Crohn’s Disease Essay, Research Paper

CROHN’S DISEASE

An inflammatory bowel disease is characterized by intermittent and recurrent abdominal pain associated with ulceration in bowel function. Inflammatory bowel disease is a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Most often, inflammatory bowel disease is classified as ulceration colitis or Crohn’s disease but may be referred to as colitis, enteritis, ileitis, or proctitis (Crohn’s disease-website).

Crohn’s disease is characterized by inflammation of segments of the GI tract. The parts of the tract where Crohn’s disease is most often seen are in the terminal ileum, jejunum, and right side of colon. Involvement of the esophagus, stomach, and duodenum is rare. Crohn’s disease is an inflammation that extends into all deep layers of the intestinal wall. Areas of involvement are usually discontinuous, with segments of normal bowel occurring between diseased portions. Thickening of the bowel wall occurs, as well as narrowing of the lumen. Narrowing of the lumen is caused by scar tissue from inflammation and this may cause strictures and obstruction. Fistulas are a cardinal feature and may develop between segments of bowel. Typically ulcerations are deep and longitudinal and penetrate between pieces of inflamed edematous mucosa, causing the cobblestone appearance. Persons with Crohn’s disease are hospitalized frequently and often become depressed because of the painful character of the disease (Lewis et al, 1996, p.1231-1232).

Cause

Crohn’s disease is of unknown etiology. Although Crohn’s disease has no known cause, there are many theories about what might cause this disease. One theory is that some agent; perhaps a virus or bacterium affects the body’s immune system to trigger an inflammatory reaction in the intestinal wall. Although there is a lot of evidence that patients with this disease have abnormalities of the immune system, doctors do not know whether the immune system problems are a cause or a result of this disease. Doctors believe however, that there is little proof that Crohn’s disease is caused by emotional distress or by unhappy childhood (Crohn’s disease-website).

Crohn’s disease may occur at any age but occurs most often between the ages of 15 and 40 years. Crohn’s disease tends to run in some families. About 20 percent of people with Crohn’s disease have a blood relative with an inflammatory bowel disease. Crohn’s disease rates appear to run higher in those that smoke. This means an individual who may inherit an inflammatory bowel disease, is more likely to develop Crohn’s disease if they smoke (Satsangi, 1996, p.40). Both sexes are affected with the women as a slightly higher chance. Crohn’s disease occurs more often in Jewish and upper-middle class urban populations (Lewis et al, 1996, p.1231).

Symptoms / Complications

The principal symptoms of Crohn’s disease are diarrhea and abdominal pain. Other symptoms include abdominal cramping and tenderness (often in lower right area), abdominal distention, fever, fatigue, and rectal bleeding. Bleeding may be serious and persistent, leading to a low red blood cell count or anemia. As the disease progresses, malnutrition, dehydration, electrolyte, imbalances, increased peristalsis, and pain around umbilicus may occur. Another symptom to be cautious of is extraintestinal and includes arthritis and finger clubbing. Cutaneous fistulas, common in the perianal area and rectovaginal fistulas also occur. Fistulas also communicating with the urinary track may cause urinary tract infections (Lewis et al, 1996, p.1234).

The most common complication in Crohn’s disease is blockage of the intestine. Blockage occurs because the disease tends to thicken the bowel wall with swelling and fibrous scar tissue, narrowing the passage. Crohn’s disease also can lead to complications that affect the other parts of the body. These systemic complications include various forms of arthritis, skin problems, inflammation in the eyes of mouth, kidney stones, gallstones, or other diseases of the liver and biliary system (Crohn’s disease-website).

