ABSTRACT
Human beings deal with the reality of a world with a plethora of conditions, illnesses and diseases that threaten the health and livelihood of the population on a day-to-say basis. One such persistent disease that many Americans, both young and old, are suffering from is Crohn’s Disease. Crohn’s disease is commonly diagnosed on a regular basis all across the United States, however the reality is that medical realm does not specifically known what causes Crohn’s disease or why it has become so prevalent; some believe it is a combination of immune system deficiencies, genetic predisposition and environmental factors. The condition effects teens and young adults, but can also affect the very young and very old. Treatments include medicinal and surgical with high recommendations of dietary and nutritional changes. There are alternative treatments that, while should not be substituted for medical intervention, when combined with medical therapies made the symptoms and coping abilities of patients stronger and therefore more beneficial. There is a need for further research and study dedicated to the understanding, causes, and, possible preventions and cures; all of these endeavors are worthwhile.
INTRODUCTION
Human beings deal with the reality of a world with a plethora of conditions, illnesses and diseases that threaten the health and livelihood of the population on a day-to-say basis. Chronic diseases are, more or less, epidemic in the United States today. People are struggling each and every day with health problems that cause them persistent pain, discomfort and interfere with their daily quality of life. From chronic pain issues ranging from permanent back injuries to conditions like fibromyalgia, most average people do not know what it is like to be in pain all of the time; pain pills and medications can only do so much; these individuals, ultimately, must learn to live with pain that cannot be permanently cured and will, likely, never go away. While some of these conditions can be eased and aided by medications or pain killers, the condition remains permanent. One such persistent disease that many Americans, both young and old, are suffering from is Crohn’s Disease. This chronic inflammation of the intestines effects, nearly, 2 million people in the United States. (Derrer, 2015).While there is no cure for this condition there are many treatments and therapies being offered today, as well as, greater in-depth and dedicated to understanding more about this condition and how to bring relief to its sufferers. That said it is essential that that modern medical realms invest time and energy into understanding, addressing and preventing the condition’s prevalence in future generations.
BACKGROUND
IBD, or Inflammatory Bowel Disease, is the term that is applied to a chronic condition that involves inflammation and immense pain in the entirety of the digestive tract. It is often confused with another condition called IBS, or Irritable Bowel Syndrome, which also effects the intestines, specifically the colon, often referred to as a spastic colon, and shares many of the symptoms with IBD, but does not cause inflammation and does not lead to permanent damage. IBD is far more severe. IBD can be broken into two specific subtypes, ulcerative colitis and Crohn’s disease. The former is diagnosed when the focus of inflammation in the large intestine and colon specifically, while Crohn’s disease, can cause inflammation anywhere along the digestive tract, from the mouth to the anus, however it is most common at the end of the small bowel, or ileum, and beginning of the colon (Crohn’s & Colitis Foundation of America, 2015). Sufferers of Crohn’s Disease will experience abdominal pain, weight loss, rectal bleeding or bloody and soft stool and loss of appetite. Although not related to the gastrointestinal tract, Crohn’s patients may also present with eye pain, skin rashes, sores in the mouth, joint pain and fever. The internal damage of Crohn’s Disease involves the inflammation of the tissues along the intestinal walls. In the most severe cases or when left untreated the inflammation leads to a thickening and scarring of the digestive tract. The thickening narrows and restricts the passageways intended for food. Deep ulcerations can lead to the development of tunnels, called fistulas. These fistulas may build tunnels between locations that should not be bridged, for example the bladder and the skin (Lewis, 2015). There are presently five types of Crohn’s Disease commonly diagnosed, named for the specific area of the digestive tract that is most affected by the condition.
Ileitis: this form of Crohn’s only effects the ileum; prone to developing fistulas and abscesses in the lower right quadrant of the patients abdomen (Crohn’s & Colitis Foundation of America, 2015).
Gastroduodenal Crohn's Disease: This form of Crohn’s Disease specifically affects the stomach and the first section of the small intestine called the duodenum. The symptoms most associated with this form present with nausea, vomiting, weight loss and loss of appetite (Crohn’s & Colitis Foundation of America, 2015).
