Crohn’s disease overview
Crohn’s disease (also called ileitis or enteritis) is a chronic, relapsing–remitting, non-infectious form of bowel disorder that mainly causes inflammation of the digestive tract, and is the general term for diseases that cause swelling in the intestines.
This term has replaced older terms that include regional or terminal ileitis and granulomatous colitis; it doesn’t just imply any cause, site, or pathological response. The terminal ileum and the right colon are two sites that are most vulnerable, a close to this pathological disability can negatively influence multiple parts of the body, but this negative effect is connected with the gastrointestinal tract system first of all: it can affect starting from the mouth to the perianal area, through the intestinal wall from mucosa to serosa, but it usually affects the lower part of the small intestine called the ileum. In the beginning only a tiny part of the gastrointestinal tract may be affected, but Crohn’s disease can progress extensively. Clinically, Crohn's disease usually presents itself with abdominal pain and perianal disease. Inflammation caused by it may involve all 3 layers of intestines and can cause intestinal swelling, intestinal scarring, and obstruction of the intestines. As soon as the swelling is extending progressively deep inside the lining of the organ it can result pain and can make the intestines empty frequently, resulting in diarrhea.
According to Cummings, the geography of Crohn's disease suggests a north-south gradient of spreading, but recent studies have reported growing prevalence in regions of Australia, South Africa, and Northern America. Urban population has higher disease rates than rural population, and ethnic minority groups (south Asians, South Africans, and Bedouin Arabs in Israel) are at lower risk. People of Jewish origin coming from Central Europe, and those of Scandinavian descent are at higher risk, with blacks being at lower risk of developing this disease.
This illness usually presents at any age, although usually early in life at age 16-30 years; about one-sixth of the infected present before turning 15 years old, with the average diagnosis age of 27 years. More than 90% of patients start to feel symptoms before turning 40, thus having a disproportionate effect on economically active individuals (Cummings, 2008).
The causes of Crohn's disease
Medical experts do differ in their opinions on the causes; there are several theories on what can be the causes for Crohn’s disease, but none of those have been scientifically proven, however, weighty genetic influences are believed to be caused by the chance of occurrence of this abnormality in families. The human immune system consists of cells that protect a human being against infection. The National Institutes of Health states that the most frequent concept is that the body’s immune system starts working in abnormal way with the case of people that are affected with Crohn’s disease; this can be triggered by certain bacteria, substances such as food and other things that do not belong to the body itself. The immune system responds by attacking the “invaders.” The process often causes white blood cells accumulations in the intestinal mucosa, causing a chronic inflammation, which can lead to ulcerations.
Scientists are not sure if the irregularity in the functioning of the immune system is actually caused by the abnormalities brought by this disease or not. Studies show that the inflammation in the gastrointestinal tract is comprised of the following factors such as: genes that were inherited as well as the environment and the immune system. Foreign substances, also known as antigens can be found in the environment. A response of our body to these antigens is of the possible causes of inflammation, or the antigens themselves might be causing the inflammation. Scientists have found that individuals with Crohn's disease have a high amount of protein produced by the immune system, called tumor necrosis factor (TNF).
Symptoms of Crohn's disease
There are a lot of ways in which the Crohn’s disease can show itself. To start off with diarrhea and abdominal cramps, moreover it is followed by the fever and significant weight loss. Sometimes there is a delayed growth (in case with prepubescent people), a quadrant abdominal mass in the right lower (if the abnormality has arose in the ileal area). It is a common case when the patients’ health is connected with tests even before the illness is being diagnosed; they have an insidious onset course if the ilecolitis or ileititis is developing. The average time between being diagnosed and being treated used to be 2.5 years in average, but this period has been significantly shortened with the advancement of imaging techniques, that are conducted by computed tomography as well as ultrasonography methods, which are used in case of a high percentage of being diagnosed with Crohn’s disease.
As for the Crohn’s disease subtypes – it is easily classified onto ileitis, colitis, jejunoileitis and ileocolitis. Each of the following subtype has its own specific diagnosis and treatment course which is determined afterwards. People that are affected by the inflammation of the ileum and jejunum often suffer from cramping abdominal pain after eating that can transform into diarrhea. These patients, whose age varies from teenage years to young adultery, may have extraintestinal manifestations including arthritis, fever, skin lesions, and delayed growth. As a direct consequence to this – people begin to eat much less in order to not face the discomfort again, which results in massive weight loss. The inflammation in the ileum may spread into connected structures as tracks or fistula, or may lead to perforation of an abscess connected to the bowel. This form is specifically known as perforation of fistulizing. This is the worst case scenario of prognosis, in most cases – surgery is inevitable once in every 3 or 4 years. Another group of patients affected with ileitis can often acquire a developed form of intestinal obstruction 8-10 years after the start of disease, due to the fibrosis narrow the lumen of the bowel and muscle hypertrophy. In this case a disease with such type of development is called stenosing or structuring type. Another interesting fact connected with Crohn’s disease is that sometimes it is hard to distinguish ulcerative colitis from it, due to the fact that Crohn’s disease might also result in diarrhea.
