A Family Doctor's Tale - CROHN DISEASE

DOC I HAVE CROHN'S DISEASE

Crohn's Disease was once thought to occur mainly in Jews but the disease is now increasingly found in Asians as well.

It was thought to be localized in the ileum but have being found to affect the entire lining of the gastrointestinal tract.

One priest I know suffers from it and has very severe abdominal pain, bleeding and diarrhea.

However surgical treatment by resecting the affected part of the intestine has helped to ease his discomfort to a very great extent.


Crohn's Disease (Regional Enteritis) is a chronic inflammatory disease of the gastrointestinal tract which affects the layers of the lining of the whole gastrointestinal tract from mouth to anus.

It was originally called regional ileitis because the ileum was typically affected but has been extended to regional enteritis because the whole layer of the lining of the gastrointestinal tract can be affected from the mouth to anus.



Crohn's Disease is more common in Jews than non-Jews and in whites than non-whites

It occurs equally in men and women and can be found in families.

Crohn's Disease can be found in all ages but are more common in the 20-30 years age group.



The exact cause of Crohn's Disease is not known.

It has been suggested that an autoimmune disease is the main cause of Crohn's Disease.

A protein produced by the immune system, called anti-tumor necrosis factor (TNF) may be a possible cause of the body's reaction in the lining of the gastrointestinal tract resulting in inflammation.

Infectious causes has also been blamed.



Symptoms varies from mild to severe:

1.severe abdominal pain, especially in the right iliac fossa

2.diarrhea

3.Rectal Bleeding

4.fever

5.weight loss

6.loss of appetite

7.joint pain

Signs:

1.Abdominal distension and tenderness
Abdominal mass may be felt in the right iliac fossa

2.Rectal examination may show blood in the stool

3.pallor due to anaemia

4.skin lesions

Diagnosis of Crohn's Disease is made through:

1.A history of abdominal pain , diarrhea and bloody stools

2.The physical exam consists of
a.palpation of the abdomen for tenderness and right iliac fossa mass

b.digital rectal exam to detect blood.

3.stool may be tested for blood

4.blood tests(Hb, WBC, ESR, blood culture) are done for evidence of infection.

5.X-rays of the abdomen, barium meal and barium enema may be done to show evidence of extent of inflammation and narrowing of segment of intestine

6.Colonoscopy is also done to confirm extent of colon involvement.
A biopsy of inflamed lining may be done for microscopic examination.

7.A small camera which can be swallowed and passed out in the faeces can take photos of the entire gastrointestinal tract.



Bowel complications:

1.Strictures of intestine leading to blockage

2.Fistula especially in the rectal region

3.Fissures in the anal region

4.hemorrhage

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.mouth ulcers

4.Skin: eczema

5.Nutrition: malabsorption and vitamin deficiency



Treatment is symptomatic to relieve discomfort, correct nutritional deficiencies, and control inflammation of the gastrointestinal tract.

Medications:

1.Antidiarheal and bulk forming agents

2.Antispasmotic medication for spasm of the colon

3.Anti-inflammation drugs like Sulfasalazine (immunosuppressant) given indefinitely.
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Oral corticosteroids in high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.

5.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

6.Infliximab (Remicade). This drug helps by blocking the body's inflammation response

7.Antibiotics like ampicillin, septrim, flagyl, cephalosporin, tetracycline helps to treat bacterial infections in strictures, fistulas.

8.Correction of anemia and nutritional deficiencies is important to enhance the immune system

9.Replacement of fluids and electrolytes are important in cases of dehydration especially in children.

10.Regular hemoglobin, blood counts and liver function tests

Surgery:

Surgery is required:

1.if medications cannot control the symptoms or progression of the disease
2.to treat complications such as blockage, perforation, abscess, or bleeding in the intestine.

Resection of the inflamed segment of the intestine is removed and may relieve symptoms but is not a cure. There has been instances where recurrence occur in the un-operated segment next to the resected intestine.

In more severe cases a total colectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.



The prognosis depends on the severity of the disease

75 per cent of patients with Crohn's Disease will require surgery sooner or later.

There will temporary relief of symptoms but recurrence are common.

In many cases with proper treatment, patients are able to lead a normal life.

Preventive measures in Crohn's Disease are:


1.A nutritious diet with vitamin supplements can strengthen the body resistance against illness.


2.Certain foods such as spicy food, milk products and alcohol may spark off an attack of abdominal discomfort and diarrhea.


3.Stress can also trigger off episodes of Crohn's disease.