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Living with Crohn’s Disease
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Disclaimer
The advice contained in this material might not be suitable for
everyone. The author provided the information only as a broad
overview by a lay person about an important subject. The author
used information from sources believed to be reliable and from his
own personal experience, but he neither implies nor intends any
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About the Author
Lois Fordham is the pen-name of a person whose life has been
affected by Crohn’s Disease.
She has enjoyed writing fiction with some success for several years
and never thought of writing non-fiction.
But she found that people who had this condition or whose
immediate families included sufferers were often unable to discuss
their situation or get answers to common questions about the
disease.
Lois hopes that her ebook, though only an informed lay-person’s
opinion, will help people that have or care for those with Crohn’s
Disease.
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TABLE OF CONTENTS
Please Read This First ........................................................................ 2
About the Author ................................................................................. 4
TABLE OF CONTENTS........................................................................ 5
Crohn’s Disease - An Overview ......................................................... 8
What is Crohn’s Disease? ................................................................ 11
What Happens with Inflammation of The Bowels? ............................................ 11
Who Named Crohn's Disease?......................................................... 14
What Causes Crohn's Disease?....................................................... 15
Signs and Symptoms of Crohn’s Disease....................................... 17
Signs and Symptoms of Crohn’s Disease .......................................................... 17
Who Gets Crohn’s Disease? ............................................................ 20
Common Complications of Crohn's Disease .................................. 21
Common Crohn’s Disease Complications.......................................................... 21
Types of Crohn’s Disease................................................................. 24
Crohn’s Disease in Children............................................................. 26
Treatments for Crohn’s Disease in Children ...................................................... 28
Crohn’s Disease in the Elderly......................................................... 29
Crohn’s Disease and Women ........................................................... 30
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Effect of Crohn’s Disease on Reproductive Abilities of Women...................... 30
How is Crohn’s Disease Diagnosed? .............................................. 32
What to Expect During Testing for Crohn’s Disease...................... 36
How is Crohn’s Disease Treated?.................................................... 38
Surgery for Crohn's Disease ............................................................ 44
Medication for Crohn's Disease ....................................................... 48
Cure Research for Crohn's Disease ................................................ 52
Complementary and Alternative Treatments for Crohn’s Disease 54
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Living with Crohn's Disease............................................................. 56
Diet and Nutrition for Crohn's Disease............................................ 58
Nutritional Requirements of Crohn’s Disease.................................................... 58
Important Foods That You Should Include......................................................... 59
Essential Dietary Tips for Crohn’s Disease Patients......................................... 60
Travel Tips for People with Crohn's Disease .................................. 63
Emotional Factors and Coping with Crohn's Disease.................... 66
Coping with Stress and Emotional Factors ........................................................ 66
Simple Treatments and Lifestyle Changes ..................................... 69
Management of Crohn’s Disease ..................................................... 72
Support Groups for Crohn's Disease .............................................. 74
Crohn’s Disease FAQ........................................................................ 75
Glossary of Crohn's Disease Medical Terms .................................. 78
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Part-I: Introduction
Crohn’s Disease - An Overview
Crohn’s disease is an inflammation of the
gastrointestinal tract.
It is a type of bowel disease, although it
can erupt anywhere between the mouth
and the anus. Crohn’s disease affects the
digestive system of the body. However,
most incidences of the disease manifest
in the lower part of the small intestine or
the early part of the large intestine.
There can be perfectly normal parts of
the bowel between severely affected parts.
Crohn’s disease normally affects people between the ages of fifteen
and thirty years with some instances among people in their sixties
and seventies. It does not affect young children.
This disease affects around 400,000 and 600,000 people in North
America. Estimates suggest that around 27 to 48 people in every
100,000 are affected by Crohn’s disease in Northern Europe. The
incidence of Crohn’s disease is higher in women than in men. This is
not an infectious disease.
Crohn’s disease gets its name from an American gastroenterologist
surgeon, Burrill Bernard Crohn. Crohn, with two of his colleagues,
described the disease in 1932. Together, they explained the
presence of the disease in specific patients with inflammation of
terminal ileum. A Polish surgeon, Antoni Lesniowski, had also
described the disease as early as 1904.
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There is no specific cause of Crohn’s disease. It could have a genetic
cause. Siblings and relatives of people with Crohn’s disease have a
higher than average chance of suffering from the disease at some
time.
Most gastroenterologists are of the opinion that Crohn’s disease
could be due to overreaction of the body’s immune system to any
specific virus or bacteria. Once you develop Crohn’s disease, it
becomes your lifelong companion, although with periods of
remission.
Doctors hint at various environmental factors and dietary habits that
could be the main cause for Crohn’s disease. Smoking is an inherent
risk factor. Other than that, foods rich in sugar, fats, and refined
products could cause this disease. High intake of shellfish with low
intake of fruits, potassium, water, magnesium and vitamin C-rich
products could encourage Crohn’s disease. Regular intake of oral
contraceptives might also be a factor with this disease.
