Crohn's disease and ulcerative colitis, are referred to as inflammatory bowl disease (IBD) and affect approximately 500,000 to 2 million men and women in the United States.
Definition of Crohn’s diseaseCrohn’s disease, a disease named after the physician who first described it in 1932, is a disease that is closely related to the inflammation of the digestive tract. As ulcerations crohn's disease can affect any area of digestive tract, also called gastrointestinal tract, which is from mouth to anus, but is most common in the lower part of small intestine. The swelling extends deep into the lining of the affected organ and causes pain and can make the intestines empty frequently, resulting in diarrhea.
Crohn’s disease is also called colitis, granulomatous enteritis, regional enteritis, ileitis, or terminal ileitis. Disease has no medical cure and once it begins, it tends to fluctuate between periods of inactivity (remission) and activity (relapse). Crohn’s disease is closely related to irritable bowl movement and ulcerative colitis. Inflammatory bowel disease is a general name for diseases that cause swelling in the intestines.
Who is affected?Only in United Stated 500,000 to 2 million men and women suffer from Crohn's disease. Both, men and women are equally affected and disease seems to run in the family: namely more than 20 percent of patients with Crohn's disease have a blood relative (most often sister, brother, parent) with some form of inflammatory bowel disease, either Crohn's disease, irritable bowl movement or ulcerative colitis.
Statistics show that people of Jewish heritage have an increased risk of developing Crohn’s disease, while African Americans are at decreased risk.
Crohn's disease occurs in all age groups- during childhood to later in life, but most commonly begins during adolescence and early adulthood, which is between the ages of 20 and 30.
Studies showed that the inflammation seen in the gastrointestinal tract of people suffering from Crohn’s disease involves several factors:
- the genes the patient has inherited,
- the immune system itself,
- the environment.
What causes Crohn's disease?There are actually several theories about potential causes of Crohn's disease, but non of them have been proven. The most popular one claims that body's immune system reacts abnormally and mistakes foods and other substances for being foreign, which as defence results as chronic inflammation, which is an important mechanism of defense used by the immune system. The truth is that the cause of Crohn's disease is unknown: it may be bacteria, body's reaction, diet, although it is unlikely that diet is responsible for the disease. As stated above: genes are one of the main factors determining how body responds to bacterial products, which means that individuals prone to mutations in this gene are more susceptible to developing Crohn's disease.
Symptoms of Crohn’s diseaseDisease is not always present, but tends to fluctuate between periods of inactivity (remission) and activity (relapse). However, when disease is active, its most common symptoms are:
- abdominal pain (most often in the lower right area)
- weight loss.
- poor appetite
- rectal bleeding and rectal pain,
- weight loss,
- skin problems.
Up to one third of patients may suffer from following conditions involving anal area:
- swelling of the tissue of the anal sphincter, which is the muscle at the end of the colon that controls defecation.
- development of (long) ulcers within the anal sphincter, which cause bleeding and pain with defecation.
- development of anal fistulae between the anus or rectum and the skin surrounding the anus. As a result mucous and pus may drain from the openings of the fistulae on the skin.
- development of peri-rectal abscesses, which can cause fever, pain and tenderness around the anus.
Crohn's disease treatmentAs said at the beginning of this article, there is no cure for this disease, but treatment can help control the disease by lowering the number of times person experiences disease activity. Some people are free of disease for years and then it appears again. Crohn's disease behaves different in every case.
Thus, the goal of treatment is to control or relieve symptoms, such as inflammation, abdominal pain, diarrhea and rectal bleeding. Treatment of Crohn's disease includes drugs, nutrition supplements, surgery, or a combination of these options.
Drug therapy includes anti-inflammation drugs (drugs containing mesalamine, a substance that helps control inflammation- most commonly used is sulfasalazine; patients that cannot tolerate sulfasalazine are put on other mesalamine-containing drugs, generally known as 5-ASA agents). Mesalamine-containing drugs have potential side effects, that include nausea, vomiting, diarrhea, heartburn and headache. Other drug therapies include cortisone or steroids, drugs that suppress the immune system, antibiotics to treat and control bacterial overgrowth in the small intestine, anti-diarrheal drugs and fluid replacements.
As treatment option doctor may recommend nutritional supplements, which is commonly done for children whose growth has been slowed. On the other hand, specific foods must be avoided: this is not because these foods cause Crohn's disease, but because certain foods (like hot spices, milk products, alcohol, bulky grains) may increase diarrhea, cramping or some other symptoms.
Third treatment option is surgery: actually two-thirds to three-quarters of patents suffering from Crohn's disease require surgery at some point in their lives. This is either because they do not respond to medical therapy or medications cannot control symptoms or because of certain complications. However surgery is not considered to eliminate the disease, which means the disease often recurs after surgery. For that reason surgery is not appropriate for everyone and people faced with decision about surgery should get as much information as possible to weight its benefits and risks compared with other treatments.