Crohn Disease

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Crohn Disease can be a large burden to bear. At times it is painful and very intrusive to its sufferers. Its symptoms come and go, sometimes for no apparent or predictable reason. It is chronic and ongoing and patients must usually manage and deal with it for their entire lives. Perhaps we can gather some information about Crohn’s that will help us to understand and combat it more effectively…

What is Crohn Disease?

Crohn Disease is a chronic degenerative illness of the digestive tract. It most often attacks the middle parts of the digestive tract, at the intersection of the end of the small intestine and the beginning of the large intestine (cecum). It is also commonly found in the anal area. It is called by other names as well, including regional enteritis (inflammation of the entero), and ileitis (inflammation of the ileum). Together with ulcerative colitis, which is a similar condition, it is bundled into a family of diseases called Inflammatory Bowel Diseases (IBD).

Crohn disease is very progressive in nature. It usually begins in the mucous membranes that line the intestine. It may advance by attacking deeper into the intestinal walls, and can thus spread to other areas in the bowel. As it progresses, painful ulcers may develop causing greater inflammation and compromise of the digestive tract. Eventually, malabsorption of food and nutrients may occur. This can lead to a variety of related problems, such as malnutrition, kidney and gall stones, and dehydration.

As the progression continues, partial or total blockage of the bowel may occur, narrowing what is called the bowel lumen, and not allowing food to pass as intended. This may be an intermittent condition, or may become permanent. Permanent bowel blockage is very serious, and may be fatal. Usually surgery is required.

If Crohn continues unchecked, the inflamed tissues may actually break through the intestinal wall, and begin to affect other areas of the body. These include the genitals, bladder, or the outer skin of the body. This can cause a serious risk of infection as intestinal material can enter into areas of the body it was never intended to visit. Some common areas of the body that can become inflamed include the liver, bile ducts, mouth, eyes, and joints.

A special complication of Crohn may affect the anus. Tiny painful cracks in the anal skin called anal fissures may occur. Tunneling sores called fistulas may also become a problem. These help the infected tissues to spread to adjacent parts of the body. An abscess, or pocket of dead or infected tissue, can form. These are especially painful for most patients.

Crohn disease has a very high rate of incidence here in the United States, as compared to the rest of the world. Approximately 7 people out of every 100,000 Americans have Crohn. It seems to be more common in nations with a higher standard of living. (Perhaps affluence without moderation has its drawbacks). Caucasians have a higher risk for Crohn than African-Americans or Asians do. It is found slightly more often in men than in women. It is also more common (2-4 times than other ethnic groups) in many Jewish populations in the world. Is age a factor? It appears that Crohn can develop at any age, but most cases are found in folks aged 15-30 years. It is sometimes found in children, and in these cases it can lead to developmental problems and stunted growth.

What Are the Causes of Crohn Disease?

An exact cause for Crohn has yet to be discovered. Theories abound that factors such as diet, blood vessel dysfunction, and genetics are responsible. Genetics certainly play a role, as risk is increased if Crohn runs in your family.  There is some evidence that points to immune system. Some researchers believe that Crohn may be brought on when the immune system overreacts to viral or bacterial infections. Possibly this tendency for the immune system to react this way is inherited. Scientists have not gathered enough evidence as of yet to render a good hypothesis as to the probable causes of Crohn.

How Do I Know If I Have Crohn Disease?

The symptoms of Crohn can be ambiguous and nonspecific, meaning they can be the result of any of a number of different disorders. Thus, a definitive diagnosis is hard to come by. A thorough health care provider will analyze your case looking at your family history, lifestyle, personal health history, and other factors.

There are some blood tests that can be helpful. Most of these will measure deficiencies or detect inflammation. Therefore, they can indirectly point towards or away from a Crohn diagnosis:

  • Blood cell counts: Readings can indicate anemia or inflammation.
  • Protein (albumin): Below normal readings may indicate your digestive tract is unable to absorb food and nutrients adequately.
  • Electrolytes: Below normal numbers may also indicate food and nutrient absorption problems.
  • C-reactive protein and orosomucoid:  These markers of inflammation can be very helpful at gauging how currently active the disease is. The same can be said for erythrocyte sedimentation rate.
  • p-ANCA antigen and anti-S cerevisiae antibodies can be measured and used to help determine whether a patient has Crohn or ulcerative colitis.

