Crohns Disease

What is Crohn's Disease?

Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal (GI) tract. It affects the ileum (small intestine) and the colon (large intestine) in most cases, but can occur in any section of the GI tract from the mouth to the anus.

What are common CD symptoms?
Common CD symptoms may include some or all of the following symptoms:

Cramping - abdominal pain 
Diarrhea 
Low or high grade fever
Weight loss 
Bloating or gas
Anal pain or drainage 
Anal bleeding
Skin lesions 
Rectal abscess 
Fissure 
Joint pain 
Symptoms may range from mild to severe and be sporadic in nature.
How is CD diagnosed?
The diagnosis of Crohn's disease is suspected in patients with fever, abdominal pain and tenderness, diarrhea with or without bleeding, and anal diseases. Laboratory blood tests may show elevated white cell counts and sedimentation rates, both indicating infection or inflammation. Other blood tests may show low red cell counts (anemia), low blood proteins, and low body 
minerals, reflecting loss of these elements due to chronic diarrhea.

Barium x-ray studies can be used to define the distribution, nature, and severity of the disease. Barium is a chalky material that is visible by x-ray and appears white on x-ray films. When barium is ingested orally, pictures can be taken of the stomach and the small intestines. When barium is 
administered through the rectum, pictures of the colon and the part of the ileum closest to the colon can be obtained. Barium x-rays can show ulcerations, swelling, narrowing, and, sometimes, fistulae of the bowel. 

Direct visualization of the rectum and the large intestine can be accomplished with flexible viewing tubes (colonoscopes). Colonoscopy is more accurate than barium x-rays in detecting small ulcers or small areas of inflammation in the bowel. Colonoscopy also allows for small tissue samples 
(biopsies) to be taken and sent for examination under the microscope to confirm the diagnosis of Crohn's disease. Colonoscopy is more accurate than barium x-rays in assessing the activity and the degree of inflammation.

Computerized axial tomography (CAT or CT) scanning is a computerized x-ray technique that allows imaging of the entire abdomen and pelvis. It can be especially helpful in detecting abscesses.

The use of serology to test for antibodies to yeast and bacteria helps us confirm the diagnosis and often helps us decide the best treatment strategy. We have shown that the use of these tests improves the diagnostic accuracy between Crohn's and ulcerative colitis where overlapping features of both diseases may be present.

What causes CD? 
The exact cause of CD has yet to be proven.  Current theories and research focus on immunologic and bacterial causation.  Some researchers believe that the immune system, acting by itself, attacks the GI tract.  Some researchers believe that a strictly environmental agent is involved and some believe that an environmental agent causes  triggering of the immune response. 

Where does CD occur? 
CD can occur anywhere along the GI tract, from the mouth to the anus, but is most common in the colon and distal ileum. 
  

How is CD treated?
Drug therapy is the front line for treating CD, drug treatments can include one or more of the following:

Corticosteroids
Antidiarrheal medication
5-ASA agents
Immunomodulators
Antibiotics
Herbal or supplement
Monoclonal antibody
Surgery
Corticosteroids: Prednisone, medrol, methylprednisolone, hydrocortisone have been used since the 1950's for acute flare ups. Patients should take a calcium supplement to prevent osteoporosis.
Antidiarrheal: Imodium and Lomotil can help to reduce some symptoms, great care should be used to avoid blockage.

5-ASA: Asacol, Pentasa, Dipentum and Rowasa enema, deliver the 5-aminosalicylate molecule which has anti-inflammatory properties to the intestine wall. 5-ASA is a topical anti-inflammatory. 5-ASA are usually well tolerated.

Immunomodulators: Imuran, 6-MP, and Purinethol work by blocking the immune system from causing inflammation, but may take up to six months before being effective. Methotrexate may work quicker, but pregnancy needs to be avoided if either partner has taken methotrexate in the past three months.

Antibiotics: Ciprofloxacin (Cipro), metronidazole (Flagyl), are used primarily to fight intestinal infections that can lead to a flare, they are also helpful in healing fistulas. RMAT (Rifabutin and macrolide antibiotic therapy) treatment consist of clarithromycin (Biaxin) and rifabutin (Mycobutin) plus a probiotic (good bacteria). In limited studies the remission rate for RMAT is around 70%. Any antibiotic treatment should be coupled with a good probiotic.

Herbal or supplement: Probiotics, Omega 3, and certain herbs have shown promise in the treatment of CD or the relief of the symptoms. Please remember that herbs and supplements act with in your body as drugs. It is important to inform your doctor before attempting any herbal or supplement treatment.

Monoclonal antibody: Infliximab (Remicade) an anti-tumor necrosis factor. This antibody blocks the production of tumor necrosis factor-alpha (TNF-alpha). Studies show that TNF-alpha plays a role in inflammation. The long term side effects have not been determined.

Surgery: Normally reserved for strictures or blockages. The chances of a recurrence of the disease after surgery is very high.

New treatments.
A renewed interest in Crohn's research is bringing forth the great promise of new and novel treatments. RMAT is on the forefront of these new treatments. You can read about RMAT here.
 

 The information contained in this site is intended for information purposes only and is not intended as a means of diagnosing or treating disease. Please consult your doctor before starting any treatment.

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