SCD Research Section

Crohn's Disease   The following are traditional, common descriptions of Crohn's Disease. You are encouraged to incorporate the SCD into your own regimen and path towards a controlled remission of Crohn's Disease.     From the CCFA and other web sites: What is Crohn's disease? Crohn's Disease (CD) is an inflammatory disease of the gastrointestinal (GI) tract. It affects the ileum (small intestine) and the colon (large intestine) in most cases, but can occur in any section of the GI tract from the mouth to the anus. Areas of inflamed tissue are often separated by areas of normal tissue. The large intestine is inflamed in 65% of the people who have Crohn's disease. The small intestine is inflamed in 35% of people with the disease. Crohn's disease generally occurs in young adults. How does it occur? The cause of Crohn's disease is unknown. In Crohn's disease, the inflammation occurs in all the layers of the small or large intestine as well as nearby tissues and lymph nodes. The sores and swollen areas may thicken and eventually block the intestines. The inflammation can cause holes and sores in the bowel walls. Because the inflammation also affects the outer intestinal walls, the loops of bowel may attach to each other. What are the symptoms? Symptoms of Crohn's disease include: abdominal pain or cramping diarrhea fever fatigue weight loss rectal fistula (abnormal opening at or near the anus) rectal fissure (a painful crack in the mucous membrane of the anus) skin lesions joint pain How is it diagnosed? To diagnose Crohn's disease, your doctor will review your symptoms and examine you. The exam usually includes a sigmoidoscopy or colonoscopy (a procedure in which the doctor uses a scope to look at the inside of your intestine or colon). Often the doctor will take a small piece of bowel tissue for testing. The doctor may also want a sample of your stool (bowel movement) for testing. Other tests may include a blood test and a barium x-ray study to examine the colon and small bowel (particularly the end section of the bowel). Computerized axial tomography (CAT or CT) scanning is a computerized x-ray technique that allows imaging of the entire abdomen and pelvis. It can be especially helpful in detecting abscesses. How is it treated? There is no cure for Crohn's disease. [SCD Editors' note: wake up and check out the SCD] The best treatment is frequent checkups with your doctor to control the disease. The doctor will probably prescribe one or more medications for you to take. If you have diarrhea, avoid certain foods that have a laxative effect, such as raw fruits and vegetables and concentrated fruit juices. You can rest your bowel by not eating solid foods for a while. Drink just clear fluids frequently during the day (electrolyte or rehydrating fluids are best). It is important to drink often so that you do not become dehydrated. When an attack of diarrhea is over, eat small frequent meals. Return to your normal diet gradually. Limit or avoid food additives and stimulants such as caffeine (in coffee, tea, or chocolate). Avoid eating or drinking milk products. Enzyme supplements may help if you develop an intolerance to lactose (a sugar in dairy products). Ask your doctor if you should reduce the amount of roughage in your diet. If you have cramps or abdominal pain, it may help to put a hot water bottle or electric heating pad (set on low) on your abdomen. If your condition is more serious, hospital treatment may include: intravenous feeding (into a vein) to replace lost nutrients and fluids blood transfusions to restore lost blood use of medications such as antibiotics and steroids to reduce inflammation nasogastric suction (through a tube passed through the nose to the stomach) to drain out acidic digestive juices. If the disease is not kept under control you may get sores, tears, or abnormal openings in and around your intestines. In this case you may need surgery. Drug therapy is the front line for treating CD, drug treatments can include one or more of the following: Corticosteroids Antidiarrheal medication 5-ASA agents Immunomodulators Antibiotics Herbal or supplement Monoclonal antibody Surgery Corticosteroids: Prednisone, medrol, methylprednisolone, hydrocortisone have been used since the 1950's for acute flare ups. Patients should take a calcium supplement to prevent osteoporosis. Antidiarrheal: Imodium and Lomotil can help to reduce some symptoms, great care should be used to avoid blockage. 5-ASA: Asacol, Pentasa, Dipentum and Rowasa enema, deliver the 5-aminosalicylate molecule which has anti-inflammatory properties to the intestine wall. 5-ASA is a topical anti-inflammatory. 5-ASA are usually well tolerated. Immunomodulators: Imuran, 6-MP, and Purinethol work by blocking the immune system from causing inflammation, but may take up to six months before being effective. Methotrexate may work quicker, but pregnancy needs to be avoided if either partner has taken methotrexate in the past three months. Antibiotics: Ciprofloxacin (Cipro), metronidazole (Flagyl), are used primarily to fight intestinal infections that can lead to a flare, they are also helpful in healing fistulas. RMAT (Rifabutin and macrolide antibiotic therapy) treatment consists of clarithromycin (Biaxin) and rifabutin (Mycobutin) plus a probiotic (good bacteria). In limited studies the remission rate for RMAT is around 70%. Any antibiotic treatment should be coupled with a good probiotic. Herbal or supplement: Probiotics, Omega 3, and certain herbs have shown promise in the treatment of CD or the relief of the symptoms. Please remember that herbs and supplements act with in your body as drugs. It is important to inform your doctor before attempting any herbal or supplement treatment. Monoclonal antibody: Infliximab (Remicade) an anti-tumor necrosis factor. This antibody blocks the production of tumor necrosis factor-alpha (TNF-alpha). Studies show that TNF-alpha plays a role in inflammation. The long term side effects have not been determined. Surgery: Normally reserved for strictures or blockages. The chances of a recurrence of the disease after surgery is very high. How can I take care of myself? It is important to follow your doctor's instructions. If your symptoms persist or if you develop new symptoms, tell your doctor. In addition, you can: Be aware of the possibility of the symptoms coming back. Otherwise a recurrence may make you feel discouraged, anxious, fearful, or tense. Keep a healthy, positive attitude. Learn to use relaxation techniques such as mental imaging, muscle relaxation exercises, and deep breathing. Talk with a mental health professional about how to manage events in your life that trigger anxiety. Develop a positive support system (family, friends) for talking about the normal stresses of daily life. Follow a balanced, nutritious diet, but avoid raw fruits and vegetables and milk products during a flare-up. Exercise 20 minutes at least three times a week. Get enough rest even if you cannot sleep. Allow time each week for play and recreation. Take the full course of treatment your doctor prescribes. For more information you may also want to write or call: Crohn's and Colitis Foundation of America 444 Park Avenue South New York, New York 10016 Phone: (212) 685-3440   from the HBOC Call Center group:          Crohn's disease involves inflammation in the gastrointestinal tract. Most cases involve the small intestine or the colon. The patient has recurrent flare-ups and remissions. It is almost always a lifelong illness. The cause is unknown. Early signs include chronic diarrhea, abdominal pain, fever, weight loss, and loss of appetite. The first sign for some patients is an "acute abdomen" resembling appendicitis. Usually there is one or more of the following clinical situations: inflammation of intestines, blockage of intestines, bloating and constipation, abnormal intestinal connections, or anal fissure or abscess. There may be problems outside of the intestinal tract. These include arthritis, kidney stones, malabsorption, or inflammation of the spinal vertebrae. There is no cure for Crohn's disease. Treatments work to control the disease and relieve symptoms. People receive anti-inflammatory drugs, such as steroids or drugs that suppress the immune system. Patients should eat a well-balanced diet. Unless there is an obstruction, people benefit from supplemental fiber. During extreme flare-ups, the person may require intravenous feeding. Over half of all people with Crohn's disease eventually need at least one surgical procedure. Removal or bypass of the affected section of the intestine often results in relief for 5 to 15 years. With proper medical and surgical treatment, most people are able to cope with Crohn's disease and lead productive lives.