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Crohn's disease
is a chronic inflammatory
disease of the digestive tract and it can
involve any part of it - from the mouth to
the anus. Crohn's disease typically affects the terminal
ileum as well as demarcated areas of large
bowel, with other areas of the bowel being
relatively unaffected. Crohn's disease is often
associated with
auto-immune disorders
outside the bowel, such as aphthous
stomatitis and
rheumatoid arthritis.
Crohn's
disease should not be confused with a
non-progressive and non-degenerative
digestive disorder called
irritable bowel
syndrome.
IBS is not an
autoimmune disease.
Ulcerative colitis is a sibling
autoimmune
disease
to Crohn's disease but only impacts the
colon while Crohn's disease can impact any part of
the digestive tract. Furthermore,
Crohn's
disease
tends to impact multiple layers of the bowel
lining which can lead to many additional and
hard to treat complications.
Symptoms of
Crohn's Disease
Crohn's
disease patients typically suffer from
chronic diarrhea and disrupted digestion,
making it difficult for sufferers in the
acute phase of the disease to eat and/or
digest food. The inflammation
of Crohn's disease can be
extremely painful and debilitating. Other
common complications of Crohn's disease
include
fistulas of the colon, hemorrhoids, lipid
absorption problems, and
anemia. Bleeding is
seen in 20% cases of Crohn's bisease, against 98% cases in
ulcerative colitis.
It is recommended that
Transfer Factor
be used in autoimmune conditions.
Transfer Factor Plus
is generally preferred for conditions caused by
infection.
Incidence of Crohn's Disease
Crohn's disease typically first appears in a
young adults in their late teens and
twenties, although it is not unknown for
symptoms to first appear quite late in life.
Additionally, there has been an increase in
cases occurring in young children. Recent
studies suggest that
up to 30% off all newly
diagnosed Crohn's disease cases are in children and teens
under the age of 18. Estimates suggest that
up to 60,000 people in the UK (about 1 in
1200) and 1,000,000 Americans have the
disease (around 1 in 300). Some ethnic
groups (such as Ashkenazi Jews) have a
significantly higher rate of prevalence than
others. Increased rates of Crohn's disease have also
been noted in some families, leading to
speculation of a possible genetic link; in
2001 a susceptibility locus for Crohn's
disease has been mapped to chromosome 16,
and named NOD2/CARD15 gene. Epidemiological
research indicates that
Crohn's
disease belongs to
the group of diseases of affluence. In other
words, the incidence of Crohn's disease is much
higher in industrialized countries than
elsewhere. However,
Crohn's
disease symptoms are
typically diagnosed over a long period of
time, in order to establish a pattern; in
countries where medical help is expensive or
less available, it may be difficult to
arrive at a diagnosis.
Smoking increases the risk of
Crohn's
disease. Some women find that their disease
is exacerbated by taking the birth control
pill oral contraceptives, while others find
it can help keep their flare ups at bay.
More research needs to be done on the impact
of hormones on Crohn's disease.
The efficacy of
immunosuppression, as
well as scanty reports of complete disease
resolution after bone marrow transplant, is
highly suggestive of an
autoimmune
pathogenesis. A definite epitope to which
the autoimmunity is directed is unknown,
which also hampers the search for a virus or
other pathogen that could induce molecular
mimicry. The exact role of a genetically
determined focus termed NOD2/CARD15 is not
yet completely known, but it is suspected to
participate in the inflammatory process at
the heart of Crohn's disease.
It is recommended that
Transfer Factor
be used in autoimmune conditions.
Transfer Factor Plus
is generally preferred for conditions caused by
infection.
Mycobacterial infection
Crohn's disease has long been suspected of
being due to a Mycobacterium because of the
similarity of many features to human
tuberculosis and veterinary Johne's Disease.
Mycobacterium avium subspecies
paratuberculosis (MAP), which causes Johne's
disease in cattle, is a primary area of
research for many scientists and doctors
involved in Crohn's disease. MAP has been
proven to affect both cattle and human hosts
and is passed on through the mammary glands.
Current pasteurization methods have proved
ineffective in ridding dairy products of
Mycobacterium Paratuberculosis. This remains
a controversial area of research, although
recent studies have lent more credence to
the theory, and government agencies in some
countries have begun investigations into the
possibility.