Common symptoms of Crohn’s disease includes abdominal pain,
diarrhea, weight loss, loss of appetite, rectal bleeding and, in some
cases, fever.
Additionally, it causes mouth ulcers, eye inflammation, joint pains,
and inflammation or ulcer-like eruptions on the skin.
In severe cases, Crohn’s disease could cause inflammation of
neighboring body parts like the other bowels, vagina or bladder. It
could also cause infections of the urinary tract. Sometimes, it
causes bowel cancer.
Crohn’s disease could also cause osteoporosis, arthritis, and a
thinning of bones leading to bone fractures.
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Perianal discomfort with itchiness and inflammation around the anus
is common. Fecal incontinence with twenty to thirty bouts of fecal
discharge, sometimes even in the middle of night, is common with
Crohn’s disease. Teenagers developing this disease could exhibit
retarded growth.
Symptoms of Crohn’s disease are very similar to those of ulcerative
colitis. Both diseases cause inflammation of the bowels. However, a
clear distinction in the diagnosis of the disease is essential to decide
a definite pattern of treatment.
Doctors can diagnose the presence of Crohn’s disease after studies
of various tests. These tests include blood tests, stool tests, X-rays,
gastroscopy, colonoscopy, CT, ultrasound, and MRI scans.
There is no single cure for Crohn’s disease. You can take drugs or
medications, undergo surgery, and follow a specific dietary routine
to combat the disease. All medications and surgeries can only
reduce the effects of this disease. Nothing can completely clear your
system of Crohn’s disease at this time.
However, it is possible to live a full life with Crohn’s disease. It does
not cripple you in any way. You can continue with the normal
routines of your life. You only need to follow a strict diet regimen
and take regular medications. There can be flare-ups of Crohn’s
disease. Since these are most unpredictable, it is best to stay within
reach of medical help.
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Part-II: Understanding Crohn’s Disease
What is Crohn’s Disease?
Crohn’s disease is a specific disorder of the digestive tract. It
affects the gastrointestinal tract. Although Crohn’s disease can
affect any part of the intestine, it mostly affects the ileum or the
lower part of the small intestine. Inflammation causes swelling of
the ileum which, in turn, causes immense pain and discomfort.
You feel increasing intensity and frequency to empty your
intestines. This causes a diarrhea-like situation. This disease is the
same as enteritis or ileitis.
Inflammation of the bowel can occur at any age. However, this
mostly starts in the teens and extends into adulthood. Crohn’s
disease can lead to various other diseases like colon cancer,
arthritis, kidney stones, gallstones and skin ailments like eruptions
and eczemas.
What Happens with Inflammation of The Bowels?
Crohn’s disease can affect any part of the bowel, although it
primarily affects the lower part of the small intestine and the upper
part of the large intestine. Inflammation causes the formation of
various muscular layers in-between.
Additionally, this inflammation causes swelling of the mesentery, a
fan-shaped tissue containing lymph glands and intestinal blood
vessels. The mesentery connects the small intestine to the back
abdominal wall. It may cause total dysfunction of the intestinal
tract.
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Inflammation of the intestine causes redness and swelling of the
small intestine. It also disrupts functioning of the small intestine
immensely. The disease may not affect the entire small intestine.
There could be some good patches. Other parts of the intestine
could appear as pits. These pits are Crohn’s disease. It has caused
tissues to shed in this region.
Inflammation can also occur at the mouth, stomach, or esophagus.
The affected areas are regional enteritis while normal areas are skip
areas.
Effects of Crohn’s Disease
Crohn’s disease symptoms keep coming and going. There are
periods of intense symptoms while sometimes you may not feel any
symptoms at all.
There is no permanent cure for Crohn’s disease at this time.
The disease causes irritation of the inner walls of the intestine. This,
in turn, causes cracks, ulcers and fissures. Inflammation could also
cause formation of abscesses.
In between attacks, the intestine tries to rebuild tissues damaged
due to the disease. Such healing could be in the form of a new
lining. Sometimes during the healing process, the intestine is unable
to distinguish between the inside and outside of different parts of
the intestine. This could lead to the formation of lining across ulcer
edges. This is called a fistula. This causes an irregular connection
between different parts of the intestine. This could lead to further
complications.
Crohn’s disease is primarily due to inappropriate reactions of the
immune system. The body’s immune system mistakes the bacteria
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for foreign substances and turns hostile towards them. Therefore,
white blood cells attack the intestine walls and causes chronic
inflammation. This causes bowel dysfunction, inflammation and all
the misery associated with Crohn’s disease.
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Who Named Crohn's Disease?
Crohn’s disease is an inflammatory disease of the small intestine.
The disease started as a disease of the terminal ileum. The very first
reported case of the disease dates from the time of Giovanni
Battista Morgagni, between 1682 and 1771. The patient died due to
severe colic pains. The next reported cases of this colon disease
were by John Berg in Stockholm in 1898 and by Antoni Lesniowsky
from Warsaw in 1904. Again, in 1913, Scottish physician T. Kennedy
Dalziel, reported thickening of the patients’ small intestine in around
nine cases.
