What Is It?
Crohn’s disease is a chronic inflammatory disorder that affects the digestive tract, characterized by cramping pain, diarrhea, and sometimes nausea or vomiting. It is estimated that there are about 500,000 persons with Crohn's disease in the United States, with another 500,000 suffering from ulcerative colitis. Another statistic that is given by some doctors is 7 cases per 100,000 in the general population in Canada and the United States. Crohn's is primarily a disorder of adults, most often beginning in late adolescence or the early adult years. The most common age at onset is between 15 and 30 years, although the disorder may begin at any age.The rate of Crohn's disease in North America has been increasing since the 1960's, although the reasons for the increase are not known as of 2009. Southern Europe, South America, Africa, and Asia have considerably lower rates of the disease —as low as 0.5–0.08 cases per 100,000 people. Around the world, however, the rates of Crohn's disease are higher in cities than in rural areas, and higher among people with higher incomes than among lower-income groups. One argument for the presence of a genetic factor in Crohn's disease is that it runs in some families; people who have a sibling with the disease are 30 times more likely to develop it than the normal population. Crohn's disease is also relatively common among certain ethnic groups, particularly Jews of Eastern European origin. A two- to four-fold increase in the frequency of Crohn's disease has been found among the Jewish population in the United States, Europe, and South Africa compared to other ethnic groups. In terms of other ethnic groups in the United States, Crohn's disease appears to be slightly more common in non-Jewish Caucasians than in African or Asian Americans. The disease is more common in men than in women; the male/female ratio is 1.8:1.
Description:
Crohn’s disease is named for Dr. Burrill Bernard Crohn (1884–1983) who, with his colleagues, first described the disease in 1932. Crohn’s disease can affect any part of the digestive system, however, it develops most often in the section of the small intestine just before the large intestine begins. This region is called the ileum, and Crohn’s disease that develops there is sometimes called ileitus. The other common site for Crohn’s disease is in the colon or large intestine. Crohn’s disease is one of several inflammatory bowel diseases. It can be mistaken for ulcerative colitis. Both these diseases cause watery diarrhea or bloody diarrhea and abdominal cramps or pain. Ulcerative colitis, however, affects only the layer of cells that line the intestine forming sores or ulcers on this surface. Crohn’sdisease begins in these same surface cells, but eats its way inward, damaging all four layers of the intestine and sometimes creating a fistula (hole) through the intestine and into other tissue. Another major difference between Crohn’s disease and ulcerative colitis is that Crohn’s disease can develop simultaneously in several spots in the digestive tract, resulting in areas of damaged with patches with healthy tissue in between. Ulcerative colitis, on the other hand, spreads uniformly across an area. Crohn’s disease is somewhat treatable but not curable, and can cause many complications beyond the digestive system. Eventually the walls of the intestine thicken and blockages may occur that can only be corrected by surgery (The Gale Encyclopedia of Medicine 2011).
In some cases of Crohn's disease, the underlying layers of intestinal tissue are damaged also, leading to complete perforation (puncturing) of the wall of the intestine. This form of the disease is sometimes called penetrating Crohn's disease. Penetrating disease may cause a serious infection in the abdomen or the formation of fistulas. In Crohn's disease, fistulas are most likely to form in the area around the anus, leading to the formation of abscesses (pus-filled sores). About 30 percent of patients with Crohn's disease develop fistulas. Another subtype of Crohn's disease is called stricturing disease. Stricture is the medical term for an abnormal narrowing of a hollow organ such as the bowel. In stricturing disease, the inflammation and swelling of tissue inside the bowel leads to changes in the size of the patient's stools and eventual blockage of the intestinal passages (2011). Severe abdominal cramping is often an indication of stricturing disease, as are nausea and vomiting.
