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“Living with Crohn’s Disease” by Lois Fordham

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Please Read This First

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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

guarantee of accuracy. The results you obtain will depend largely on

your own efforts and other factors beyond the knowledge and

control of the author, publisher and distributors. No particular result

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practices are constantly being developed in this area.

The author, publisher and distributors never give legal, accounting,

medical or any other type of professional advice. The reader must

always seek those services from competent professionals that can

“Living with Crohn’s Disease” by Lois Fordham

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apply the latest technical information and review their own

particular circumstances.

The author, publisher and distributors particularly disclaim any

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All pictures used in this book are for illustrative purposes only.

“Living with Crohn’s Disease” by Lois Fordham

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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.

“Living with Crohn’s Disease” by Lois Fordham

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TABLE OF CONTENTS

Please Read This First ........................................................................ 2

Disclaimer................................................................................................................. 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

Effects of Crohn’s Disease ................................................................................... 12

Who Named Crohn's Disease?......................................................... 14

What Causes Crohn's Disease?....................................................... 15

Other Factors ......................................................................................................... 16

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

Crohn's Disease Symptoms in Children ............................................................. 26

Effects of Crohn’s Disease in Children ............................................................... 27

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

Osteoporosis ......................................................................................................... 31

How is Crohn’s Disease Diagnosed? .............................................. 32

Blood Tests ............................................................................................................ 32

Stool Samples .................................................................................................... 32

Endoscopy ............................................................................................................. 33

Barium X-rays ........................................................................................................ 34

White Blood Cell Scan .......................................................................................... 34

CT scan............................................................................................................... 35

What to Expect During Testing for Crohn’s Disease...................... 36

How is Crohn’s Disease Treated?.................................................... 38

Need for Treatment of Crohn’s Disease.............................................................. 38

Treatment Options of Crohn’s Disease............................................................... 38

Drug Therapy ......................................................................................................... 39

Nutrition Supplements .......................................................................................... 41

Surgery ................................................................................................................... 41

Alternative Therapies ............................................................................................ 42

Surgery for Crohn's Disease ............................................................ 44

Surgery and Crohn’s Disease .............................................................................. 44

Partial bowel resection ......................................................................................... 45

Correction of Fistulas ........................................................................................... 46

Strictureplasty ....................................................................................................... 46

Draining of Abscess.............................................................................................. 46

Medication for Crohn's Disease ....................................................... 48

Types of Medication for Crohn’s Disease........................................................... 48

Inflammation Reducing Drugs ............................................................................. 48

Symptom Treating Drugs...................................................................................... 50

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

Diet Patterns of Crohn’s Disease......................................................................... 58

Important Foods That You Should Include......................................................... 59

Foods Better to Avoid ........................................................................................... 59

Essential Dietary Tips for Crohn’s Disease Patients......................................... 60

Specific Carbohydrate Diet................................................................................... 61

Important Constituents of the Diet ...................................................................... 61

Travel Tips for People with Crohn's Disease .................................. 63

Essential Tips .................................................................................................... 63

Emotional Factors and Coping with Crohn's Disease.................... 66

Coping with Stress and Emotional Factors ........................................................ 66

Simple Treatments and Lifestyle Changes ..................................... 69

Small Lifestyle Changes and Cures .................................................................... 69

Diet and Nutrition .............................................................................................. 69

Exercise .............................................................................................................. 69

Special Events ................................................................................................... 70

Relationships and Physical Intimacy .................................................................. 70

Stress Management............................................................................................... 71

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,