Subsequently, American clinician and pathologist Eli Moschowitz and
A. O. Wilensky of the Mount Sinai Hospital published a work,
“Nonspecific granulomata of the intestine”, in 1923. This paper
discussed thickening of the distal ileum. On May 13, 1932, Burrill
Bernard Crohn, Gordon Oppenheimer, and Leon Ginzburg gave a
lecture on, “Terminal ileitis: A new clinical entity” at a meeting of
the American Medical Association in New Orleans. This discussion
reported fourteen cases of inflammation of the distal ileum.
However, since all patients were alive, the name was changed to
“Regional ileitis - a pathologic and clinical entity”. Publication of this
article in a medical journal caused widespread attention. Although
Oppenheimer and Ginsburg were more experienced, Crohn’s name
appeared first on the publication due to alphabetical reasons.
Therefore, the name of the disease also stayed as Crohn’s disease.
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What Causes Crohn's Disease?
There is no specific and proven cause for Crohn’s disease. There
are several theories indicating possible causes of Crohn’s disease.
The most popular among them is adverse reactions by the body's
immune system. Your body's immune system consists of various
body cells containing various proteins. These cells help fight off
infections and harmful elements from your body.
Scientists claim that your body’s immune system for some unknown
reason recognizes bacteria, food, and similar substances in your
intestine and digestive system as foreign. It therefore attacks these
foreign particles. Such attacks cause white blood cells to form a
lining on the intestine walls. This leads to chronic inflammation and
resultant bleeding, ruptures, and ulcers. These injure your bowels
extensively.
Some scientists claim such functioning of immune system as the
result of Crohn’s disease within your system. Therefore, there is no
clear evidence if your immune system is the cause or result of
Crohn’s disease.
Nevertheless, the majority of scientists are of the opinion that such
mysterious functioning of your body's immune system causes
Crohn’s disease in your intestines.
In normal and healthy intestines, there are specific bacteria, enteric
microflora. There are around a billion and a trillion such bacteria in
every gram of intestinal content. These help digestion and prevent
abnormal bacteria coming in through water and food to invade the
intestines.
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If by any chance abnormal bacteria thrive within your intestines,
your immune system does not attack them at once. Instead, it has
a certain level of tolerance. However, such tolerance level is absent
in persons affected by Crohn’s disease. Therefore, it causes
inflammatory damage to intestinal cells.
Other Factors
Among other possible factors for the cause of Crohn’s disease are
environmental factors and the genetic history of the patient. In
many cases, genetic build-up could be the cause for Crohn’s
disease.
Of course, there is no simple relation for this disease to pass on to
offspring from parents. Yet, the disease could manifest in families.
This is especially true in cases of intermarriage between close
relations. As for instance, Crohn’s disease has a high-level of
incidence in Jewish families of Eastern Europe.
There are disputes regarding inheritance of Crohn’s disease. In
more than eighty percent of people having Crohn’s disease, there is
no incidence of any of their close relatives having any ulcerative
colitis or similar disease.
Crohn’s disease is common and prevalent among the industrialized
sections of society in western countries. Therefore, scientists are of
the view that specific environmental factors and features coupled
with diet patterns of such societies could be behind the occurrence
of this disease in large numbers among members of the society.
Your body's immune system produces a protein, anti-tumor necrosis
factor. This could cause inflammation as present in Crohn’s disease.
Yet, there is no clear evidence to prove this fact.
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Signs and Symptoms of Crohn’s Disease
Crohn’s disease affects more than a million Americans. There are
various signs and symptoms of this disease. Different people report
different symptoms. Nevertheless, the most common symptom is
loose bowel movements with blood.
Signs and Symptoms of Crohn’s Disease
Abdominal pain: Most suffer from severe abdominal pain,
specifically in the lower right area. This is the position of the ileum
within your intestine. Many confuse Crohn’s disease for appendicitis
in the initial days due to such pain. Pain could range from severe to
unbearable. It could be a steady pain or occur after meals.
Sometimes, it could start while eating. Pain could occur in bouts
while doing physical exercises like jogging.
Diarrhea: Diarrhea could range from mild loose motions to severe
and uncontrollable loose motions. Sometimes, fecal discharge could
have blood or mucus with it. Sometimes, it could be a tendency to
go to toilet but without passing anything. However, if your Crohn’s
disease is concentrated only in the small intestine, you may not
suffer from diarrhea.
Weight Loss and Malnutrition: If Crohn’s disease affects the
major part of your intestines, your body cannot absorb any
nutrients from your food intake. This causes sudden and huge
weight loss. In children, it manifests as malnutrition. This is due to
the absence of essential vitamins and nutrients. It also causes
stunted growth and delayed development of body tissues and
mental health.
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Ulcers: This refers to the raw lining of the gut that causes bleeding.