Symptoms:
Symptoms of Crohn’s disease vary, depending on the location of the damaged cells and the length of time the individual has had the disease. Symptoms can be mild or severe. They can develop suddenly or gradually, and they may improve or even disappear, and then worsen many times throughout an individual’s life. Some people may have only occasional episodes of diarrhea, for example, while others may have 20–30 bowel movements in a single day that interfere with sleep, work, school, or other activities. In general, symptoms can be divided into those that affect the digestive tract and those that affect the rest of the body (Sick! 2007). The most common symptoms that affect the digestive tract are:
Description:
Crohn’s disease is named for Dr. Burrill Bernard Crohn (1884–1983) who, with his colleagues, first described the disease in 1932. Crohn’s disease can affect any part of the digestive system, however, it develops most often in the section of the small intestine just before the large intestine begins. This region is called the ileum, and Crohn’s disease that develops there is sometimes called ileitus. The other common site for Crohn’s disease is in the colon or large intestine. Crohn’s disease is one of several inflammatory bowel diseases. It can be mistaken for ulcerative colitis. Both these diseases cause watery diarrhea or bloody diarrhea and abdominal cramps or pain. Ulcerative colitis, however, affects only the layer of cells that line the intestine forming sores or ulcers on this surface. Crohn’sdisease begins in these same surface cells, but eats its way inward, damaging all four layers of the intestine and sometimes creating a fistula (hole) through the intestine and into other tissue. Another major difference between Crohn’s disease and ulcerative colitis is that Crohn’s disease can develop simultaneously in several spots in the digestive tract, resulting in areas of damaged with patches with healthy tissue in between. Ulcerative colitis, on the other hand, spreads uniformly across an area. Crohn’s disease is somewhat treatable but not curable, and can cause many complications beyond the digestive system. Eventually the walls of the intestine thicken and blockages may occur that can only be corrected by surgery (The Gale Encyclopedia of Medicine 2011).
In some cases of Crohn's disease, the underlying layers of intestinal tissue are damaged also, leading to complete perforation (puncturing) of the wall of the intestine. This form of the disease is sometimes called penetrating Crohn's disease. Penetrating disease may cause a serious infection in the abdomen or the formation of fistulas. In Crohn's disease, fistulas are most likely to form in the area around the anus, leading to the formation of abscesses (pus-filled sores). About 30 percent of patients with Crohn's disease develop fistulas. Another subtype of Crohn's disease is called stricturing disease. Stricture is the medical term for an abnormal narrowing of a hollow organ such as the bowel. In stricturing disease, the inflammation and swelling of tissue inside the bowel leads to changes in the size of the patient's stools and eventual blockage of the intestinal passages (2011). Severe abdominal cramping is often an indication of stricturing disease, as are nausea and vomiting.
Symptoms:
Symptoms of Crohn’s disease vary, depending on the location of the damaged cells and the length of time the individual has had the disease. Symptoms can be mild or severe. They can develop suddenly or gradually, and they may improve or even disappear, and then worsen many times throughout an individual’s life. Some people may have only occasional episodes of diarrhea, for example, while others may have 20–30 bowel movements in a single day that interfere with sleep, work, school, or other activities. In general, symptoms can be divided into those that affect the digestive tract and those that affect the rest of the body (Sick! 2007). The most common symptoms that affect the digestive tract are:
- Chronic diarrhea
- abdominal pain or cramps, often in the lower right portion of the abdomen
- rectal bleeding
- blood in the stool or black tarry stools
- ulcers in the digestive tract, usually in the intestine
- fistulas, or holes in the intestine that connect the intestine to such other parts of the body as the bladder, stomach, vagina, or another section of bowel
- nausea and vomiting , usually from Crohn’s disease in the stomach
- abscesses, fistulas, and ulcers around the anus, usually from Crohn’s disease in the colon. These occur in about 45% of patients
- constipation, usually after many years when the bowel has thickened and the diameter of the intestine has narrowed
A barium X ray showing the colon of a patient with Crohn's disease where the large and small intestines join at the bottom left (Sick 2010).
What Causes It?
At one time, researchers thought that stress and diet caused Crohn’s disease, particularly by eating sweet or high-fat foods. It is also known that smoking is a risk factor for developing Crohn's. Now researchers know that these are not causes in the strict sense, although both stress and diet can worsen symptoms in people who already have the disease. What researchers do know is that Crohn’s disease is caused by an inappropriate immune system reaction that affects cells in the digestive tract. Beyond that, the reasons why some people develop the disease are not clear as of 2009.
