Symptoms And Treatments Of Crohn's Disease

Symptoms And Treatments Of Crohn's Disease
A chronic form of inflammatory bowel disease (a group of
chronic disorders that cause inflammation or ulceration in the small
and large intestines). Crohn's disease causes severe irritation in the
gastrointestinal tract. It usually affects the lower small intestine
(called the ileum) or the colon, but it can affect the entire
gastrointestinal tract. Also called regional enteritis and ileitis. See
also Inflammatory Bowel Disease (IBD) and Granuloma.

Most often, IBD is classified either as Colitis (Ulcerative)

or Crohn disease. While ulcerative colitis affects the inner lining of
the colon and rectum, Crohn disease extends into the deeper layers of
the intestinal wall. It is a chronic condition and may recur at various
times over a lifetime. Crohn's disease may also be called ileitis or
enteritis.

About 20% of cases of Crohn disease appear to run in families. It is
a 'complex trait', which means that several genes at different
locations in the genome may contribute to the disease. A susceptibility
locus for the disease was recently mapped to chromosome 16.

Because some of the genetic factors involved in Crohn disease may
also contribute to ulcerative colitis susceptibility, research into
Crohn disease may assist in further understanding both types of IBD.

Crohn's disease causes inflammation in the small intestine. Crohn's
disease usually occurs in the lower part of the small intestine, called
the ileum, but it can affect any part of the digestive tract, from the
mouth to the anus. The inflammation extends deep into the lining of the
affected organ. The inflammation can cause pain and can make the
intestines empty frequently, resulting in diarrhea.

Crohn's disease affects males and females equally and seems to run
in some families. About 20 percent of people with Crohn's disease have
a blood relative with some form of IBD, most often a brother or sister
and sometimes a parent or child.

The most common symptoms of Crohn's disease are abdominal pain,
often in the lower right area, and diarrhea. Rectal bleeding, weight
loss, and fever may also occur. Bleeding may be serious and persistent,
leading to anemia. Children with Crohn's disease may suffer delayed
development and stunted growth.

The most common complication is blockage of the intestine. Blockage
occurs because the disease tends to thicken the intestinal wall with
swelling and scar tissue, narrowing the passage. Crohn's disease may
also cause sores, or ulcers, that tunnel through the affected area into
surrounding tissues such as the bladder, vagina, or skin. The areas
around the anus and rectum are often involved. The tunnels, called
fistulas, are a common complication and often become infected.
Sometimes fistulas can be treated with medicine, but in some cases they
may require surgery.

Nutritional complications are common in Crohn's disease.
Deficiencies of proteins, calories, and vitamins are well documented in
Crohn's disease. These deficiencies may be caused by inadequate dietary
intake, intestinal loss of protein, or poor absorption (malabsorption).

Other complications associated with Crohn's disease include
arthritis, skin problems, inflammation in the eyes or mouth, kidney
stones, gallstones, or other diseases of the liver and biliary system.
Some of these problems resolve during treatment for disease in the
digestive system, but some must be treated separately.

Treatment for Crohn's disease depends on the location and severity
of disease, complications, and response to previous treatment. The
goals of treatment are to control inflammation, correct nutritional
deficiencies, and relieve symptoms like abdominal pain, diarrhea, and
rectal bleeding. Treatment may include drugs, nutrition supplements,
surgery, or a combination of these options. At this time, treatment can
help control the disease, but there is no cure.

Drugs are the usual therapy for Crohn's disease and ulcerative
colitis. These include anti-inflammatory agents like Azulfidine as well
as steroids and immunosuppressant agents borrowed from the cancer
arena. All these medications have side effects and are often
ineffective. With ulcerative colitis, the ultimate "solution" is
removal of the large intestine, with ileostomy (external bag). For
Crohn's disease, however, surgery produces less conclusive results.
Sometimes patients with Crohn's disease are subjected to multiple
surgeries with progressive shortening of their intestines until they
are subject to the debilitating end-game of short-gut syndrome.

The doctor may recommend nutritional supplements, especially for
children whose growth has been slowed. Special high-calorie liquid
formulas are sometimes used for this purpose. A small number of
patients may need periods of feeding by vein. This can help patients
who need extra nutrition temporarily, those whose intestines need to
rest, or those whose intestines cannot absorb enough nutrition from
food.

Of greatest interest is Omega-3 fish oil, recently demonstrated to
be helpful in both ulcerative colitis and Crohn's disease. Antioxidants
appeared to play a special role in protection of the intestinal cells
from inflammation. It is believed that highly reactive free radicals
literally disrupt cell membranes and cause inflammation in the gut.
Several studies point to critical depletion of vitamin C, selenium,
zinc, and vitamin E in patients with inflammatory bowel disease.
Vitamin C and zinc must be supplemented carefully, particularly because
of their potential to cause gastrointestinal upset.

Additional vitamins that appear to play a role in repair include
folic acid, which may be depleted due to the use of azulfidine or
related medication. A significant percentage of patients with IBD may
be B12 deficient, especially those who have undergone surgery which
removes a critical part of the intestine that absorbs B12. Because of
chronic diarrhea fat-soluble vitamins like A and D may be depleted as
well.

The loss of magnesium through diarrhea and fat malabsorption usually
occurs after intestinal surgery or infection, but it can occur with
chronic malabsorptive problems such as Crohn's disease, gluten
sensitive enteropathy, and regional enteritis. Individuals with these
conditions may need extra magnesium. The most common symptom of fat
malabsorption, or steatorrhea, is passing greasy, offensive-smelling
stools.

The
nutrients mentioned above reflect the major nutritional supplements
that may help the condition. Please do remember however that
nutritional supplementation is an adjunct to medical treatment and in
no way replaces medical treatment.

- Rude RK and Olerich M. Magnesium deficiency: Possible role in
osteoporosis associated with gluten-sensitive enteropathy. Osteoporos
Int 1996;6:453-61.