Crohn’s Disease

Crohn’s Disease is an illness that affects a person’s bowels. It is a kind of disease in which inflammation happens to large parts of the intestine. This could start from the mouth, throat, go down to the stomach, and reach the rectum and anus. But the most common form of this disease affects the lower parts of the small intestines and large intestines. The small intestine is where most of the nutrients from food are absorbed into the body. The large intestine is where the remaining parts of our food are stored and become the feces.

The inflammation brings about swelling, pain, poor digestion and abnormal bowel movements. This illness can become very painful and cripple the patient’s daily living. The patient will not be able to carry out normal activities. Many times this can lead to emotional stress and depression. Sometimes, it can bring about life-threatening complications.

Possible causes of Crohn’s Disease:

The cause of this disease is still not fully understood. In the past, diet and stress were thought to be the chief causes. But recent studies reveal these two factors can only worsen the disease, but may not really cause it. Recent studies point to an abnormal immune system could be responsible. Other researchers say that heredity or genes could be another possible cause.

3. Malfunctioning Immune system:
   The immune system is normally triggered to fight off infectious microbes like bacteria and viruses. But sometimes, the immune system can behave abnormally and attack the normal, healthy cells of the digestive organs instead.
4. Hereditary:
   Crohn’s disease is more common among people who have family relatives with the disease. So genetics can be a strong reason for this disease to happen to a person.
5. Microbes in the intestinal gut:
   New studies indicate that the kind of bacteria living in our intestines have a great influence on our health. If there is a greater number of bad bacteria, it will be easier for our bodies to have sicknesses like Crohn’s.

There is now more understanding about how Crohn’s disease happens, but much is still complicated and unknown. Studies suggest many factors and connections between heredity, the immune system, and the kinds of microbes living in our bowel which gives rise to it.

The type and severity of the disease also depend on how all of these react to the environment. This means that each patient develops a unique set of symptoms of the disease.  The symptoms of one patient could be quite different from those of other patients. This further means that treatment will be most successful if it is tailor-made or customized to the condition of the patient.

How does it happen?

Crohn’s is a type of inflammation that happens in our intestinal guts. The condition can spread into the deeper layers. It can even go through the whole thickness of the infected parts of the bowels. In serious cases, the inflammation penetrates the bowel walls and spread to other organs “touching” the affected areas. This causes adhesions, or the touching surfaces of the walls begin to stick to one another. The inflammation can also puncture the affected bowels. This allows the contents of the bowel to leak outside to other parts of the bowel or to other organs. An infection can happen and develop into an abscess (which appears like a big pimple with pus inside). This is seriously life-threatening if the abscess gets punctured or breaks apart.

B. The symptoms of the disease.

A person suffering from Crohn’s often have the following symptoms:

Pain:
The level of pain depends on the location of the inflammation and how severe the condition is. Most commonly, the pain will be felt at the lower-right side of the abdomen. When the inflammation had already leaked through the bowel walls, the inflammation will spread to other organs. And it is expected to be very painful in these sever cases.

Ulcers in the gut:
Ulcers are raw areas in the gut wall that the inflammation had “eaten” through. These may or may not bleed. If they do bleed, the patient might notice blood in their stools. Old ulcers many times form a “dried” scab from blood and secretions. These ulcers will not bleed.

Mouth ulcers:
These are common symptoms.

Diarrhea:
This symptom could be mild to severe (when the person needs to be hospitalized). Sometimes there may be mucus, blood, or pus. The patient may get the urge to go but find nothing comes out.

Fatigue:
Individuals often feel extremely tired. Fever is also possible during fatigue.

Poor appetite:
If the digestive system is badly affected, then the appetite will suffer.

Weight loss:
A loss of appetite after a long time will result in this.

Anemia:
Severe ulcers can lead to a loss of blood and then to anemia.

Rectal bleeding and anal fissures:
The skin of the anus becomes cracked, leading to pain and bleeding.

Other possible symptoms:
arthritis, uveitis (eye inflammation), skin rash and inflammation

C. Diagnosis

There are other diseases that affect our bowels. These may have symptoms which are similar to Crohn’s Disease. So during your appointment, the doctor may have to run some tests. These are aside from the physical examination and interview usually done to determine the disease.