Nearly all practicing physicians and many
researchers are unwilling to accept that MAP
is a primary cause of Crohn's disease. Dozens of
studies have been done in which evidence of
MAP infection could not be found in tissue
and blood samples of Crohn's disease patients.
However, other studies have been performed
which (with more stringent methodology)
showing that MAP was found in up to 90% of
the Crohn's disease patients in the study.
Mycobacteria are known to be fastidious,
which means they are extremely difficult to
grow in culture. Therefore, unless very
stringent precautions are taken, cultures
for mycobacteria can underestimate the
presence of the bacterium.
For this reason, PCR is a more promising
technique than culture. Researchers have
identified an insertion sequence called
IS900 that is unique to the MAP organism,
and many studies have been performed using
PCR to test for the presence of MAP.
However, the problem with PCR is that it
will detect dead or near-dead ("non viable")
MAP organisms, so often times a combination
of PCR and careful culture is needed to
prove that MAP is present.
Researchers using PCR and careful culture
have found that
live MAP bacteria are
present in significant numbers of Crohn's
disease
patients, and other studies using PCR and
culture have shown that live MAP bacteria
are present in significant percentages of
pasteurized milk in the United States, the
United Kingdom, and the Czech Republic.
It is recommended that
Transfer Factor
be used in autoimmune conditions.
Transfer Factor Plus
is generally preferred for conditions caused by
infection.
Short-term effects of Crohn's Disease
The bowel shows segmental "hose pipe"
thickening and shows full thickness chronic
inflammation, giant cell granulomas, and
fissures with acute inflammation. Fistula
formation is quite common in Crohn's
disease. Bowel
obstruction is a known complication which
may require surgical resection.
Approximately 50% of surgical cases require
additional surgery within five years because
the disease tends to reappear at the site
where the bowel was rejoined, and some
patients eventually develop short bowel
syndrome which makes it extremely difficult
to digest food. For this reason, surgery is
considered by many doctors only as a last
resort in the treatment of Crohn's
disease.
Long-term risks for symptoms of crohn
disease
Some patients can be treated with the
existing drugs quite effectively and can go
into long-term remission, sufficient to
allow the sufferer to lead a normal life.
Patients are at somewhat larger risk of
colon cancers, and should have regular
colonoscopies both to check for precancerous
growths and to monitor the success of
treatment. It does not seem to have as great
a risk of malignancy compared to ulcerative
colitis.
Treatment of Crohn's Disease
Acute treatment
for Crohn's Disease
Steroids are often necessary in initial
stages and during flare-ups, although
long-term steroid therapy is discouraged
because of its well-known side effects.
Steroid-sparing
for Crohn's Disease
A well-established group of drugs,
especially useful in mild-to-moderate
Crohn's disease, are salicylates - 5-ASA derivates -
5-aminosalicylic acid compounds such as
sulfasalazine, mesalamine (Pentasa®, Asacol®),
olsalazine, and balsalazide.
Immunomodulating drugs such as azathioprine,
6-mercaptopurine and methotrexate are given
mainly in moderate-to-severe cases. Research
trials are being conducted on treatment with
drugs in the same family as thalidomide. Infliximab (brand name Remicade®) is given
in patients with therapy-resistant or
fistulating Crohn's disease.
Surgery
Surgery (resection of parts of the bowel)
is avoided, as this does not cure
Crohn's
disease - it can recur at any site in the
digestive tract. 50% of all Crohn's disease patients
eventually undergo one or more resections to
control highly active disease. Most often,
this is of the terminal ileum.
Dietary
Treatment for Crohn's Disease
Some patients find some foods (such as
foods high in fiber, dairy foods, and
sugars) make their Crohn's disease symptoms worse, but the
disease cannot be controlled simply through
diet modifications. However, paying close
attention to diet can help reduce the number
of flare-ups for many sufferers.
Differential diagnosis
Crohn's disease and ulcerative colitis
are quite distinct diseases but in practice
there are sometimes difficulties
distinguishing between them, especially in
mild cases - these are usually simply
classified as "chronic inflammatory bowel
disease" or "indeterminate colitis".
Crohn's disease is often initially
misdiagnosed as food poisoning,
gastroenteritis, appendicitis (due to the
common locus of pain in the lower right-hand
quadrant of the abdomen), and irritable
bowel syndrome.
History of Crohn's Disease |