Diagnosis

Diagnosis of Crohn’s disease can be made by means of a thorough history and physical examination to establish clinical signs and symptoms. The exam will include blood test to find out if you are anemic as a result of blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process in your body. Also a stool sample will be taken and examined to cite blood loss, or to rule out an infection by a parasite or bacteria causing the symptoms (Crohn’s disease-website). Barium studies are useful in determining location and extent of the disease and may uncover findings, such as stricting of the ileum, cobblestoning of the mucosa, fistulas, and areas of abnormal and normal mucosa. These examinations may include an upper gastrointestinal series, a small bowel, and a barium enema intestinal x-ray. The inflammation or ulceration and other abnormalities in the intestine. The doctor may also use endoscopic studies such as colonoscopy and sigmoidoscopy for diagnosis. By using an endoscope the doctor may look inside your rectum and colon through a flexible tube inserted through the anus. During this exam, the doctor may take a biopsy of tissue from the lining of the colon to look at under a microscope to determine the presence of granulomas (Lewis et al, 1996, p.1234). Computed tomography scans may also be helpful in diagnosing an individual with Crohn’s disease. The image will have increased thickening mostly in the terminal ileum with increased fat around the area. The fat shows up dark on the scan. Also, a Halo effect may be detected and this leads the radiologists to believe that the patients have had Crohn’s for a while. The Halo effect has different rings of wall thickening with fat (Dr. Lynch Radiologist).

Treatment

Several drugs are helpful in controlling Crohn’s disease, but at this time there is no cure. Corticosteroids are used to inhibit the production an action of cytokines and inflammatory mediators, enhance sodium and water absorption, and improve the sense of well being. Corticosteroids may be administered orally, parenterally, or rectally and a daily dose may range from 20-60 mg. Drugs may help abdominal cramps and diarrhea. The drug sulfasalizine often lessens the inflammation, especially in the colon. This drug can be used for as long as needed, and it can be used along with other drugs. Sulfasalizine is not as effective as Corticosteroids for inducing remission in-patients with moderate or severe disease. Side effects such as nausea, vomiting, weight loss, heartburn, diarrhea, and headaches occur in a small percentage of cases. Patients who do not do well on sulfasalazine often do very well on related drugs known as mesalamine or 5-ASA (5- aminosalicylic acid) agents. Mesalamine has been developed to maximize its release at sites of inflammation while limiting its absorption. In the United States, mesalamine is marketed in the form of suppositories and enemas for rectal administration and in oral formulations either with a resin coating that breaks down at a pH of 7 (the approximate pH of the distal ileum and proximal colon) or as a controlled-release preparation encapsulated in ethlcellulose microgranules. A daily dose of up to 4-6 g of sulfasalazine of 4-5 g of mesalamine may be effective. More serious cases may require steroid drugs, antibiotics, or drugs that effect the body’s immune system such as azathioprine per kilogram per day, and 1-1.6mg mercaptopurine per kilogram per day. Both azathioprine and mercaptopurine may cause pancreaitis and bone marrow suppression. The usual goals of therapy are to correct nutritional deficiencies; to control inflammation; and to relieve abdominal pain, diarrhea, and rectal bleeding (Hanauer, 1996, p.341-846).

Crohn’s disease can be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return in areas of the intestine next to the area that has been removed. Many Crohn’s disease patients require surgery, either to relieve chronic symptoms of active disease that does not respond to medical therapy or to perforation, abscess or bleeding. Drainage of abscesses or resection due to blockage is common surgical procedures (Crohn’s disease-website).

In conclusion, Crohn’s disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return. You just need to be aware of the symptoms to treat it as soon as possible for a healthier future.

Bibliography

Crohn’s disease (website). Available HTTP: http://members, aol.com/bospol/homepage/crohns info.htm#c/[1998, March 11].

Hanauer, S. (1996, March). Inflammatory bowel disease. New England Journal of Medicine, 334(13), 841-846.

Lewis, S., Collier, I., & Heitkemper, M. (1996). Crohn’s disease (4). St Louis, MI: Mosby-Year Book.

Satsangi, J. (1996, January). Unifying hypothesis for inflammatory bowel disease and associated colon cancer. Lancet, 347(8993), 40-44.