As an example, Crohn’s Disease and ‘ulcerative colitis’ are both infectious inflammations of the bowels. Ulcers can also be caused by both diseases. However, there are differences between the two:

• Crohn’s can typically happen in many parts of the intestines, while ulcerative colitis mostly happens in the colon and rectum (parts of the bowel where the stool feces are kept before our toilet routine).
• Ulcers caused by Cronhs’ commonly appear in between healthy areas. Ulcerative colitis affects the colon and rectum in a wide, continuous pattern.
• Crohn’s can affect even the deeper layers and penetrate the bowel walls. Ulcers due to ulcerative colitis look shallower. These only appear at the top layer of the large intestine.

The following are the usual lab tests that a doctor needs to confirm this disease:

1. Blood examination:
   Your blood will be taken to examine for signs of anemia or a low number of red blood cells. Ulcers in the gut cause the blood to leak. The more severe, the greater the blood loss. The blood is also tested to check for signs of infection. This is done by counting the number of white blood cells. A count which beyond a certain standard number means an infection is happening.
2. Fecal occult blood test:
   This is another test which helps to find out the presence of ulcers. The feces or stool sample is examined to check for signs of blood- a possible sign for the presence of ulcers. Blood leaking from ulcers will find its way into the stool. If the blood looks fresh (bright red) it means it was not digested by the intestine. This means, the ulcer could be present in the colon and rectum, where digestion does not take place any longer. If the blood seen looks digested (very dark red or brown), then the ulcer could be present in the part of the bowels where the blood was digested.Remember that ‘ulcerative colitis’ only happens in the colon and rectum. So the presence of digested blood in the stool could eliminate the possibility of this illness.
3. Colonoscopy:
   This procedure uses a thin, flexible tube with a very small camera at one end. The other end has an eyepiece to view the images caught by the camera. It is usually attached to a computer or viewing screen. This test allows the direct viewing of the illness and its effects on the bowel organs. So it is most advantageous for positively confirming the identity of the disease.
4. Computerized tomography (CT) scan:
   This is a procedure which is more well known as “CAT scan.” It uses x-rays controlled by a computer. The computer makes it possible to take a series of precise x-ray shots of the target organ. The result is a view in sections of an organ like a loaf of bread. This enables the doctor to view the affected areas in a very good detail for a more accurate diagnosis.

D. Treatment

The principle behind the treatment of the disease

There is no known specific treatment which can cure Crohn’s disease. The disease has a complicated origin and research is still not advanced enough. The conventional overall strategy is just to manage symptoms so these do not worsen. This will also allow the patient to have a normal life as much as possible.

The following are drugs usually prescribed by a doctor for this disease:

Anti-inflammatory drugs are often the first line to tackle the disease. These are used to lessen the inflammation and pain felt by the patient.

• Oral 5-aminosalicylates. These are anti-inflammatory drug related to the common aspirin used but have been specifically used to fight inflammation caused by an abnormal immune system. These kinds of drugs include sulfasalazine (brand name Azulfidine), and mesalamine (sold under brand names like Asacol HD and Delzicol). Oral 5-aminosalicylates have been commonly used. But many doctors now prefer using other medications due to the limited effectiveness against bowel inflammation.
• Corticosteroids – These are anti-inflammatory drugs made from steroids. Corticosteroids such as prednisone and budesonide (brand name  Entocort EC) can be effective to help reduce inflammation in many parts of the body. But with Crohn’s disease, many patients do not experience relief. Doctors generally use them only as an option if other drugs do not cause improvement. Corticosteroids have to be used for short-term (three to four months) to try and improve the
  symptoms of the disease. This is because this group of drugs cause their own side effects for patients. For increased effectiveness, corticosteroids have also been used in combination with a drug for immune system suppression.

Drugs which retards the Immune system to prevent inflammation

To bring about inflammation is one of the functions of the immune system. Some inflammation is actually good for the body! A part of the body could be injured from physical or chemical trauma. It could also be due to invading microbes. Inflammation is one of the responses of the body. This will isolate the microbes for example. Inflammation will also increase the blood flow to the affected part. So more blood components like the white blood cells can fight off the microbes. The inflammation will also help to isolate the injury and prevent its spread to other areas. Only after the correct amount of inflammation has happened can the affected body start to heal itself.

