Crohn's disease, also known as regional ileitis or enteritis, is a chronic inflammatory condition of the intestines. Although the disease usually develops at the end of the small intestine (called the ileum) or in the colon, it can affect any part of the digestive tract, from the mouth to the anus.
The condition begins slowly, causing such symptoms as crampy abdominal pain, fever, diarrhea, weight loss, and a chronic feeling of sickness. For unknown reasons, Crohn's disease tends to flare up and then subside, sometimes for months, before another episode occurs.
Over time, the disease can cause abscesses and ulcers to form, which may then deeply erode the intestinal wall. In especially severe cases, further complications--such as fistulas and anal fissures--can develop. Fistulas are abnormal passages between body organs that allow pus and fluids to drain; in Crohn's, fistulas form between loops of intestine, or between the intestine and the skin or the intestine and the bladder.
Rarely, Crohn's-related inflammation and a thickening of the small intestine is so severe that an intestinal obstruction occurs. Such an obstruction, which causes extreme abdominal pain with vomiting, is an emergency that requires immediate medical attention.
About 500,000 Americans--mostly adolescents and young adults--are affected with Crohn's disease. Some people have only one or two attacks in their lifetime, while others suffer from repeated flare-ups.
Currently, there is no specific cure for Crohn's disease, but the condition can be managed with medications and, in some cases, surgery. Lifestyle changes--with a special emphasis on diet--and the use of certain supplements can dramatically improve the course of the disease and the quality of life of people who have been diagnosed with it.
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What Causes Crohn's Disease?
The exact cause of Crohn's disease is a mystery. Heredity may play a role since the condition sometimes runs in families and is more prevalent in certain ethnic groups. Men and women are equally affected. Diet is another possible contributor. In countries where people consume a lot of fiber, Crohn's disease is not nearly as common as it is in Western countries, where diets tend to be high in fat and sugar and low in fiber.
Other theories on what causes Crohn's disease include:Infection. Perhaps the most popular theory is that infection with a virus or bacterium generates ongoing inflammation in the intestines. Autoimmune involvement. Intestinal inflammation appears to get triggered from within, when the body's own immune system turns on itself and attacks the intestines. Many Crohn's sufferers are, in fact, found to have immune system abnormalities. Food allergies. Numerous nutritionally oriented doctors think that food sensitivities (particularly to dairy and gluten) can contribute to the intestinal irritation that ultimately sets Crohn's disease in motion. Stress. It's not uncommon for the initial bout of Crohn's disease to come on the heels of an episode of significant stress, such as the death of a family member. Some doctors, however, point out that there's no proof at all that the disease is caused by emotional distress, and that claiming that it is puts an unfair burden on the patient.
Crohn's disease is one of the two major conditions that cause a chronic inflammation in the intestines. The other major inflammatory bowel disease (IBD) is ulcerative colitis, which primarily affects the lining of the large intestine (colon). Both conditions damage the intestines in their own way and produce their own set of symptoms. The two diseases can be very challenging to distinguish from one another, based on symptoms alone. Fortunately, the medical management of each disease is similar.
In contrast, there is a third extremely common intestinal ailment called irritable bowel syndrome (IBS), which causes cramping and diarrhea but not bleeding or inflammation. Although quite uncomfortable, IBS does not pose a danger to a person's overall health, nor does it lead to either ulcerative colitis or Crohn's disease.
Nutritional issues. Because the small intestine is involved with the absorption of food and nutrients, careful attention to the diet is important for anyone with Crohn's disease because vitamin and mineral deficiencies can develop.
Preliminary findings reported in the February 2001 European Journal of Gastroenterology and Hepatology indicate that a diet designed to minimize soil contaminants and such chemicals as titanium dioxide and aluminosilicates may even lead to the remission of the disease in some patients. More research is needed, however.
Although they recognize that nutrition can be problematic, most conventional physicians do not believe that dietary changes will affect the overall course of Crohn's. They do caution patients to reduce their fiber intake in order to prevent an intestinal blockage if there is X-ray evidence of a significant narrowing of the small intestines.
Surgery is generally reserved for complications of the disease rather than for treating it directly. A bowel obstruction, the formation of a severe fistula, or the perforation of the intestinal wall would merit surgery, for example. Surgical treatments are not very helpful in altering the progression of Crohn's disease, however.
For mild attacks, over-the-counter antidiarrheal medications or pain-relievers may be recommended.
For chronic illness or flare-ups, drugs containing a substance called mesalamine (sulfasalazine and various 5-ASA agents) are often prescribed to help control inflammation.
Corticosteroids are also used to manage inflammation, but studies have shown no benefit in continuing to take them once a remission has occurred. This is because the cost of long-term steroid use, in terms of side effects, can be high. In addition, long-term use of either steroids or sulfasalazine has not been shown to reduce the recurrence rate of Crohn's disease.
Drugs to suppress the immune system, such as azathioprine and mercaptopurine, are prescribed for both acute flare-ups and to prevent recurrences. As an added benefit, these medications can reduce the overall activity of the disease, causing fistulas to close and abscesses to heal, and reducing the need for corticosteroids.
Currently, gastroenterologists generally start patients on sulfasalazine for acute episodes, and move on to steroids if this drug fails. Immunosuppressive drugs are added if the first two are not working; they may then be used as maintenance (allowing the steroids to be reduced or even discontinued) in order to prevent a relapse.
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Treatment and Prevention
While there's no cure for Crohn's disease, there is a lot that you can do to control it. Working with your doctor, you may well find a way to manage the intestinal inflammation, lessen abdominal pain and diarrhea, minimize rectal bleeding, and avoid the nutritional deficiencies caused by such problems. In many cases, people with Crohn's experience months or even years of remission--with no pain or other symptoms.
As a complement to your traditional medical care, there are a number of important things you can do to keep yourself healthy and to minimize the frequency and severity of your flare-ups (See the Self-care Remedies, below). Eliminating foods and beverages that trigger attacks is a good first step. Quitting smoking and reducing the amount of stress in your life can also help.
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How Supplements Can Help
The intestinal damage caused by Crohn's disease can seriously interfere with the body's ability to absorb important nutrients. Therefore, it is essential to maintain a healthy diet, and nutritional supplements often can play a key part.
Just a reminder: If you have a serious medical condition or are taking medication, always check with your doctor before beginning a program of supplements.
To begin, a daily high-potency multivitamin and antioxidant complex help to rectify the many nutritional deficiencies associated with the disease. It's useful to have blood tests measuring specific levels of individual vitamins and separate supplements may be necessary. Nutritional deficiencies can develop in the following:
- Low levels of vitamin A are common with Crohn's. This is important because vitamin A affects the function of intestinal cells, including mucus secretion and cell regeneration. Excessive amounts of this nutrient can be toxic, so it should be used with caution.
Deficiencies in vitamins C and E can occur as well. Both have healing properties; vitamin E, a leukotriene inhibitor, can be helpful as an anti-inflammatory agent as well.
Deficiencies in the B vitamins are also common, although the amounts in your multivitamin are probably sufficient. However, folic acid can be inhibited by the commonly prescribed drug, sulfasalazine. Levels of vitamin B12 can also be low because Crohn's disease often damages that portion of the small intestine where this nutrient is absorbed.
Failure of the intestines to absorb vitamin D occurs frequently, and worsens when steroid drugs are used as part of an anti-inflammatory therapy. Softening of the bones (osteomalacia, often caused by the malabsorption of vitamin D) is a complication of Crohn's.
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Although "curing" this disease is not an option, a number of practitioner-based alternative therapies can help relieve the painful symptoms of Crohn's, and may be useful to continue on a maintenance basis.