Clinical presentation of Crohn's disease is dependent on the involved bowel parts. Patients with ileal involvement might become a subject to a serious decline in their health, which is followed by enteric pain shortly after having a meal (usually 1 or 2 hours after). The discomfort is usually created by inflammation of the bowel lumen and partial obstruction; can be localized to the periumbilical area. Because of anorexia, nausea, or fear, patients eat not as much, thus losing weight. Most patients with small-bowel Crohn's disease have a number of bowel movements, which does not exceed more than 5 per day and is often followed by unformed stools.
Crohn's disease is associated with extraintestinal manifestations, which can deliver more problems than the bowel abnormality. Colitic arthritis in its turn, is an arthritis that affects the knees, ankles, hips, wrists and elbows and can be a one of the symptoms of Crohn's disease (although it is rare when Crohn's disease is confined to intestine). The following symptoms are quite common: swelling, stiffness and joint pain parallel this disease. Successful medical therapy of the disease leads to improvement of arthritis according to National Institutes of Health (National Institutes of Health, 2006).
Diagnosis of Crohn's disease
A thorough physical exam and various tests might be necessary to examine and determine the Crohn's disease. Additionally to this certain blood tests are usually performed with a specific purpose – to check if anemia is present in this case, if it is so – it might result in massive bleedings in entrails. Additionally, such tests can also show a high amount of white blood cells, it is a direct sign of inflammation in one of the organ system. Moreover, by performing tests on stool, the doctor is able to determine if certain infections are there in intestines. Besides this the specialist can also execute an upper GI series to examine the small intestine. In order to perform this test, a patient must drink a certain portion of barium, which main purpose is to coat the small intestine, just a moment before the x-rays shots are being taken. Barium appears white on the x-ray ILM, showing inflammation or other abnormalities in the intestine. If these tests indicate Crohn’s disease, it is necessary to proceed with a couple more x rays of both the upper as well as lower digestive tract to see the part of the GI infected by the disease.
The specialist has also an option of performing a colonoscopy or sigmoidoscopy to get the precise data. These both tests involve a prolonged tube with a camera which is directly connected to a computer. It is inserted into the anus. In its turn, Sigmoidoscopy gives the possibility to look at the lower part of the large intestine, while at the same time colonoscopy is a procedure which provides the physician with the data of the entire large intestine. By performing such tests the physician has all the information regarding bleedings or inflammations which can be determined during these tests. The very last but not least option for doctor is to perform a biopsy test, which is basically about taking some tissue samples from the intestine to examine later under the microscope.
Treatment of Crohn's disease
The disease itself is incurable, but there are treatments available to relieve symptoms of the disease. Ways of treating Crohn's disease have changed over the past time, with biological therapy being introduced and increasing usage of immunomodulators. Knowledge of the medical potential is needed for benefit and protection of patients from unwanted risks caused by medicines.
According National Institutes of Health, treatment is mainly performed for the purpose of relieving the pain and uncomfortable feelings connected with the disease and active treatment of acute disease should be differentiated from relapse prevention. Management options for Crohn's disease consist of attention to nutrition, drug therapy, giving up of bad habits such as smoking and drinking, and if the disease is severe or chronic – surgery will be the only option. The purpose of medical treatment is to reduce symptoms and even improve the quality of life, while minimizing toxicity associated with the drug. Glucocorticosteroid treatment, 5-aminosalicylate (5-ASA) treatment, antibiotics, immunosuppressives, and tumor necrosis factor (TNF) alpha inhibitors are among the treatment ways of Crohn's disease. Enteral nutrition is widely used as first-time therapy for children and teenagers to ensure their normal growth and development, but it is less commonly used for adults. From 50 to 80% of people with Crohn's disease might require surgeries for strictures causing obstructive symptoms, and other various complications such as fistula formation, perforation or failure of medical therapy (National Institutes of Health, 2006).
Conclusion
Being a chronic, relapsing–remitting, non-infectious form of bowel disorder that mainly leads to inflammation of the GI tract; it is most presented among the people of Jewish origin coming from Central Europe, and those of Scandinavian descent. Though it is incurable, there are treatments available to relieve symptoms of the disease, which can make the living with this type of disease ubearable.
References
Cummings, F. (2008). Medical Management of Crohn's disease. BMJ. Retrieved from http://www.med.upenn.edu/gastro/documents/BMJcrohnsdisease.pdf
FDA Consumer Health Administration (2009). Facts about Crohn’s disease. FDA Consumer Health Information. Retrieved from http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm107364.pdf
National Institute for Health and Clinical Execellence (2012). Crohn's disease. Retrieved from http://www.nice.org.uk/nicemedia/live/13936/61001/61001.pdf
National Institutes of Health (2006). Crohn's disease. Retrieved from http://www.digestive.niddk.nih.gov/ddiseases/pubs/crohns/Crohns.pdf
The Patient Education Institute, Inc. (2011). Crohn's disease. Retrieved from http://www.nlm.nih.gov/medlineplus/tutorials/crohnsdisease/ge159105.pdf