Crohn's (granulomatous) Colitis: This form is specifically found affecting the colon. This form is associated with the symptoms of rectal bleeding, chronic diarrhea, and issues, like ulcers, fistulas and abscesses in and around the anus. Patients with this form of Crohn’s Disease complain of joint pains and skin lesions more than any other form (Crohn’s & Colitis Foundation of America, 2015).
Jejunoileitis: This form is focused in the upper part of the small intestine, known as the jejunum. Patients of this form complain of cramping and diarrhea, particularly after meals. In severe cases fistulas will likely form (Crohn’s & Colitis Foundation of America, 2015).
Ileocolitis: This is the most common form of Crohn’s Disease diagnosed. It specifically affects the bottom of the ileum and the large intestine. This form leads to excessive weight loss and the sufferers will complain about pain and cramping in the middle or lower parts of the abdomen (Crohn’s & Colitis Foundation of America, 2015).
DISCUSSION
Crohn’s disease is commonly diagnosed on a regular basis all across the United States, however the reality is that medical realm does not specifically known what causes Crohn’s disease or why it has become so prevalent. While the cause cannot be specified there is also no cure for Crohn’s disease, only treatments, therapies and management. Most sufferers of Crohn’s disease generally start to feel and complain of the effects between the age of 15 and early 30s (Lewis, 2015). However, there are many sufferers who development the condition in the senior years, as well as, children much younger than 15 can also be effected. There are approximately, 100,000, or more, teenagers under the age of 15 and children, suffering from the effects of Crohn’s Disease. While children with Crohn’s Disease must struggle with all of the same symptoms, chronic pain, diarrhea, and bloody stool, it, also, effects children in a way it does not affect their adult counterparts. Because children and young teens are still growing and going through puberty, children with Crohn’s Disease often suffer from stunted growth and the weakening of the bones. This can make living with the condition very difficult for children (Faris, 2012). In order to understand the possible theories being considered as potential causes for Crohn’s Disease and the differing treatments it is best to discuss them individually.
There are a number of different theories being proposed to explain the development of Crohn’s Disease, however, as of yet, all are being considered, but none have been definitively proven. The three most popular theories offer that Crohn’s Disease is caused by internal immune system problems, genetic predispositions and environmental factors.
Immune System Problems
In properly functioning immune systems the body reacts to foreign bodies by sending cells to attack and eliminate the threat. However, a normal immune system can differentiate between dangerous invaders and friendly microbes and helpful bacteria, many of which assist in digestion (Eckburg & Relman, 2007). In a patient with Crohn’s Disease the immune system attacks the friendly bacteria or does not know when to stop attacking, leading to persistent to inflammation and this causes disruptions in healthy digestion, which can lead to ulcers, fistulas and general intestinal damage (Derrer, 2015).
Genetic Predisposition
Researchers estimate that there is a 10% to 20% greater likelihood of developing IBD, including Crohn’s Disease, if another member of the family has the condition. They have also determined that there is a predisposition suspected among certain ethnic groups, Caucasian people and people of Jewish decent appear to be more effected by than condition than other ethnic groups. Presently, studies have confirmed the identification of a gene that aids the body in deciding how to respond to microbes in the body; if mutated it could lead to abnormal reactions and therefore contribute to Crohn’s Disease and similar conditions (Derrer, 2015).
Environmental Factors
As with many modern conditions, there are toxins, chemicals and substances that people come in contact with on regular basis. While these things, like cigarette smoke and car exhaust, can contribute to developments of disease they are not necessarily a direct cause. However, if a person who already may have a familial predisposition or an existing immune system problem when exposed may exacerbate those issues and make the likelihood of developing Crohn’s Disease all the more likely (Derrer, 2015).