Ruptures on intestinal walls could cause ulcers. It is also common to
develop mouth ulcers with Crohn’s disease. This causes passing of
blood with stools.
Fatigue: Insufficient nutrition and lack of proper absorption of food causes a lethargic and tired feeling. You lose your appetite overtime
and at times develop irritable moods. All such factors together could
cause a fever.
Anal fissures: These are cracks around your anus. These cause
pain and lot of discomfort. Sometimes small tag like skin or small
skin lumps could appear around the anus.
Anemia: Loss of a lot of blood over a period of time could lead to
anemia. Loss of blood is due to excessive flow of blood with stools.
Inflammation of Joints: Severe pain in the joints of hands, knees,
ankles, wrists, elbows, and legs could be a precursor of Crohn’s
disease. Pain could seem to be shifting from one joint to another.
This could be with inflammation and reddening of the eyes and in
some cases of the liver. Although there is no specific reason for
occurrence of such a symptom, there are various reported cases of
prevalence of such symptoms with people affected by Crohn’s
disease.
Fever: Fever could sometimes be a slight increase in body
temperature. In some other cases, it could manifest as a high rise in
body temperature due to a flare-up. It could be a daytime fever or
occur at night causing sleep disturbances and night sweats.
Swelling: Some people experience a swelling in the lower right part
of the abdomen. This swelling is of the size of a small grapefruit.
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Sometimes it is firm while at other times it is soft. Softness
indicates its presence in the small intestine while firmness indicates
its presence in the large intestine, enlarged lymph glands, and
surrounding tissue.
Constipation: This is among the rare symptoms of Crohn’s disease.
Obstructions in the intestinal passage restrict thorough clearance of
waste materials from your body. This leads to build up of such
materials. It then causes nausea, pain, vomiting, and constipation.
Intestinal Hole: This is rare. This is due to increased thickness of
the intestinal wall. This causes a hole to form on the outer wall of
the intestine. This is very dangerous as outside bacteria could enter
through this hole and cause severe infections, some of which could
be life threatening.
Symptoms of Crohn’s diseases range from mild to severe. They
could occur in isolation or in bouts. You enjoy perfect health in
between bouts.
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Who Gets Crohn’s Disease?
Crohn’s disease is a common ailment among Americans. Normally,
it affects people between the ages of fifteen and thirty-five.
Additionally, it can affect people over the age of seventy.
Ten percent of the total people affected by Crohn’s disease are
under the age of eighteen. It can affect males and females alike,
although there is a higher incidence among females.
Crohn’s disease affects ethnic groups more than other people.
American Jews of European descents have a higher incidence of the
disease. It can affect people of any race although some specific
ethnic groups like Jews, whites, and blacks of European descent
report more cases than Hispanics and Asians.
Crohn’s disease is predominant among people of the developed
world. Similarly, it affects urban people more than rural people.
People living in northern climates report more cases of Crohn’s
disease than people living in the southern climates do.
In some cases, family members develop Crohn’s disease. Normally,
around twenty percent of people with Crohn’s disease have family
members having the same disease. Genes do play a part in this
disease, although there is no supportive evidence. Most patients
with Crohn’s disease have a close relation suffering from the disease
or similar form of ulcerative colitis.
You cannot exactly predict which family member would contract the
disease. Contraction of the disease is high in the teenage years and
it develops further in the early twenties and thirties.
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Common Complications of Crohn's Disease
People suffering from Crohn’s disease over a prolonged period
develop various complications. Crohn’s disease primarily affects the
intestine. Therefore, most complications arise in this area.
Common Crohn’s Disease Complications
Strictures: These are blockages in the intestine. Crohn’s disease
causes inflammation of intestines. This results in swelling of parts of
the intestine with formation of scar tissue along the intestinal walls.
This swelling interrupts smooth movement of food and waste
materials through the intestines. This results in severe abdominal
pain and instances of throwing up.
Fistulas: Inflammation causes formation of channels between
different parts of the bowel. These are fistulas. Such fistulas can
exist between different parts of the bowel or between the intestine
and any other organ. It could form a connection between the
intestine and the bladder or between the skin surface and
intestines. This is most common around the anus. It could also form
tunnels around surrounding organs like the vagina, rectum, bladder,
and others causing serious infections in these organs. Bowel
contents could pass to other organs and thereby cause infection and
other related complications and diseases.
Abscesses: These develop as fallout of fistulas formation.
Sometimes fistulas around the anus could develop pockets
containing pus. These are abscesses. These cause immense pain
and discomfort around the anus. They could also lead to serious
infections.
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Perforation: Deep swelling in the bowel often causes formation of
a small hole in the intestine. This is a perforation. Food and bowel
contents leak out through such perforations causing serious
infections. Perforations require immediate treatment. Otherwise, it
could turn fatal.
Fissures: These are deep cuts in the soft skin around the anus.