There is almost certainly an inherited component that predisposes some people to the disease. Individuals who are blood relatives of a parent, sibling, or child with Crohn’s disease are 30 times more likely to develop the disease than the general population. Scientists believe multiple genes are involved in development of the disease. However, more than genetics determines who gets Crohn’s disease, because only about 44% of identical twins both develop the disease (2011). Researchers have found mutated genes in many people who have Crohn’s disease. These genes are: ATG16L1, IRGM, NOD2, and IL23R. Also, Crohn's disease is related to chromosomes 5 and 10. The main player in the cause of Crohn's disease is IL23R and it is responsible for providing instructions for making a protein called the interleukin 23 receptor. This protein is embedded in the cell membrane of several types of immune system cells, including T cells, natural killer (NK) cells, monocytes, and dendritic cells. These cells identify foreign substances and defend the body against infection and disease(Genetics Home Reference 2009) .
Current thinking is that interactions among genes, the environment, the individual’s health, and body chemistry affect a person's risk of developing Crohn’s disease. When foreign materials (antigens) enter the body, the immune system produces antibodies, which are proteins that neutralize the foreign invader. One theory about Crohn’s disease is that some foreign organism or material stimulates an immune system response in the digestive system, and then through an error in genetic control, the response cannot be “turned off.” A second theory suggests that the cells of the immune system mistake good bacteria, food, or some other substance that is normally present in the digestive tract and make antibodies against this material as if it were a foreign substance. Either way, an inappropriate immune system response occurs that appears to be the root cause of the symptoms people with Crohn’s disease experience (2011).
There is almost certainly an inherited component that predisposes some people to the disease. Individuals who are blood relatives of a parent, sibling, or child with Crohn’s disease are 30 times more likely to develop the disease than the general population. Scientists believe multiple genes are involved in development of the disease. However, more than genetics determines who gets Crohn’s disease, because only about 44% of identical twins both develop the disease (2011). Researchers have found mutated genes in many people who have Crohn’s disease. These genes are: ATG16L1, IRGM, NOD2, and IL23R. Also, Crohn's disease is related to chromosomes 5 and 10. The main player in the cause of Crohn's disease is IL23R and it is responsible for providing instructions for making a protein called the interleukin 23 receptor. This protein is embedded in the cell membrane of several types of immune system cells, including T cells, natural killer (NK) cells, monocytes, and dendritic cells. These cells identify foreign substances and defend the body against infection and disease(Genetics Home Reference 2009) .
Current thinking is that interactions among genes, the environment, the individual’s health, and body chemistry affect a person's risk of developing Crohn’s disease. When foreign materials (antigens) enter the body, the immune system produces antibodies, which are proteins that neutralize the foreign invader. One theory about Crohn’s disease is that some foreign organism or material stimulates an immune system response in the digestive system, and then through an error in genetic control, the response cannot be “turned off.” A second theory suggests that the cells of the immune system mistake good bacteria, food, or some other substance that is normally present in the digestive tract and make antibodies against this material as if it were a foreign substance. Either way, an inappropriate immune system response occurs that appears to be the root cause of the symptoms people with Crohn’s disease experience (2011).
The three most common sites of intestinal involvement in Crohn's disease are ileal, ileocolic and colonic (2011).
How Do We Fix It?
There is no medical or surgical cure for Crohn's disease. Treatment consists of managing the patient's symptoms, getting the disease into remission, and preventing relapses. Patients with Crohn's disease are usually started on one or more different types of medications to relieve pain and discomfort. These medications may include cortisone and other drugs that reduce inflammation; drugs that block or lower the body's immune response; antidiarrheal drugs and fluid replacements; antibiotics; and nutritional supplements. Special high-calorie liquid formulas may be prescribed for patients whose intestines may need a rest (2007). Treatment for Crohn's disease focuses on four major objectives:
Nutritional supplements are used to treat malnutrition. The supplements are chosen because they are easily absorbed through the intestinal wall. Patients may also need to learn which foods they cannot digest (such as milk or spicy foods) and avoid eating those foods. In severe cases, a patient may need to be fed intravenously. Intravenous feeding involves the insertion of a tube into a vein. Nutrients are then given to the patient through the tube (2011).