The treatments for Crohn’s Disease vary; different combinations of treatments may work better for some sufferers and not for others. Once the diagnosis of Crohn’s Disease has been made healthcare professionals must decide how to individually treat different Crohn’s Disease patients, after all different patients may have differing types, differing symptoms, are at differing stages of the condition with varying levels of damage and differing reactions to the treatments available (Baran & Karaca, 2013). Some patients may have sudden severe bouts of associated symptoms and then ceases to have any episodes for long periods of time, even years, regardless of treatments. This, of course, makes gauging the success of treatments over time, often, difficult to determine (Fraser Cummings, Keshave. & Travis, 2008). The treatment for Crohn’s Disease is one involving a combination of interventions, including medication, surgery, nutritional approaches, as well as, support services and alternative therapies that have been shown to be beneficial to Crohn’s Disease sufferers. Medicinal interventions may include the use of antibiotics, however, while they are beneficial in effecting related infections, it does not act as a cure for Crohn’s Disease as a whole (Derrer, 2015). The inclusion of corticosteroids has shown to ease symptoms and induce remission, but does not prevent later relapse. Mesalazine, an Aminosalicylate, which has had some success in treating ulcerative colitis, it does little to ease symptoms, even in mild cases of Crohn’s disease, but it does seem to beneficial in reducing the risk of relapse after a surgery has been performed; however this effect does not occur if the remission has been medicinally induced. Presently there are, also, biomedical therapies being researched involving the use of engineered substances to effect the course of the condition. (Fraser Cummings, Keshave & Travis, 2008). In children the focus of medicinal treatment may involve the above drug therapies, but a greater focus is placed on the nutritional aspects of the child’s health. Again, children are more likely to develop weak bones and stunted growth, making certain that they consume the proper foods to counteract these symptoms and remain physically active is of great importance as opposed to adult patients (Grossman, Mamula, & Cuffari, 2015).
The reality is that for 65% to 75% of all patients with Crohn’s Disease will require surgery in order to improve function or to remove damage portions of intestines. Some patients require the surgeon to correct damage, like ulcers, fistulae and any bleeding of the intestine; others may require a strictureplasty, which involves widening of the intestinal passageways, without removing any of the small intestine. Bowel resections involve the removal of the damaged sections and sewing the new existing ends together. In the most severe cases the patient may require the removal of the entire large intestine; in these cases the patient will need to have a substitute pouch, internal or externally, for waste removal (Lewis, 2015).
Crohn’s Disease is more about management and coping with the incurable condition no singular treatment plan is ideal for all patients universally. Finding the right interventions and balance is essential (Lichtenstein, Hanauer & Sandborn, 2009). There are a number of alternative treatments, many non-invasive, being considered to improve the quality of life for all sufferers. The therapies involving probiotics as a supplement for the lacking good bacteria in the gut has shown some benefit. Prebiotics are non-digestible carbohydrates found in foods like artichokes, honey and garlic; they are essentially food for the probiotics to use to bolster normal function. The consumption of fish oil has long been thought to ease the inflammation associated with Crohn’s Disease. Acupuncture, Biofeedback and Herbal and Botanical therapies are also considered to aid in relaxation and coping techniques to deal with this, all too common, condition (Herndon & Faris, 2014). All the same, these alternatives are not cures and should not necessarily be used as a substitute for the tried and true medical and surgical intervention previously mentioned; in fact they should be considered complimentary to medical and surgical treatments, at least until definitive prevention measures and curative agents are found.
CONCLUSION
The reality is that Crohn’s Disease is a serious health concern that is affecting a large portion of the American population and may be attributable to a number of causes be it genetic, an immune system flaw, environmental factors or a combination of all three. People of all ages from children to the elderly are living, each and every day, with the sometimes debilitating effects of Crohn’s Disease. For adults it is a condition that may worsen throughout the lifetimes, and children may suffer physical effects that will limit their quality of life and diminish their proper development. While a great deal of research has been dedicated to the cause, symptoms and treatment there is as yet no cure, that said greater and more dedicated research is still required and worthwhile. Crohn’s Disease is a condition that needs a cure and preventative measures; any studies to that end cannot be anything but ultimately beneficial.
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