Crohn’s Disease – Symptoms and Treatment

Crohn’s disease is a chronic inflammatory disease of the digestive tract. The disease is also called granulomatous enteritis, colitis, regional enteritis, regional ileitis, ileitis, or terminal ileitis and it causes ulcerations of the small and large intestine. The disease can affect the digestive system anywhere from the mouth to the anus, but distinctively affects the terminal ileum as well as demarcated areas of large bowel. The disease is named after the American physician, Burrill Bernard Crohn (1884-1983), who described the disease in 1932.

Crohn’s Disease Symptoms

Crohn’s disease symptoms may include:

• Chronic diarrhea & disrupted digestion: It becomes difficult for the patients in the acute phase of the disease to eat and/or digest food.
• Painful and debilitating inflammation
• Fistulas of the colon
• Hemorrhoids
• Lipid absorption problems
• Anemia: Persistent rectal bleeding may lead to anemia.
• Bruising of the shins.
• Fever, pain and psychological damage in many cases
• Crohn’s disease in children may cause delayed development and stunted growth.

Crohn’s Disease Treatment

Crohn’s disease treatment may include medication, surgery, dietary advice and Helminthic therapy (current research).

Medication Treatment

Acute treatment: steroids are used in the initial stages. Long-term steroid therapy is discouraged because of their side effects. Corticosteroids like prednisone are traditionally used medications. The side effects of steroids may include insulin resistance and frank diabetes, hypertension (high blood pressure), glaucoma, osteoporosis, severe psychological issues etc.

Chronic treatment (Steroid-sparing): The treatment may include Salicylates – 5-ASA derivates – 5-aminosalicylic acid compounds such as sulfasalazine (Azulfidine®, Salazopyrin®), mesalamine (Pentasa®, Asacol®), olsalazine, and balsalazide. Immunomodulating drugs such as azathioprine, 6-mercaptopurine and methotrexate are given mainly in moderate-to-severe cases. Infliximab (brand name Remicade®) is given in patients with therapy-resistant or fistulating Crohn’s. Adalimumab (brand name Humira®) has been used in patients who show allergic reaction to infliximab. The drugs like thalidomide are under study trials.

Surgery

In the case of widespread intractable Crohn’s colitis, the colon and rectum (protocolectomy) are removed by the surgery ileostomy. Surgery is generally avoided, as this does not cure the disease. Crohns disease can recur at the site of the anastomosis or ileostomy.

Dietary Advice

Crohn’s patients should avoid the following foods and liquids:

• Dairy foods
• High fiber foods should be avoided during flare-ups.
• Hot spicy foods
• Alcohol & caffeine
• Foods containing saturated fats, found in meat and dairy products. However some fats such as in fish oil may actually be helpful.
• Products containing corn or gluten, those made from wheat, oats, barley, or triticale
• Foods, such as soy, eggs, peanuts and tomatoes
• Gas-producing foods such as cabbage family vegetables (broccoli, cabbage, cauliflower and brussels sprouts), dried peas and lentils, onions and chives, peppers and carbonated drinks
• Foods that may irritate the intestine (particularly the cabbage family vegetables)
• Simple sugars
• Dried fruits or high-sugar fruits, such as grapes, watermelon, or pineapple
• Sorbitol (an artificial sweetener)

Beneficial Foods:

• Fluids to keep the body hydrated and prevent constipation
• Fruits may be protective
• A high protein diet with lean meats

Advice:

• Eat small frequent meals
• Prebiotics such as psyllium may help in the healing process.
• Probiotics may also be helpful in aiding recovery of the intestines.

Helminthic Therapy

Recent studies have come up with a promising Crohn’s disease and ulcerative colitis treatment. Helminthic therapy is a new treatment that has shown impressive results in clinical trials. It argues that the absence of intestinal worms (due primarily to higher hygiene standards) from the human intestinal tract may cause the immune system that is not evolutionary adapted to this condition, to over-react causing inflammation and other negative effects, and that reintroducing helminths through ingesting eggs of a certain species (which is not dangerous to humans) can help down regulate and normalize immune responses.

Helminthic therapy like the fecal bacterio therapy induces a characteristic TH2 white cell response in the diseased areas which seems to be the key in achieving and maintaining remission, and may prove to be of key significance in further research.