These affect bowel movements extensively and cause deep pain
disallowing free bowel movements. These are open wounds and
therefore cause infection through bowel contents. These are difficult
to heal. Similar fissures include formation of external skin tags and
hemorrhoids. These cause immense irritation. Frequent bowel
movements also increase incidences of bleeding with bowel
movements.
Malnutrition: Chronic inflammation of the intestine causes loss of
appetite, nausea, and fatigue. These conditions accumulate as
severe malnutrition, as you are unable to eat and digest properly.
Inflammation in the intestines restricts thorough absorption of
vitamins through the intestine. This causes extensive weight loss
due to high nutritional deficiency.
Anemia: Lack of sufficient nutrition could cause anemia. In
children, this complication manifests as retarded growth, excessive
and unexplained weight loss, and consequent poor physical health.
Inflammation of joints: Crohn’s disease could cause serious
arthritis complications with inflammation of joints of legs, elbows,
knees, ankles, wrists, and arms. It could cause inflammation of the
eyes with various eruptions of pus on the skin surface. Sometimes,
it could also cause inflammation of the spine, bile ducts, and pelvic
joints.
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Osteoporosis: Osteoporosis is another important complication
arising from Crohn’s disease. This condition causes severe
brittleness of bones and you become very susceptible to bone
fractures. People with Crohn’s disease should undergo regular tests
for osteoporosis.
Cancer: People with Crohn’s disease have a higher chance of
developing colon cancer. Cancer can develop in the intestines as
bowel cancer. This is due to various strictures and fistulas in the
colon area causing disruptions with easy bowel movements. These
also increase the chances of infection through improper absorption
of food and lack of thorough discharge of waste materials.
Other complications due to Crohn’s disease could be kidney stones,
gallstones, and various diseases of the liver and biliary system.
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Types of Crohn’s Disease
Crohn’s disease affects your intestines. There are five different
types of Crohn’s disease according to the part of intestine affected
by the disease.
Gastro duodenal Crohn’s Disease: The affected part is the
stomach and start of the small intestine popular as duodenum.
Often, Crohn’s disease here is misinterpreted as an ulcer. Correct
diagnosis could be possible only after the disease spreads into the
lower parts of the small intestine. Common symptoms of this
disease include nausea, stomach pain, vomiting, loss of appetite,
and therefore excessive weight loss.
Jejunoileitis: This is Crohn’s disease of the larger part of the small intestine, jejunum, lying between the ileum and duodenum. Your
body absorbs maximum nutrients in the jejunum area. Crohn’s
disease in this area could cause fistulas. Such fistulas could form a
connection with other organs like the bladder and cause infections in
associated organs. Symptoms of Jejunoileitis include diarrhea, mild
to intense abdominal pain with cramps after meals, and malnutrition
due to insufficient absorption of nutrients.
Ileitis: Ileum is the longest and last part of the small intestine,
Crohn’s disease affecting this part of the intestine is Ileitis. Crohn’s disease here could cause fistulas due to serious inflammation. These
cause severe pain the lower right part of abdomen with serious
cramps. Insufficient and irregular absorption of nutrients could
cause tingling of toes. Folate deficiency could cause anemia due to
irregular development of red blood cells.
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Ileocolitis: This is the most common type of Crohn’s disease. It
affects the lowest part of the small intestine, ileum, and the large
intestine, colon. Since the ileum continues into the colon, Crohn’s
disease also affects the ileocecal valve. Symptoms include severe
pain in the abdomen area, anemic conditions, and diarrhea.
Crohn's Colitis (Granulomatous Colitis): This is Crohn’s disease
affecting the colon. This type of Crohn’s disease may not affect the
rectum. It causes inflammation in various parts of the colon.
Common symptoms include rectal bleeding, diarrhea, fistulas,
abscess, ulcers, and irritation around the anus. Joint pains and skin
lesions also result due to this type of Crohn’s disease.
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Crohn’s Disease in Children
Crohn’s disease affects children and teenagers. Normally, this
disease is common among people of ages from fourteen to thirty-
five. Yet, young children could also suffer from this disease. Crohn’s
disease could occur with a gap of a few years or months. However,
Crohn’s disease in children is non-contagious.
Crohn's Disease Symptoms in Children
In the early stages of Crohn’s disease in children, most symptoms
go unnoticed.
Children may exhibit any or a combination of these symptoms:
Pain in the abdominal region, sometimes causing:
• abdominal cramps
• abdominal swelling
• anemia
• incessant diarrhea
• loss of appetite
• sudden constipation with difficulty in passing gas
• unexplained and constant fever
• pain and redness in joints
• inflammation of eyes
• rectal bleeding
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• rashes and openings on skin surface for no apparent
reason
Effects of Crohn’s Disease in Children
Childhood is the growing period for children. This period requires
special care and attention to ensure a healthy life.
Crohn’s disease can cause:
Growth Retardation: Children with Crohn’s disease could project a
slow growth. Lack of sufficient nutrition slows the growing process.
