Posts Tagged ‘Bowel Movements’

Living with Crohns Disease

03.30.10

Most people living with Crohns disease find that periods of remission (when they are free from symptoms) are longer and more frequent than periods of acute illness. This has never been truer than it is today, when doctors have large and growing arsenal of treatment options to prescribe.

The severity of Crohns disease can be measured objectively with indexes that chart symptoms, including:
•    The number of bowel movements per day
•    Appetite level
•    Fever
•    Number of days in a month when an individual must modify his or her work, home, or social schedule because of diarrhea, fatigue, fever, and other symptoms

Severity can also be measured subjectively, through a doctor’s assessment of an individual’s general state of being (such as whether he or she is angry, depressed, in pain, or embarrassed by needing to use the toilet frequently in social or business situations).There is considerable variation in how people with Crohns disease experience their illness.

An individual whose radiological examinations reveal an extent of disease that would seem to be debilitating may lead a relatively normal life, while a person with few objective signs of disease may find his or her symptoms totally debilitating, both physically and mentally.Although Crohns disease is a chronic (long-term) inflammatory bowel disease, it is not a constant disease.

That is, Crohns disease is characterized by acute flare-ups of symptoms followed by remissions that last for varying periods of time. Each individual’s pattern of symptoms is different, and conscientious doctors treat patients according to their reported symptoms rather than the results of laboratory tests or radiological exams. Diarrhea, pain, and fever-along with fatigue, chills, and possibly vomiting-come and go, sometimes in waves and sometimes in sharp bursts.

Flare-ups can occur out of the blue, following a viral illness such as a head cold, or during times of extreme personal, business, or social stress. People with Crohns disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohns disease are able to hold jobs, raise families, and function successfully at home and in society.

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Crohns Disease Surgery

01.17.10

Crohns disease can cause a variety of symptoms of gastrointestinal distress.

The three classic (though not specific) symptoms of inflammatory bowel disease are:
•    Persistent or recurrent diarrhea (possibly with blood, mucus, or pus)
•    Abdominal pain
•    Fever

There also may be signs and symptoms unrelated to the gastrointestinal tract. A doctor will obtain a complete medical history and perform a thorough physical examination, along with laboratory and diagnostic tests, to diagnose Crohns disease. The examination and other tests are necessary to rule out a number of transient conditions, such as viral, bacterial, or parasitic infection, that cause symptoms similar to Crohns disease.

Diarrhea
In cases of Crohns disease, patients often experience frequent loose or watery bowel movements. The stool is occasionally accompanied by thick, dark blood (not bright red smears of blood, which usually result from a bleeding hemorrhoid). There is less mucus or pus in the stool than in cases of ulcerative colitis.

Pain
Patients may experience crampy, achy, or even sharp pain in the affected area. Most often, patients with Crohns disease feel pain on the lower right side of the abdomen (lower right quadrant) and just below the bellybutton. This is because the majority of cases of Crohns disease involve disease in the terminal ileum, where the small intestine meets the large intestine. The terminal ileum crosses from left to right just above the beltline, and joins the large intestine in the lower right quadrant. The type of pain associated with Crohns disease depends on what part of the GI tract is affected. Disease in the terminal ileum generally causes sharp pain, while disease in the colon causes more crampy pain, similar to that that of ulcerative colitis. Pain is sometimes relieved (temporarily) after a bowel movement.

Fever
Crohn’s is an inflammatory disease, and one of the key characteristics of the inflammatory process is fever. (The others are pain, swelling, and redness.) Some individuals with Crohns disease suffer a high fever, especially during the acute phase of a flare-up. Others run a persistent, low-grade fever. Fever may be accompanied by irritability and fatigue. Sometimes, the fever recurs each day, especially late in the day, then repeatedly breaks during sleep, causing night sweats.