However, too much inflammation is not good, seriously bad in extreme cases. This is especially when it lasts for a very long time (weeks to months). This is too much for the body to handle and its function will begin to suffer overall. This is the bad kind of inflammation that happens in diseases like Crohn’s.

So some types of drugs are used to suppress the immune system in order to lessen inflammation.

The doctor will prescribe either one or a combination of this kind of drugs to get the best result possible. This often depends on how the patient’s condition reacts to the medication. Immunosuppressant drugs include:

• Azathioprine (brand names: Azasan, Imuran) and mercaptopurine (Purinethol, Purixan) are the most commonly used medications of this type for treating inflammatory diseases of the bowel. It needs close monitoring by the doctor to watch out for side-effects. These could cause stomach upset and vomiting. The liver and blood could also be affected.
• Infliximab (brand name: Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia).These work by stopping the action of an immune system component called tumor necrosis factor (TNF). This is a kind of protein molecule. Its action leads to inflammation.
• Methotrexate (brand name: Trexall) is a second-option drug for Crohn’s patients who do not respond well to other medications. This could cause side-effects so doctor monitoring is essential for its use.
• Natalizumab (brand name: Tysabri) and vedolizumab (Entyvio). These are highly regulated medications with a high risk to the patient’s condition. These drugs stop certain molecular components of the immune system from attaching to the walls of the intestine. Inflammation is prevented through this action. Use of these drugs needs special authorization because it could badly affect the brain. So these are also medications of last resort.
• Ustekinumab (Stelara)

Drugs to fight off microbial infection

Antibiotics are used to fight off the increase in bad microbes in the bowels. The increase in the number of bad microbes results in an increase in toxins. The toxins will damage the intestines. This results in inflammation of the intestines and symptoms like diarrhea and pain in the abdomen.

If the treatment is successful, it can reduce the population of bad bacteria. Antibiotics can also reverse the damage to the tissues and help heal fistulas and abscesses. But using antibiotics for a long time can also kill off the good bacteria. This results in an imbalance causing symptoms like diarrhea.

Commonly used antibiotics have names like ciprofloxacin (brand name: Cipro) and metronidazole (brand name: Flagyl). These drugs could fight off many kinds of bacteria and microbial parasites.

Drugs to lessen diarrhea or manage bowel movements

Examples of fiber supplements are psyllium powder and methylcellulose (Citrucel). These help to reduce diarrhea by adding bulk fiber in order to draw in water. Drugs like loperamide (Imodium A-D) could be more effective for more severe diarrhea. This drug controls bowel movements in order to prevent diarrhea.

Vitamin and mineral supplements

Crohn’s primarily affects the digestive system. So in the long run, this will reduce the body’s ability to absorb and retain nutrients efficiently. Deficiencies in nutrients will happen. It is important that vitamin and mineral supplements be a part of treatment.

Bleeding in the bowels due to Crohn’s can lead to heavy blood loss and anemia. Supplementing the diet with the mineral iron can help to recover the amount of blood to a normal level. Body levels of other nutrients vitamin B-12, vitamin D, and calcium can also be affected by this disease. Crohn’s disease can make the bones brittle so adding a supplement for these nutrients can help prevent this.

Nutrition Therapy

This is a way to help the digestive system to rest and recover from the effects of Crohn’s disease while supplementing the body with the nutrients it needs. One way is through parenteral nutrition. This is simply feeding the nutrients through a solution delivered into the blood through tubes and needles into the vein. This is called intravenous or IV fluid therapy. The supplements are added into the fluids and slowly drip into the veins.

Surgical Procedures

This is the most extreme measure to take when all other conventional methods fail. Surgery aims to remove the affected parts of the bowels and stitch the remaining healthy areas together. Oftentimes, the condition of the patient has already deteriorated at this point. This could even stack the odds against the recovery of the patient. Surgery is invasive since the body will be cut open. It puts a lot of stress on the body. This reduces the chances of the body to heal and recover. The patient’s condition is already very compromised by the illness. Surgery should be as the very last resort and best avoided as much as possible.