|
Crohn's disease is a chronic, recurrent inflammatory
disease of the intestinal tract.
The intestinal tract has four major parts: the esophagus, or
food tube; the stomach, where food is churned and digested; the
long, small bowel, where nutrients, calories, and vitamins are
absorbed; and the colon and rectum, where water is absorbed and
stool is stored.
The two primary sites for Crohn's disease are the ileum,
which is the last portion of the small bowel (ileitis, regional
enteritis), and the colon (Crohn's colitis). The condition
begins as small, microscopic nests of inflammation which persist
and smolder. The lining of the bowel can then become ulcerated
and the bowel wall thickened. Eventually, the bowel may become
narrowed.
What Causes Crohn's Disease?
After many years of intense research, the cause of Crohn's
disease is still unknown. One theory is that the condition is
caused by an unidentified, slow-growing microorganism. The
body's immune system, which protects it against many
different infections, is also known to be a factor. In spite of
the unknown cause, enormous understanding and knowledge currently
exists about the disease and its treatment.
Who Develops Crohn's Disease?
The condition occurs in both sexes and among all age groups,
although it most frequently begins in young people. For unknown
reasons, Jewish people are at increased risk of developing
Crohn's, while African Americans are at decreased risk.
Symptoms
The symptoms of Crohn's disease depend on where in the
intestinal tract the disorder first appears. When the ileum
(ileitis) is involved, recurrent pain may be experienced in the
right- lower abdomen. At times, the pain mimics acute
appendicitis. When the colon is the site, diarrhea (which is
sometimes bloody) may occur, as well as fever and weight
loss.
When the inflammation is active, fatigue and lethargy appear.
In children and young people there may be difficulty gaining or
maintaining weight.
Diagnosis
Usually there is no one conclusive diagnostic test for
Crohn's disease. The physician uses a series of tests to
assess the patient's overall condition and then makes a
diagnosis. The patient's medical history and physical exam
are always helpful. Certain blood and stool tests are performed
to arrive at a diagnosis. X-rays of the small intestine and colon
(obtained through an upper GI series and barium enema) are
usually required. In addition, a visual examination
(sigmoidoscopy) of the lining of the rectum and lower bowel is
usually necessary. A more extensive exam of the entire colon
(colonoscopy) is often the best way of diagnosing the problem
when the disease is in the colon.
Course and Complications
The disorder often remains quiet and easily controlled for
long periods of time. Most people with Crohn's disease
continue to pursue their goals in life, go to school, marry, have
a family, and work with few limitations or inconveniences. Some
problems, outside the bowel, can occur. Arthritis, eye and skin
problems, and-in rare instances--chronic liver conditions may
develop. The disease can occur around the anal canal. Open sores
called fissures can develop, which are often painful. A fistula
can also form. This is a tiny channel that burrows from the
rectum to the skin around the anus. In addition, when
inflammation persists in the ileum or colon, narrowing and
partial obstruction may occur. Often surgery is required to treat
these problems. When Crohn's disease has been present for
many years there is an increased risk of cancer.
Treatment
Effective medical and surgical treatment is available for
Crohn's disease. It is particularly important to maintain
good nutrition and health with a balanced diet, adequate
exercise, and a positive, upbeat attitude.
Four types of medications are usually used in treating this
disease:
1. Cortisone or Steroids--These powerful drugs provide highly
effective results. Often, a high dose is used initially to bring
the disorder under control. The drug is then tapered to a low
maintenance dose, perhaps taken just every other day. Hopefully
the drug may eventually be stopped altogether. This medicine is
administered by pill or enema. Prednisone is a common generic
name.
2. Anti-inflammation Drugs-sulfasalazine (Azutfidine),
Dipentum, Asacol, Rowasa, and Pentasa belong to a group of drugs
called the 5-aminosalicylate group. These drugs are most useful
in maintaining a remission, once the disease is brought under
control. They are available in oral and enema preparations.
3. Immune System Suppressors-These medications suppress the
body's immune system, which appears to be overly active and
to perpetuate the disease in Crohn's patients. The names of
two of these commonly used medications are azathioprine (trade
name: lmuran) and 6 MP (trade name: Purinethol). There are other
potent immune-suppressing drugs that may be used in difficult
cases.
4. Antibiotics--Since there is frequently a bacterial
infection along with Crohn's disease, a wide assortment of
antibiotics is available to treat this problem. One that is
commonly used is metronidazole (trade name: Flagyl).
Diet and Emotions
There are no foods known to actually injure the bowel.
However, during an acute phase of the disease, bulky foods, milk,
and milk products can increase diarrhea and cramping. Generally,
the patient is advised to eat a well-balanced diet with adequate
protein and calories. A multivitamin and iron supplement may be
recommended by the physician.
Stress, anxiety, and extreme emotions may aggravate symptoms
of the disorder, but are not believed to cause it or make it
worse. Any chronic disease can produce a serious emotional
reaction, which can usually be handled through discussion with
the physician.
Surgery
Surgery is commonly needed at some time during the course of
Crohn's disease. It may involve removing a portion of
diseased bowel, or simply the draining of an abscess or fistula.
In all cases, the guiding principle is to perform the least
amount of surgery to correct the problem. It should be understood
that surgery does not cure Crohn's disease.
Summary
Most people with Crohn's disease lead active lives with
few restrictions. Although there is no known cure for the
disorder, it can be managed with present treatments. For a few
patients, the course of the disease can be more difficult and
complicated, requiring extensive testing and therapy. Surgery
sometimes is required. In all cases, follow-up care is essential
to treat the disease and prevent or deal with complications that
may arise.
|
