Crohn’s Disease By Stephen Boulton

1. Crohn’s Disease By Stephen Boulton

2. Key Terms • Fistulas-Abnormal openings from then intestines to skin or other organs • Gastrointestinal Tract(GI tract)- It’s a big tube that begins at the mouth and ends at the anus • Ulcerative Colitis- A similar disease that affects the colon. Together with Crohn’s disease it is known as IBD (inflammatory bowel disease) • Ileum-final section of the small intestines • Abscesses-localized collection of pus in any part of the body that is surrounded by swelling

5. Definition • It is defined as a chronic disease in which the bowel becomes inflamed leading to scarring and narrowing of the intestines. • Cell lining of the bowel/small intestines becomes inflamed leading to erosion of tissues and bleeding • Can affect any part of the GI tact including the mouth (not common). Most common in the ileum. • Believed by some to be an autoimmune disease ( a disease that occurs because the body attacks itself. • Other names include… (terminal/regional) ileitus, enteritis, and granulomatous

7. History • Identified in 1932 by Burill B. Crohn • Thought to have been around longer, but mistaken for something else • The number of cases have doubled in the past 30 years • It wasn’t talked about long ago because of the disgusting symptoms

8. Cause • There is no known cause for Crohn’s disease • It is a mutation of a gene on chromosome 16 that increases the chances of getting this. • Is thought to be a problem with the immune system, caused by a foreign organism, in which white blood cells target all things in the intestines mistaking them for being foreign. They build up and eventually cause inflammation. • Some believe that it is due to toxin releasing bacteria from the gut. • It is thought to be linked genetically (It is common between brothers and sisters)20% have an infected close relative • Stress and nutritional factors have been linked to flare ups.

10. Who Gets Affected • 30 000 Americans diagnosed yearly • 1 to 3 people in 1000 develop disease • Begins to appear in late teens and young adults • 90% develop disease by age 40 • Jews are more common to get the disease • Women are more common to the disease also • More common in caucasians than other races • Left handed people are twice as likely to get it • Occurs more so in temperature climates that tropical ones. Also, it occurs in developed countries like North America and Europe and is very uncommon in Asia.

11. Effects • Cell lining of the bowel/small intestines becomes inflamed leading to erosion of tissues and bleeding • When inflamed intestine heals, it can become scarred near areas that were previously inflamed. • This leads to a narrowing of the bowel or intestines that can cause bowel obstruction (the scar tissue gets in the way of things passing by)

13. Symptoms • Most common symptom is a recurring pain in the lower right abdomen. • Inflammation may spread to joints, skin, eyes, mouth and sometimes liver • Other minor symptoms include: diarrhea, bloody or black tar like stools, nausea, fever, abdomen swelling or tenderness, weight loss, and a lack of energy • 1/3 develop anal abscesses • Some of the more serious symptoms include sores in the anal area, hemorrhoids, fissures, and fistulas • Mouth lesions are also quite common • With children it may stunt growth or delay development

14. Complications • Most common complication is the blockage of the intestines • Many people later develop enteric arthritis • Can be associated with a variety of other medical problems including skin conditions, kidney stones, cancer and gall stones. • May also cause sores or ulcers that tunnel through surrounding tissues such as the bladder, vagina or skin. • Nutritional complications are also common because you cannot extract all the proper stuff. (protein, calories and vitamins are deficient)

15. Diagnosis • It is difficult to diagnose because symptoms are similar to other bowel problems. • First, the medical history of the family should be taken to find out if there are other members with like symptoms. If there are it is more likely to be Crohn’s disease • X-rays are taken to show development of abscesses and fistulas. They make the person either take a barium enema or drink a barium sulfate suspension and then take the X-ray • Other methods include colonoscopies, endoscopies, ultrasounds, CAT scans, MRIs and Leukocyte (white blood cells) scans

17. Treatment • Medicine can reduce symptoms but the disease cannot be cured. • In 1/3 of the cases the disease just goes away over time • ½ the people with this disease will need corrective surgery • Abdominal pains are usually associated with eating. Patients have to go on a special diet consisting of high calorie, high protein foods. • Emotional issues such as stress can cause flare ups too, so stress reducing techniques can help. • Corticosteroids such as prednisone are used to reduce inflammation and induce remission. They’re quite effective but have many negative side effects

18. Treatment cont. • Aminosalicylates (drugs that suppress the immune system) are used in moderate cases as they are consistantly effective with few side effects • Antibiotics are used for people who have fistulas or are recovering from surgery. • Immunosuppressive drugs are used to block inflammation and are also quite effective against fistulas • Surgery (resection) they remove pieces of the intestine that are badly scarred and then sew you back up. This usually very effective at first, there is a chance of it returning elsewhere. • Strictureplasty is another procedure in which they widen the intestines to free it up from blockage.

19. Future Outlook • Genetic engineering allows researchers to study aspects of the reaction so they can develop new more effective therapies. • Drug researchers are looking for steroids that inactivate after acting to reduce side effects • They’re no looking into small bowel transplants • Laparoscopic surgery (Many small incisions instead of one big one) is also being looked into for surgery procedures.

20. References ______. (2001). Treatment Options for Crohn’s Disease. Retrieved March 31, 2007 from < www.mayoclinic.org/crohns/treatment.html >. ______. (2002). Crohn’s Diease. Magill’s Medical Guide (Vol. 1, pp. 532-534). Pasadena: Salem Press inc. ______. (2003). Crohn’s Disease. Diseases (Vol. 2, pp. 116-118). Danbury: Grolier Educational. Carter, John M. (Ed). (1989). The New Good Housekeeping Family Health and Medical Guide. New York: Hearst Books. _______. (February 2006). Crohn’s Disease. Retrieved March 30, 2007 from < www.digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm >. Hunter, J. O. (2004). Crohn’s Disease. Retrieved March 30, 2007 from < www.crohns.org.uk >. Saibil, Fred. (1996). Crohn’s Disease & Ulcerative Colitis. Toronto: Key Porter Books.