Such children may not grow to the required height or develop
proper weight. You can monitor this deficiency by recording your
child’s height and weight every six or twelve months. You can then
compare it with a growth chart that shows national average growth
rates of children of the same age. Growth retardation could also
translate into late onset of puberty.
Emotional Issues: Crohn’s disease causes severe changes in the
normal routines of children. It prevents them from doing and taking
part in normal childhood and adolescent activities. This segregates
them from the normal crowd. Parents, teachers, relatives, and
doctors should provide extensive sensitive support and help them
overcome their health shortcomings.
Dietary Patterns: Children with Crohn’s disease should follow strict
diets to manage and overcome this disease. Crohn’s disease over
many long years could cause serious damage and ruptures to your
child’s colon. Restrict its effects by adhering to a proper diet plan.
Supplement diet with nightly feeds of liquid diet. Children could use
small feeding tubes and slip them through the nose to the stomach.
This helps them feed while they are asleep.
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Treatments for Crohn’s Disease in Children
Crohn’s disease in children is similar to that in adults. The major
concern is that it restricts normal growth. Ideal treatments include
use of strong drugs like steroids. Nevertheless, such drugs should
be according to their body weight. This will prevent any adverse
effects of steroids on normal growth patterns. Surgery to reduce
inflammation is also another treatment option for Crohn’s disease in
children. However, it is better to use this treatment option as a last
resort.
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Crohn’s Disease in the Elderly
Although Crohn’s disease is primarily a disease affecting the young
population, it does affect the elderly. Recent cases of Crohn’s
disease indicate its prevalence among people in their sixties and
seventies. Often, diagnosis of Crohn’s disease in the elderly poses
certain problems. Symptoms of the disease are similar to other
common ailments of the elderly like diverticulosis, eschemic colitis,
and colon cancer. This could delay diagnosis of Crohn’s disease in
the elderly.
Treatment options available for Crohn’s disease in the elderly are
the same as those available for younger patients. However, elderly
people are usually unable to tolerate the required doses of
medications. They therefore have to have reduced doses of
medications.
Further, elderly people with Crohn’s disease may already be on
medications for other ailments. Therefore, they need to consult their
health-care providers to assess possible medicine reactions. This
can prevent any unnecessary flare-ups of adverse reactions
between different medical treatments. Flare-ups can also be due to
stress, cigarettes, or food.
Crohn’s disease requires extensive regulation of diets. This could
pose problems with the elderly, as they may have to limit salt and
sugar intakes to combat other ailments. However, Crohn’s disease is
not fatal. Most patients respond positively to available treatment.
You can live full lives with Crohn’s disease even if you are in the
elderly group.
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Crohn’s Disease and Women
Crohn’s disease affects men and women alike. Symptoms and
preconditions of this disease could prove very difficult for women at
times. Excessive diarrhea and rectal bleeding could be very painful.
Further, Crohn’s disease affects normal reproductive functioning of
women and causes disruptions in menstruation, reproduction, and
other areas.
Effect of Crohn’s Disease on Reproductive Abilities of
Women
Menstruation: Crohn’s disease causes severe disruptions in the
normal body mechanism. It causes inflammation, swelling, pain,
and malnutrition. Therefore, Crohn’s disease also affects your
menstrual cycles. The disease could be very severe before or after
menstrual periods.
Sexual Intercourse: Sexual intercourse could cause excessive
pain around the vaginal area in women with Crohn’s disease. This
could be due to formation of fistulas. Fistulas are small channels
connecting intestines to different adjacent organs. Formation of
such fistulas could cause serious infections with abscesses. Availing
early medical treatment is essential to prevent any serious cases of
infections through fistulas.
Pregnancy: If you are a Crohn’s disease patient, you should
consider your health conditions before trying to conceive. Crohn’s
disease causes restrictions in diet and sometimes leads to serious
malnutrition and dehydration. These factors could affect your
pregnancy.
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However, women with Crohn’s disease can conceive and give birth.
There are many cases of women with this disease having full term
pregnancies and delivering perfect babies. Children may not get the
disease from their mothers. Sometimes, children do get Crohn’s
disease from their mothers. These children show retarded growth
and development in later years.
If Crohn’s disease causes flare-ups and necessitates surgical
treatment, it could prove dangerous to undergo surgery while you
are pregnant. It could cause complications for your baby. Besides,
most medications for Crohn’s disease are unsuitable for intake by
pregnant women. They could cause problems for lactating mothers.
Crohn’s disease causes anemic conditions in your body due to
inflammation. These restrict growth of the fetus. Such women face
higher chances of premature delivery or stillbirth. You need to
consult a gastroenterologist and obstetrician right from the time you
conceive to have a full and perfect term and smooth delivery.
A gastroenterologist could suggest special diets with relevant
minerals and vitamins that prove beneficial for your health and that
of your baby. Nevertheless, since every pregnancy is unique, if you
suffer problems with one, it does not mean you will suffer similar
problems in future pregnancies.
Osteoporosis
Women have a higher incidence of osteoporosis than men do.