A number of medications are available to reduce pain and cramping. High-fiber medications may also be helpful. Complications such as obstructions, abscesses, and fistulas are sometimes treated with antibiotics. The antibiotics kill the bacteria that produce these complications. If antibiotics are unsuccessful, surgery may be necessary. The purpose of surgery is to remove an obstruction or abscess or to repair a fistula. In the most severe cases, a portion of the intestine may have to be removed.
Theoretical Cure:
Patients who are not helped by medications or who have the stricturing form of the disease are usually treated by surgery. In most cases the surgeon removes the diseased part of the intestine and reconnects the healthy portions. This procedure may have to be repeated, however, as inflammation may develop in the area of the intestine next to where a diseased portion was removed. Also, acupuncture and guided imagery may be useful tools in treating pain associated with Crohn’s disease. Acupuncture involves the placement of thin needles into the skin at targeted locations on the body known as acupoints in order to harmonize the energy flow within the human body. To treat chronic pain, such as that involved with Crohn’s disease, an acupuncturist frequently places the acupuncture needles along what is known as the large intestine meridian. Guided imagery involves creating a visual mental image of one’s pain in one’s mind. Once the pain can be visualized, the patient can adjust the image to make it more pleasing and, thus, more manageable. Other related alternative therapies include relaxation exercises, yoga, and biofeedback. Not only this but there always is the theoretical option of genetic engineering in which we would have to take the infected gene, in this case IL23R, and replace it with one fully functioning and capable to carry out its duty. Thus, this gene will properly provide instructions for making the protein called the interleukin 23 receptor and might possibly end the inflammation in the smaller intestines.
- Reduction of inflammation of the intestine
- Dealing with the patient's nutritional problems
- Relieving the uncomfortable symptoms of abdominal pain and diarrhea
- Treating possible complications, such as obstructions, abscesses, and fistulas
Nutritional supplements are used to treat malnutrition. The supplements are chosen because they are easily absorbed through the intestinal wall. Patients may also need to learn which foods they cannot digest (such as milk or spicy foods) and avoid eating those foods. In severe cases, a patient may need to be fed intravenously. Intravenous feeding involves the insertion of a tube into a vein. Nutrients are then given to the patient through the tube (2011).
A number of medications are available to reduce pain and cramping. High-fiber medications may also be helpful. Complications such as obstructions, abscesses, and fistulas are sometimes treated with antibiotics. The antibiotics kill the bacteria that produce these complications. If antibiotics are unsuccessful, surgery may be necessary. The purpose of surgery is to remove an obstruction or abscess or to repair a fistula. In the most severe cases, a portion of the intestine may have to be removed.
Theoretical Cure:
Patients who are not helped by medications or who have the stricturing form of the disease are usually treated by surgery. In most cases the surgeon removes the diseased part of the intestine and reconnects the healthy portions. This procedure may have to be repeated, however, as inflammation may develop in the area of the intestine next to where a diseased portion was removed. Also, acupuncture and guided imagery may be useful tools in treating pain associated with Crohn’s disease. Acupuncture involves the placement of thin needles into the skin at targeted locations on the body known as acupoints in order to harmonize the energy flow within the human body. To treat chronic pain, such as that involved with Crohn’s disease, an acupuncturist frequently places the acupuncture needles along what is known as the large intestine meridian. Guided imagery involves creating a visual mental image of one’s pain in one’s mind. Once the pain can be visualized, the patient can adjust the image to make it more pleasing and, thus, more manageable. Other related alternative therapies include relaxation exercises, yoga, and biofeedback. Not only this but there always is the theoretical option of genetic engineering in which we would have to take the infected gene, in this case IL23R, and replace it with one fully functioning and capable to carry out its duty. Thus, this gene will properly provide instructions for making the protein called the interleukin 23 receptor and might possibly end the inflammation in the smaller intestines.