Crohn

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Crohns 101The Basics
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Topics Discussed

• What is it?
• Who gets it?
• Symptoms
• Nutrition
• Treatment

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What is it?
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Definition

• Crohns disease is a chronic disorder that causes
  inflammation of the digestive or gastrointestinal
  tract. Most commonly it affects the small
  intestine and/or colon, but can affect any part
  of the GI tract from the mouth to the anus.
• It is one of the two main classifications of
  inflammatory bowel disease (IBD).

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A picture of the digestive tract, from mouth to
anus.

• Picture from Crohns Health Center found at
• http//www.healthcentral.com/chronic-pain/crohns/i
  ntroduction.html

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A picture of the small and large intestine that
is inflammed with Crohns.

• Picture from Crohns Health Center found at
• http//www.healthcentral.com/chronic-pain/crohns/i
  ntroduction.html

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History

• The disease is named after Dr. Burrill B. Crohn.
  
• In 1932 Dr. Crohn along with Dr. Ginzburg and Dr.
  Oppenheimer published a paper describing the
  features of what is now known as Crohns Disease.

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Who gets it?
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Statistics

• Crohns disease runs in families.
• 20 of people with Crohns disease have a
  sibling, parent or child with some form of IBD.
• Men and women are at equal risk
• People of European heritage are more likely to
  develop the disease.

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What causes it

• Scientists believe that a combination of factors
  cause people to develop Crohns.
• Genes a person inherits.
• The immune system.
• Environmental agent.
• Scientists believe that an outside agent
  (antigen) triggers the bodys immune system to
  produce an inflammation to fight off the agent.
  Once the defenses are turned on they cannot turn
  off properly.

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Diagnosis

• A doctor utilizes a combination of factors.
• Personal history
• Physical exam
• Symptoms and overall health
• Laboratory tests, x-rays, and endoscopy will
  probably be ordered. During the endoscopy the
  doctor may take a biopsy as well.
• Stool samples may be asked for to determine if
  blood is present.

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Symptoms
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Types (Most common)

• Persistent diarrhea (loose, watery, and frequent)
• Abdominal pain and cramping
• Fever and rectal bleeding at times
• Loss of appetite and subsequent weight loss
• Fatigue
• Children with Crohns may suffer delayed
  development and stunted growth.
• Most first appear between the ages of 15 and 30.
• All symptoms may range from mild to severe.
• Patients may also go through periods of flae ups
  and remission.

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Complications

• May cause blockage of the intestine.
• Ulcers in the affected area and surrounding
  tissues such as the bladder or skin.
• Development of fissures which area small cuts or
  tears in the anal canal.
• Abscess, a localized infection.
• Fistulas may form abnormal tunnels between two
  structures of the body.
• Nutritional complications deficiencies of
  proteins, calories, and vitamins.
• Others include arthritis, skin problems,
  inflammation in the eyes or mouth, kidney stones,
  gallstones, or other diseases of the liver.

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Nutrition
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Haves

• Good nutrition with a balanced, healthy diet is
  recommended.
• Should increase the daily caloric intake.
• Eat smaller meals with more frequent intervals.
• Increase amount of fluid intake to 70 ounces per
  day.
• Liquid supplements may be prescribed for easier
  absorption (especially vitamin b-12 and D).
• Low fiber diet is normally recommended.

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Have nots

• There is no definite foods that need to be cut
  out. If something is eaten that causes an
  increase in their symptoms this food should
  probably be avoided in the future. These foods
  are labeled as food intolerances.
• Foods that may cause an increase in symptoms are
• Greasy or fried foods
• Butter, margarine, and cream sauces
• Alcohol
• High fiber foods nuts, seeds, corn, and popcorn
• Caffeine

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Treatment
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Medications

• There are no cures.
• Anti-inflammatory drugs such as sulfasalazine,
  mesalamine, and aminosalicylates (5-ASA).
• Immune system suppressors such as
  corticosteroids.
• Immune modifiers such as azathioprine and 6-MP to
  help heal fistulas or maintain remission.
• Antibiotics like ampicillin and ciprofloxacin.

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Medications (biologic therapies)

• Infliximab (brand name Remicade) is an anti-tumor
  necrosis factor (TNF) drug that removes the
  proteins that cause the inflammation.
• Recommended to patients that do not respond to
  standard therapies
• First treatment approved specifically for Crohns
  disease.
• Adalimumab (brand name Humira) designed for
  patients who were intolerant to infliximab.
• Natalizumab (brand name Tysabri) inhibits types
  of white blood cells that are involved in the
  inflammation.
• Certolizumab pegol (brand name Cimzia) is a
  polyethelyen glycol which delays its excretion
  from the body and is combined with an anti-TNF.

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Surgery

• Becomes necessary when medications cannot control
  symptoms, to correct complications such as a
  blockage, perforation, abscess, bleeding, or
  removal of diseased portions of the intestine.
• This is not a cure and can reoccur in disease
  free portions of the intestine.
• If entire colon is removed in a colectomy the
  ileum is brought to the surface of the skin and a
  stoma (an opening) is made for waste removal into
  a small bag.

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Resources used

• Books
• Banks, P. A., Present, D. H., Steiner-Grossman,
  P. (1983). The Crohn's disease and ulcerative
  colitis fact book. New York Scribner.
• Sklar, J. (2007). Crohn's disease and ulcerative
  colitis An essential guide for the newly
  diagnosed. First year series. New York Marlowe
  and Co.
• Warner, A. S., Barto, A. (2007). 100 questions
  answers about Crohn's disease and ulcerative
  colitis A Lahey Clinic guide. Sudbury, Mass
  Jones and Bartlett.
•  
• Movies
• Films for the Humanities (Firm). (2000).
  Inflammatory bowel disease Coping with Crohn's
  and colitis. Princeton, N.J. Films for the
  Humanities Sciences.
• Golder, J., DiGregorio, R., Yip, M.,
  Verdi-Rose, C. (2008). True guts Struggle
  triumph over Crohn's disease and ulcerative
  colitis. Sherborn, Mass Aquarius Health Care
  Media.
• Lerner, E., Lerner, A. C., Douglas, P., Miles,
  V. (1998). Coping with Crohn's Colitis. Cutting
  edge medical report, 1125. Boca Raton, Fla
  Information Television Network.
•  
• E Books
• European Crohn's and Colitis Organisation.
  (2007). Journal of Crohn's and Colitis.
  Supplements. New York, N. Y. Elsevier Science.
  http//www.sciencedirect.com/science/journal/18739
  954.
• Zonderman, J., Vender, R. (2000). Understanding
  Crohn disease and ulcerative colitis.
  Understanding health and sickness series.
  Jackson, Miss University Press of Mississippi.
•  
• Websites
• Crohns Colitis Foundation of America at
  http//www.ccfa.org/
• National Digestive Diseases Information
  Clearinghouse at http//digestive.niddk.nih.gov/
• Living With Crohns Disease at https//www.livingw
  ithcrohnsdisease.com/livingwithcrohnsdisease/crohn
  s_disease/inside_crohns.html
• HealingWell.com at http//www.healingwell.com/ibd
  /