Signs and Symptoms Unrelated To The GI Tract
A number of signs and symptoms that do not involve the gastrointestinal tract can occur with Crohns disease. These may occur at the same time as the intestinal symptoms, or may be experienced weeks or even months before any intestinal symptoms are noticed. If your doctor suspects inflammatory bowel disease, he or she will ask you detailed questions about whether or not these extra-intestinal symptoms have appeared:
•    Reddening and inflammation of the eye (iritis)
•    Joint pain (usually in the large joints of the knees, ankles, elbows, wrists, and shoulders), which sometimes migrates from one joint to another (migrating arthralgia)
•    Skin lesions, including tender red nodules on the shins or calves (erythema nodosum)
•    Sores inside the mouth (aphthous ulcers)

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Crohns Disease Probiotics

11.30.09

Probiotics in the Treatment of Crohn’s Disease
Alterations in the bacterial milieu of the gut are common in Crohns disease. The use of various probiotic bacteria to promote a balance of appropriate intestinal flora has yielded mixed results. Mechanisms associated with the beneficial effects of probiotic therapy in Crohn’s Disease include:

(1) inhibition of pathogenic bacteria via growth suppression or epithelial binding
(2)  improved epithelial and mucosal barrier function; and
(3) altered immuno-regulation via stimulation of secretory IgA or reduction in TNF-alpha.

Saccharomyces boulardii
Plein et al demonstrated the efficacy of Saccharomyces boulardii (Sb) in a randomized, double-blind, placebo-controlled study of 20 Crohn’s Disease patients. Patients were given 250 mg Sb three times daily for 10 weeks and evaluated via bowel movement frequency and the CDAI index. Patients receiving Sb experienced a significant reduction in frequency of bowel movements (from 5.0 to 3.3 per day) and CDAI index (193 to 107) by week 10 of treatment.

Another study utilizing Saccharomyces boulardii therapy in 32 Crohn’s Disease patients demonstrated a significant benefit of a combination of Saccharomyces boulardii and mesalamine compared to mesalamine alone. Relapse in the mesalamine-only group was 37.5 percent at six months compared to only 6.25 percent in the mesalamine-plus Saccharomyces boulardii group.

E. coli (Nissle strain)
Pathogenic E. coli that adhere to and invade intestinal epithelial cells (IEC) have been isolated from ileal lesions of Crohns patients. Boudeau et al demonstrated the in vitro ability of a non-pathogenic E. coli strain (Nissle 1917) to prevent pathogenic E. coli strains from adhering to and invading IEC. When IEC were co-infected with probiotic Nissle strain and pathogenic E. coli, the Nissle strain exhibited a dose- and time-dependent adhesion to IEC, which prevented adhesion of various pathogenic E. coli strains by 78.0- 99.9 percent.

When IEC were pre-incubated with Nissle strain E. coli and pathogenic strains were added later, adhesion and invasion of pathogenic strains was inhibited by 97.2-99.9 percent. Malchow et al conducted a double-blind, randomized, placebo-controlled trial investigating the efficacy of E. coli Nissle strain 1917 for inducing and maintaining remission in 28 patients with colonic Crohns disease.

Patients were randomized to either 60 mg prednisolone daily (with a standard tapering schedule) plus twice daily doses of 2.5 x1010 probiotic Nissle strain E. coli (treatment group) or identical prednisolone therapy plus placebo (placebo group). The rate at which remission was achieved was comparable in both groups (85.7% for treatment patients versus 91.7% for placebo patients), but only 33.3 percent of patients in the E. coli treatment group relapsed at one year, compared to 63.6 percent in the placebo group.

Lactobacillus GG
Malin et al investigated the effect of oral Lactobacillus GG on the intestinal immunological barrier in a small study of 14 children with CD and seven control patients (hospitalized for investigation of abdominal pain but with no evidence of intestinal disease). Lactobacillus GG was administered to patients and controls at 1010 colony forming units mixed in liquid twice daily. Lactobacillus GG therapy significantly increased the IgA immune response in Crohns patients compared to controls, resulting in an improved mucosal barrier.

Another study of Lactobacillus GG demonstrated that administration in children with mildto- moderate stable Crohn’s Disease improved gut barrier function and clinical status after six months of therapy.228 However, a randomized, double-blind, placebo-controlled trial of 45 post-surgery Crohns patients given Lactobacillus GG for one year did not show it to be more effective than placebo in preventing disease recurrence.229