location and severity of the inflammation. Unpredictable symptomatic flare-ups and remissions characterise the long-term course of the disease.
Typical symptoms in a person with Crohn’s disease are chronic diarrhoea and abdominal pain and tenderness. Other Crohn’s disease symptoms include:
- Rectal bleeding
- Fever
- Weight loss, and loss of appetite
- Nausea, vomiting
- Malnutrition, and vitamin deficiencies
- Tiredness, lethargy
- Bone loss (osteoporosis)
- Depression, anxiety (associated with coping with the condition)
- Stunted growth in children (which may occur many years before digestive symptoms appear).
Additionally, the area around the anus may be affected by ulcers, abscesses, fissures (small ulcerated cracks) or fistulas (small abnormal holes in the wall of the intestines or rectum).
In addition to having symptoms in the GI tract, some people also may experience a variety of symptoms in other parts of the body associated with Crohn’s disease. Signs and symptoms of the disease may be evident in:
- Eyes (redness, pain, and itchiness)
- Mouth (sores)
- Joints (swelling and pain)
- Skin (tender bumps, painful ulcerations, and other sores/rashes)
- Bones (osteoporosis)
- Kidney (stones)
- Liver (primary sclerosing cholangitis, hepatitis, and cirrhosis)—a rare development
All of these are known as extraintestinal manifestations of Crohn’s disease because they occur outside of the digestive system. In some people, these actually may be the first signs of Crohn’s disease, appearing even years before the bowel symptoms. In others, they may coincide with a flare-up of intestinal symptoms.
Types of Crohn’s Diseases
The following are five types of Crohn’s disease –
Crohn’s (granulomatous) colitis – Affects the colon only.
Gastroduodenal Crohn’s disease – Affects the stomach and duodenum (the first part of the small intestine).
Ileitis – Affects the ileum.
Ileocolitis – The most common form of Crohn’s affecting the colon and ileum (the last section of small intestine).
Jejunoileitis – Produces patchy areas of inflammation in the jejunum (upper half of the small intestine).
Treatment
Conventional Treatment
Medicines – Therapeutic regimens are based upon the severity of Crohn’s disease and the extent of gastrointestinal tract involvement. These factors may vary during the course of the disease but accurate assessment of both is crucial in determining treatment. The severity of the disease impacts the use of anti-inflammatory drugs and risk of future complications. The extent of disease is relevant in the determination of what kind of therapy will be most efficacious, e.g., topical or targeted therapy. The aims of therapy include the treatment of active disease followed by maintenance of remission.
Aminosalicylates – These include medications that contain 5-aminosalicylic acid (5-ASA). Examples are sulfasalazine, mesalamine, olsalazine, and balsalazide.These drugs are not specially approved by the Food and Drug Administration (FDA) for use in Crohn’s. However, they can work at the level of the lining of the GI tract to decrease inflammation. They are thought to be effective in treating mild-to-moderate episodes of Crohn’s disease and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.
Corticosteroids – These medications affect the body’s ability to launch and maintain an inflammatory process. In addition, they work to keep the immune system in check. Corticosteroids are used for people with moderate-to-severe Crohn’s disease. They are effective for short-term control of flareups; however, they are not recommended for long-term or maintenance use because of their side effects.
Immunomodulators – This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.
Biologic therapies – These medications represent the latest class of therapy used for people with Crohn’s disease. These medications are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation.
Antibiotics – Antibiotics may be used when infections—such as abscesses—occur in Crohn’s disease. They can also be helpful with fistulas around the anal canal and vagina.
Alternative Treatment
Zinc, folic acid, vitamin B12 – The body uses these vitamins and minerals to repair cells in the intestine. In addition, drugs such as sulfasalazine and methotrexate may cause levels of folic acid in the body to drop, so that you need a supplement.
Vitamin D – The body needs vitamin D to maintain strong bones. People with Crohn disease, especially those who take corticosteroids, often have low levels of vitamin D putting them at risk for osteoporosis.
Calcium – Calcium is also needed for strong bones. Ask your doctor if you need a calcium supplement.
Omega-3 fatty acids – These fats may help fight inflammation and reduce the chances of recurrence, but studies have been mixed. The study with the most positive results used a special type of fish oil, “enteric coated free fatty acid form,” that is not sold commercially.
Probiotics – One small study indicated that this type of “friendly” bacteria helped people with Crohn’s disease reduce the incidence of diarrhea.
N-acetyl glucosamine (NAG) – Preliminary research suggests that N-acetyl glucosamine supplements or enemas may improve symptoms of inflammatory bowel disease, but more studies are needed to determine whether glucosamine would have any effect on Crohn disease.
Glutamine – Glutamine is an amino acid found in the body that that helps the intestine function properly. While there is no evidence that glutamine specifically helps reduce symptoms of Crohn disease, it may be good for overall intestinal health. It is best to take glutamine on an empty stomach.
Herbs
Slippery elm is a demulcent (a substance that protects irritated tissues and promotes their healing).
Marshmallow (Althaea officinalis) is a demulcent and emollient (a substance that soothes mucous membranes). Marshmallow may interact with lithium. It may also interfere with drugs taken by mouth.
Curcumin or turmeric shows anti-inflammatory properties in test tubes. One small study found that people with inflammatory bowel disease who took curcumin reduced their symptoms and their need for medicines.
Cat’s claw may make leukemia, as well as autoimmune disorders, worse, and may worsen low blood pressure.
Boswellia (Boswellia serrata) has anti-inflammatory properties, and a few small studies suggest that it may help treat Crohn disease.
Complementary Treatment
Acupuncture has long been used in Traditional Chinese Medicine to treat inflammatory bowel disease. One study in Germany found that acupuncture and moxibustion were effective specifically for treating Crohn disease.
Reference
http://www.corecharity.org.uk/images/information_pdfs/CrohnsDisease.pdf
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Causes.aspx