Certain imaging studies (x-rays) can be useful in diagnosis too:

  • Barium contrast studies: A contrasting dye of barium is drunk by the patient before pictures are taken. This can give doctors an excellent picture of what is going on in the intestines. This may include pictures of the upper digestive system (upper GI) and of the bowel (small intestine).
  • Barium enema: Same as above, except the area focused on is the colon and rectum.
  • When complications have infected areas outside the intestines, a CT scan, MRI, or ultrasound is sometimes used. Particularly effective in the liver and kidneys.
  • Endoscopy is a procedure whereby a tube equipped with a light and camera is inserted into the body. Doctors can then see pictures of what is going on inside the body. When used on the lower intestinal tract, it is called a colonoscopy. When used for the upper tract, it is referred to as an upper endoscopy. Biopsies can also be taken during these procedures.

What Are the Main Symptoms of Crohn Disease?

Most symptoms for Crohn Disease come and go, and these cycles are different for every patient. Subjects may experience flare ups and remissions at any time, and for no apparent reason. The most common symptoms are as follows:

  • Diarrhea: intermittent attacks. Stool may be bloody, or contain pus or mucous.
  • Abdominal pain: May be cramps or steady pain; often in right lower quarter of abdomen near the navel. Sometimes pain is relieved temporarily by a bowel movement.
  • Painful or bloody bowel movements.
  • Urinary tract infections: possibly indicates a fistula protruding into the urinary tract
  • Constipation or bloating after eating: Usually indicates bowel obstruction

There are also some secondary symptoms that may or may not occur:

  • Low-grade fever
  • Fatigue
  • Weight loss

What Kind of Treatments Are Available?

Mainstream medicine has used pharmaceutical drugs to treat Crohn, mainly anti-inflammatory drugs and antibiotics. They have had limited success, and as usual, the side effects are significant. The problem with antibiotics is that they have been so over-prescribed for all kinds of infections, that many times the infections build immunity to them and the drugs are no longer very effective. To make matters worse, there is even evidence to indicate that some antibiotics can aggravate infections and make them worse instead of defeating them.

Surgery is often prescribed. Most of the time the infected parts of the intestine are removed, but unfortunately Crohn disease frequently returns after surgery. Sometimes surgery is the only alternative, and may be necessary to save a patients life. This is particularly true for bowel blockages. However, the surgery never cures Crohn. It only improves the condition temporarily.

Are There Any Natural Treatments Available?

There has been some work done to research natural remedies to lessen the symptoms of Crohn Disease and ways to decrease the risk of causing a flare up:

Diet, as with all health issues, is extremely important. It is doubly critical with Crohn’s patients, as often they are malnourished because they cannot absorb their nutrients properly.

  • Avoid spicy or hot foods. These tend to only aggravate the situation.
  • Drink lots of pure, clean water –8 to 12 glasses daily is usually recommended.
  • Soft foods that are easily digestible may help. These include cottage cheese, ricotta cheese, and skim milk
  • If you choose to eat meat, stay away from stringy or tough cuts such as steak or pork chops. Chicken and fish is usually good for most patients.
  • Use plain, unseasoned tomato sauce or paste. Added spices may cause more inflammation.
  • Soups are good, but stay away from chunky vegetable or meat soups.
  • Watch out for very high fiber foods. This can be difficult for the digestive tract to handle.
  • Soft fruits are great. Bananas are one of the best.
  • When eating out, make sure the server double checks your special needs with the chef before your order is prepared. Also beware of condiments that may be added for aesthetics at many restaurants. An example would be sprinkling parsley over an entrée, which may make it inedible for some folks.

Exercise should not be overlooked as a form of therapy for Crohn’s. Cardiovascular exercise is good for every system of the body, including the digestive. Of particular value to the Crohn Disease patient is stretching, and learning how to flex and relax specific muscle groups in the body. In this case, learning how to relax the muscles of the digestive tract would be very helpful. Deep breathing is also a great way to relax and alleviate stress.

Finally, there are numerous vitamin and herb recommendations that have proved helpful in some cases.  Among these are: Vitamins A, E, and C. Vitamin B9, which is high in folate is very good. Omega-3 fatty acids are excellent for the Crohn patient. A supplement may be taken, or it may be gotten in white cold-water fish like salmon or cod. A high quality probiotic is also recommended to replace the friendly bacteria in the digestive tract and bring it back into balance.

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