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Crohn's Disease

painArticle Written by Andrew Weil

What is Crohn’s disease?

Crohn’s disease, sometimes called ileitis, ileocolitis or regional enteritis, is a type of inflammatory bowel disease (IBD). It is a serious condition – chronic inflammation can harm the whole wall of the colon, not just the superficial lining (as in another IBD, ulcerative colitis). Crohn’s disease can involve any part of the digestive tract, including the lower end of the small intestine. Sections of normal healthy bowel may be found between areas of diseased bowel, a presentation known as “skip lesions.”

Who is at risk for Crohn’s?

Crohn’s disease and related conditions seem to run in some families: about 20 percent of patients have a blood relative with some form of inflammatory bowel disease. Men and women are affected equally. Crohn’s disease can occur at any age but is most frequently diagnosed in those between the ages of 20 and 30. People of Ashkenazi Jewish heritage are at greater than normal risk, while African Americans have a decreased risk. Cigarette smoking has been linked to both the development and frequency of flare ups of the disease.

What are the symptoms of Crohn’s disease?

Symptoms of Crohn’s disease include loss of appetite, chronic diarrhea, (which is sometimes bloody) cramping, pain in the abdomen, and weight loss. Stress can worsen symptoms but doesn’t necessarily cause the disease. The disorder can lead to a number of complications, including intestinal blockage. This occurs as a result of the swelling and scar tissue that can thicken the intestinal wall, narrowing the passage. In addition, sores or ulcers can tunnel through the affected area to surrounding tissues including the bladder, vagina, or skin, including the areas around the anus and rectum. These tunnels, called fistulas, can become infected and may require surgery.

Crohn’s disease patients can also develop various nutritional deficiencies due to a less-than-optimal diet, loss of protein via the intestine, or poor absorption (malabsorption) of nutrients. Other possible complications include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and bile systems.

In addition, after several years of extensive inflammation, the large intestine has a greatly increased risk of developing tumorous growths and colon cancer.

What are the causes of Crohn’s disease?

The causes are unknown but the most widely accepted theory holds that the disorder is autoimmune in nature – that is, it occurs when the immune system mistakes bacteria, foods, and other substances in or on the digestive tract as threats to health and responds by attacking the tissues of the colon. This process leads to the chronic inflammation that underlies the disease.

However, rather than being triggered by irritants or allergens, the autoimmune response itself could be the cause, not the result, of the disease. Some evidence suggests that an immune system protein called anti-tumor necrosis factor (TNF), is a primary contributor to the inflammation.

Although we still don’t know for sure exactly what causes Crohn’s disease, a recently discovered gene may point the way to new treatments and perhaps even to a way to prevent the disease from occurring in the first place. The gene is linked to a cellular receptor for interleukin-23 (IL-23), a protein involved in immunity and the inflammatory process. New anti-inflammatory drugs under development may work for Crohn’s disease and for other forms of IBD.

How is Crohn’s disease diagnosed?

At present, there is no laboratory test that can specifically identify the disease, but routine blood tests may reveal anemia, high numbers of white blood cells, and indications of inflammation, such as a high Sed Rate and increased levels of C-reactive protein.

Crohn’s is often suspected in patients with recurring abdominal pain and a family history of the disease, or chronic inflammation of the skin or joints. Colonoscopy is then typically used to confirm the diagnosis, although this can sometimes miss disease that is limited to the end of the small intestine. The definitive test for Crohn’s involves a barium enema, followed by abdominal x-rays that reveal changes in the digestive tract indicative of the disease. Newer tests include CT scan and wireless capsule endoscopy, where a small camera is swallowed and sends images as it passes through the digestive tract.

What is the conventional treatment?

Crohn’s disease can’t be cured, but it can be managed successfully and remain in remission for long periods of time. Even so, the disease tends to recur unpredictably. Treatment goals are to control inflammation, correct nutritional deficiencies, and relieve symptoms. To achieve this, conventional medicine relies on a variety of drugs, nutritional supplements and, when necessary, surgery.

At first, most patients are treated with drugs to control inflammation. The most common of these is Sulfasalazine. If that doesn’t help, other anti-inflammatory drugs in this class (aminosalicylates) are available.

Corticosteroids such as prednisone may be prescribed initially in large doses to get severe symptoms under control. Because these drugs can cause serious side effects, the dosage is lowered as soon as possible. Immunosuppressive agents to block the immune reaction causing the symptoms may also be prescribed, sometimes in combination with corticosteroids. If these drugs don’t help, a newer compound, Infliximab (Remicade) may be used. It is the first medication approved by the FDA specifically for treatment of Crohn’s disease, and for treatment of open and draining fistulas. Antibiotics may be prescribed to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. Anti-diarrheal drugs such as diphenoxylate, loperamide and codeine may be prescribed for patients with diarrhea or abdominal cramping. Nutritional supplements may be recommended, particularly for children whose growth has been affected by the disease.

Up to 75 percent of patients with Crohn’s disease will need surgery at some point when medication can no longer control their symptoms. Surgery may also be needed for such complications as blockages, perforations, abscess, or bleeding in the intestine. Surgery to remove part of the intestine may help but won’t prevent the disease from striking an adjacent area in the intestine. Sometimes, the entire colon must be removed.

What therapies does Dr. Weil recommend for Crohn’s disease?

Initially, patients should see practitioners of traditional Chinese medicine. Their modern approach includes acupuncture and herbal remedies in addition to dietary adjustment and, possibly, massage and energy work, an integrated solution that can yield very good results. Ayurvedic medicine, radical dietary change, and long-term fasting (under supervision) can also be helpful. A high-fiber diet may also provide a benefit, but during the active stages of the illness, it is best to avoid raw fruits, raw vegetables, seeds and nuts because they will irritate the digestive system.

Here are some other measures that can help:

To help address inflammation, follow an anti-inflammatory diet and increase your intake of dietary omega-3 fatty acids by taking supplemental fish oil, start with one gram a day and increase slowly to two to four grams a day. If there is any increase in diarrhea, and cut back the supplement dose if necessary.

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Article Written by Andrew Weil