Further, women with Crohn’s disease could develop this ailment
early in life. This is due to insufficient absorption of calcium through
their intestines. Osteoporosis could also occur as the result of
prolonged steroid treatment for Crohn’s disease.
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Part-III: Treatment of Crohn’s Disease
How is Crohn’s Disease Diagnosed?
Doctors conduct various tests to diagnose the presence of Crohn’s
disease. There is no single test, which can determine the disease
immediately. It is a series of pathological tests, radiological tests,
and biopsies. Further, symptoms of Crohn’s disease are very similar
to those of various other diseases. Therefore, correct diagnosis
could take some time. Doctors suspect the presence of Crohn’s
disease in patients with diarrhea, and a high fever coupled with
abdominal pain and tenderness.
Blood Tests
Blood tests indicating high white blood cell count indicate
inflammation of any kind in the body. Further, blood tests also
indicate if you are anemic or lack essential nutrients due to
malabsorption of nutrients. It can bring out vitamin deficiencies like
those of B12 or even show blood loss due to passing of blood with
stools. This test can detect bleeding within the intestines. A low
presence of minerals and blood cells indicate excessive discharge of
these essential nutrients through diarrhea.
Stool Samples
Stool samples can indicate the presence of blood and help identify if
any infectious agent is the cause behind continued diarrhea. Certain
digestive disorders could have similar symptoms as that of Crohn’s
disease. Examination of stool samples can indicate the presence of
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bacteria like parasites and Clostridium difficile. This helps in easy
diagnosis.
Endoscopy
This involves passing or insertion of a tiny fiber-optic camera fitted
to a flexible tube through the rectum into the colon. This allows the
doctor to examine the intestine lining thoroughly for any signs of
inflammation and ulceration. Doctors look at a magnified image on a
television screen.
Endoscopy can the detect presence of small intestinal bumps,
strictures that obstruct digestive tract, and fistulas forming channels
within the intestines or with other organs. Endoscope can bring out
a tiny sample of your intestine for thorough examination under a
microscope. This can detect the presence of immune cells in your
intestine. This is a biopsy.
Endoscopy consists of various procedures within itself. These tests
are according to the part of the colon examined. Other endoscopic
tests include Colonoscopy, Sigmoidoscopy, ERCP, Endoscopic
Ultrasound, and Capsule Endoscopy. These endoscopic examinations
take between five to twenty minutes only. There is no need for any
sedation for all tests. Some of them can be done at a doctor’s clinic
itself.
Colonoscopy examines the entire large intestine and sometimes a
small part of the small intestine. Colonoscopy requires a mild
sedative state. This is conscious anesthesia. Doctors induce certain
sedative and pain medications before starting such tests. It could
take around thirty minutes to complete the test. This test is
normally done in a hospital only.
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Sigmoidoscopy examines the lower portion of the large intestine.
This is the sigmoid colon. Normally, sigmoidoscopy tests do not
cause any discomfort. However, if you are already experiencing
serious complications, these tests can add to your woes. It could be
painful for some time.
ERCP is Endoscopic retrograde cholangiopancreatography. This
examines the pancreatic duct and bile ducts and liver. Endoscopic
ultrasound uses an endoscope with attached ultrasound probe to
collect images of the gut. This can detect the presence of fistulas as
present in Crohn’s disease. Capsule Endoscopy requires you to
swallow capsules and a camera produces images of your intestine.
Barium X-rays
Before starting with such x-rays, you need to drink a chalky solution
of barium. Otherwise, doctors administer a barium enema through
your rectum. Barium is a white agent that helps light up your
intestine for clear x-rays. It helps in bringing out clearer details on
your x-rays. X-rays can determine the extent of Crohn’s disease in
your intestines. Barium acts like a dye for x-rays. Plain x-rays
cannot show light tissues clearly. A clear view of the bowel lining is
essential for correct diagnosis. Plain x-rays can only detect
blockages in your intestines.
White Blood Cell Scan
This test detects accumulation of white blood cells within intestinal
inflammation. Inflammation is a common symptom of Crohn’s
disease.
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CT scan
This test takes different x-rays of your intestine from different
angles to form images of your intestine and other internal organs.
Doctors use these tests to diagnose the presence of Crohn’s
disease.
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What to Expect During
Testing for Crohn’s Disease
Doctors prescribe and conduct different laboratory tests and
imaging procedures to diagnose Crohn’s disease. Laboratory tests
consist of blood and stool tests. Imaging procedures consist of X-
rays and endoscopies. X-rays project a picture while endoscopies
offer magnified pictures of the inside of your intestine. This helps
doctors detect the presence of inflammation, strictures, or fistulas
that could indicate the presence of Crohn’s disease.
Sigmoidoscopy: This requires insertion of a fiber-optic tube with a
camera lens through the anus, rectum, and into the colon. This
process causes discomfort and pain to most patients. The procedure
lasts between five and twenty minutes and can be done at a
doctor’s clinic. Doctors prescribe a couple of premixed enemas two
hours before sigmoidoscopy. This cleanses the sigmoid colon and
rectum of any stool.
