Crohn

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Crohns Disease By Stephen Boulton
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Key Terms

• Fistulas-Abnormal openings from then intestines
  to skin or other organs
• Gastrointestinal Tract(GI tract)- Its a big tube
  that begins at the mouth and ends at the anus
• Ulcerative Colitis- A similar disease that
  affects the colon. Together with Crohns disease
  it is known as IBD (inflammatory bowel disease)
• Ileum-final section of the small intestines
• Abscesses-localized collection of pus in any part
  of the body that is surrounded by swelling

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Definition

• It is defined as a chronic disease in which the
  bowel becomes inflamed leading to scarring and
  narrowing of the intestines.
• Cell lining of the bowel/small intestines becomes
  inflamed leading to erosion of tissues and
  bleeding
• Can affect any part of the GI tact including the
  mouth (not common). Most common in the ileum.
• Believed by some to be an autoimmune disease ( a
  disease that occurs because the body attacks
  itself.
• Other names include (terminal/regional) ileitus,
  enteritis, and granulomatous

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History

• Identified in 1932 by Burill B. Crohn
• Thought to have been around longer, but mistaken
  for something else
• The number of cases have doubled in the past 30
  years
• It wasnt talked about long ago because of the
  disgusting symptoms

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Cause

• There is no known cause for Crohns disease
• It is a mutation of a gene on chromosome 16 that
  increases the chances of getting this.
• Is thought to be a problem with the immune
  system, caused by a foreign organism, in which
  white blood cells target all things in the
  intestines mistaking them for being foreign.
  They build up and eventually cause inflammation.
• Some believe that it is due to toxin releasing
  bacteria from the gut.
• It is thought to be linked genetically (It is
  common between brothers and sisters)20 have an
  infected close relative
• Stress and nutritional factors have been linked
  to flare ups.

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Who Gets Affected

• 30 000 Americans diagnosed yearly
• 1 to 3 people in 1000 develop disease
• Begins to appear in late teens and young adults
• 90 develop disease by age 40
• Jews are more common to get the disease
• Women are more common to the disease also
• More common in caucasians than other races
• Left handed people are twice as likely to get it
• Occurs more so in temperature climates that
  tropical ones. Also, it occurs in developed
  countries like North America and Europe and is
  very uncommon in Asia.

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Effects

• Cell lining of the bowel/small intestines becomes
  inflamed leading to erosion of tissues and
  bleeding
• When inflamed intestine heals, it can become
  scarred near areas that were previously inflamed.
• This leads to a narrowing of the bowel or
  intestines that can cause bowel obstruction (the
  scar tissue gets in the way of things passing by)

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Symptoms

• Most common symptom is a recurring pain in the
  lower right abdomen.
• Inflammation may spread to joints, skin, eyes,
  mouth and sometimes liver
• Other minor symptoms include diarrhea, bloody or
  black tar like stools, nausea, fever, abdomen
  swelling or tenderness, weight loss, and a lack
  of energy
• 1/3 develop anal abscesses
• Some of the more serious symptoms include sores
  in the anal area, hemorrhoids, fissures, and
  fistulas
• Mouth lesions are also quite common
• With children it may stunt growth or delay
  development

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Complications

• Most common complication is the blockage of the
  intestines
• Many people later develop enteric arthritis
• Can be associated with a variety of other medical
  problems including skin conditions, kidney
  stones, cancer and gall stones.
• May also cause sores or ulcers that tunnel
  through surrounding tissues such as the bladder,
  vagina or skin.
• Nutritional complications are also common because
  you cannot extract all the proper stuff.
  (protein, calories and vitamins are deficient)

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Diagnosis

• It is difficult to diagnose because symptoms are
  similar to other bowel problems.
• First, the medical history of the family should
  be taken to find out if there are other members
  with like symptoms. If there are it is more
  likely to be Crohns disease
• X-rays are taken to show development of abscesses
  and fistulas. They make the person either take a
  barium enema or drink a barium sulfate suspension
  and then take the X-ray
• Other methods include colonoscopies, endoscopies,
  ultrasounds, CAT scans, MRIs and Leukocyte (white
  blood cells) scans

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Treatment

• Medicine can reduce symptoms but the disease
  cannot be cured.
• In 1/3 of the cases the disease just goes away
  over time
• ½ the people with this disease will need
  corrective surgery
• Abdominal pains are usually associated with
  eating. Patients have to go on a special diet
  consisting of high calorie, high protein foods.
• Emotional issues such as stress can cause flare
  ups too, so stress reducing techniques can help.
• Corticosteroids such as prednisone are used to
  reduce inflammation and induce remission.
  Theyre quite effective but have many negative
  side effects

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Treatment cont.

• Aminosalicylates (drugs that suppress the immune
  system) are used in moderate cases as they are
  consistantly effective with few side effects
• Antibiotics are used for people who have fistulas
  or are recovering from surgery.
• Immunosuppressive drugs are used to block
  inflammation and are also quite effective against
  fistulas
• Surgery (resection) they remove pieces of the
  intestine that are badly scarred and then sew you
  back up. This usually very effective at first,
  there is a chance of it returning elsewhere.
• Strictureplasty is another procedure in which
  they widen the intestines to free it up from
  blockage.

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Future Outlook

• Genetic engineering allows researchers to study
  aspects of the reaction so they can develop new
  more effective therapies.
• Drug researchers are looking for steroids that
  inactivate after acting to reduce side effects
• Theyre no looking into small bowel transplants
• Laparoscopic surgery (Many small incisions
  instead of one big one) is also being looked into
  for surgery procedures.

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References

• ______. (2001). Treatment Options for Crohns
  Disease. Retrieved March 31, 2007 from lt
  www.mayoclinic.org/crohns/treatment.html gt.
• ______. (2002). Crohns Diease. Magills
  Medical Guide (Vol. 1, pp. 532-534). Pasadena
  Salem Press inc.
• ______. (2003). Crohns Disease. Diseases (Vol.
  2, pp. 116-118). Danbury Grolier Educational.
• Carter, John M. (Ed). (1989). The New Good
  Housekeeping Family Health and Medical Guide.
  New York Hearst Books.
• _______. (February 2006). Crohns Disease.
  Retrieved March 30, 2007 from
• lt www.digestive.niddk.nih.gov/ddiseases/pubs/
  crohns/index.htm gt.
• Hunter, J. O. (2004). Crohns Disease.
  Retrieved March 30, 2007 from
• lt www.crohns.org.uk gt.
• Saibil, Fred. (1996). Crohns Disease
  Ulcerative Colitis. Toronto Key Porter Books.