Colonoscopy: Although similar to a sigmoidoscopy, a colonoscopy
allows the doctor to get images of the colon up to the end of the
ileum. This procedure takes around half an hour and you are under
conscious anesthesia with sedative and pain medications.
Colonoscopy should be performed in a hospital or endoscopy clinic
only. As it takes quite some time for sedative to wean off, it is best
stay away from work to overcome associated drowsiness.
Barium Enema: Barium acts like a dye and allows clear viewing of
soft bowel tissue. This helps in thorough bowel examination to
diagnose Crohn’s disease. Doctors prescribe a few laxative
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treatments around twelve hours before barium tests and
colonoscopy. This helps in purging the colon thoroughly. You can
take only clear fluids in the twelve hours before the tests. You
should stay away from milk or any other food products.
Blood cells also help in diagnosing the presence of Crohn’s disease.
Increased count of white blood cells and increased ESR rate point
add towards Crohn’s disease. ESR shows the rate at which blood
separates into its components of red blood cells, plasma, and
others. Low count of red blood cells indicates anemia, chronic
illness, or excessive internal bleeding. These factors indicate the
presence of Crohn’s disease.
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How is Crohn’s Disease Treated?
Crohn’s disease is a lifelong disease. Patients with this disease can
lead normal lives, attend work, raise families, and live like ordinary
beings. At times of extreme flare-ups, you need appropriate
treatment. In times of remission, you can be completely free of all
symptoms. Nevertheless, these are temporary sojourns.
Need for Treatment of Crohn’s Disease
Crohn’s disease does not have any permanent cure. All treatments
aim to reduce pain, inflammation, diarrhea, and other common
symptoms of Crohn’s disease. Treatment options are not the same
for every patient of Crohn’s disease. It all depends on the location of
the disease within your intestine and the severity.
Some patients develop extreme complications right at the start,
immediately after diagnosis of Crohn’s disease. Some others are
able to sustain and do not suffer unbearable pain or discomfort.
Problems are mild and bearable. Therefore, treatments options
differ accordingly. Again, treatment could reduce effects of the
disease substantially. However, it could come as a flare-up in some
other part of your intestine soon. Such changing patterns of Crohn’s
disease makes it difficult to ascertain the actual benefit received
through the treatment.
Treatment Options of Crohn’s Disease
Treatment goals of Crohn’s disease center on controlling
inflammation and relieving chronic symptoms like abdominal pain,
rectal bleeding, and diarrhea. They also aim at correcting nutritional
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deficiencies and providing overall relief. Treatments can at the most
reduce chances of recurrence. They do not cure your Crohn’s
disease ailment.
It is never possible to know when a remission could occur. You
could remain free of any symptoms for many long years. This does
not mean it was the success of any specific treatment. Patients with
Crohn’s disease should visit their doctor regularly and follow medical
advice strictly.
Drug Therapy
Anti-inflammatory drugs like Mesalamine and Sulfasalazine can
control inflammation effectively. Sulfasalazine consists of sulfa
antibiotics and salicylic acid. As the intestine does not absorb this
drug thoroughly, it stays within your intestine. The salicylic acid
content fights intestinal inflammation. If you are unable to tolerate
these, doctors prescribe other Mesalamine drugs like Dipentum,
Asacol, or Pentasa. Common side effects of these drugs include
headache, nausea, vomiting, diarrhea, and heartburn.
Steroid or Cortisone drugs like Prednisone could prove effective in
serious cases. This can cause extensive side effects with becoming
infection-prone. Crohn’s disease is primarily due to your immune
system reacting against you. Immune system suppressors like
azathioprine and 6-mercaptopurine can reduce the effects of your
immune system. Sometimes, these medications help with better
effectiveness of cortisone drugs. Common side effects include
vomiting, nausea, and diarrhea. Steroids are very strong drugs and
can cause extensive weakening of bones and increase susceptibility
to infections.
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Taking corticosteroids as a treatment option is a gamble between
effective treatment and strong side effects. An efficient combination
of immunosuppressive drugs and corticosteroids can bring concerted
relief. Additionally, it can also help you control and lower the dosage
of corticosteroids over a period of time. Rather, immunosuppressive
drugs reduce the effectiveness of corticosteroids.
Infliximab is a new drug to control inflammation. This anti-body
blocks tumor necrosis factor. This factor is primarily responsible for
Crohn’s disease. The first dosage of Infliximab is in a series of three
injections. Later dosages include giving it every eight weeks. The
U.S. Food and Drug Administration have specifically approved this
drug for treatment of Crohn’s disease.
Patients using Infliximab can reduce their intake of steroid
medications and need for surgery. However, you cannot use this
medicine for long periods. It can predispose you to serious
infections. Currently, there is extensive research going on to study
the ill effects of this drug so that you can harness the maximum
benefits.
Antibiotics like sulfonamide, ampicillin, metronidazole,