Posts Tagged ‘Crohn S Disease’

What is Colitis

06.13.10

Colitis is a general term for a large number of causes that result in inflammation in the lining of the bowel. Common symptoms associated with colitis are abdominal cramping, frequent loose stools or persistent diarrhea, loss of control of bowel function, fever, sleepiness, and weight loss.

Depending on the cause, colitis may be treated in several ways.One of the first steps in diagnosing colitis is identifying the cause. Some forms of colitis may be caused by infection through bacteria, certain viruses, and some parasites.

For example, exposure to the salmonella bacteria or any other bacteria needs to be treated with antibiotics to resolve the condition. Parasitic or amoebic infection usually warrants a course of either antibiotics or anti-parasitic medication. Viral colitis can be more difficult to treat.

Viruses like Rotavirus or Norovirus can result in dehydration, particularly in the very young or very old. Rest and increased fluid intake are often prescribed. However, if a person becomes severely dehydrated, he or she may need care in a hospital to receive intravenous fluids.

Certain diseases can predispose one to attacks of colitis. The most frequent cause of colitis in those with intestinal diseases is Crohn’s disease, which is a degenerative intestinal disorder. People with Crohn’s are more prone to colitis and to other serious conditions like perforated bowel.

Those with Crohn’s need to take seriously the symptoms listed above and see a doctor immediately. Any of these symptoms can necessitate medical treatment.Irritable bowel disorder (IB) can also cause bouts of colitis.

Since IB is both difficult to diagnose and to treat, anyone who has had frequent recurrences of the symptoms above is prone to colitis and should contact a doctor if he or she suspects colitis. Especially if bacteria or parasites causes the colitis, this can only worsen IB and needs immediate treatment.

While antibiotics are used to treat bacterial colitis, they can also be indicated as a cause of colitis in some cases. Additional causes of colitis may include taking birth control medication, having autoimmune disorders, or smoking.

If diarrhea and fever persist for more than two days, and you don’t have a disease that would necessitate earlier treatment, you should see a doctor quickly. If you have severe stomach pain with fever, you should not wait to see a physician during office hours but proceed to the emergency room, as this may indicate appendicitis or bowel injury.

If you suspect food poisoning, it is better to go the emergency room, since some bacteria can be very harmful.You can reduce your risk of colitis by using sanitary cooking and eating practices, avoiding caffeinated beverages, and not taking medications like ibuprofen if you have irritable bowel or inflammatory bowel conditions.

Treatment for those with frequent bouts of colitis will focus on trying to reduce symptoms such as diarrhea and stomach cramping. Sometimes these treatments of symptoms are the only way to address colitis.

Yet even with treatment, those with Crohn’s and other autoimmune or known stomach disorders should be vigilant if they suspect colitis, since other more serious conditions may also have the same symptoms as colitis.

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Ulcerated Colitis

06.05.10

Ulcerative colitis is a chronic disease in which the large intestine becomes inflamed and ulcerated (pitted or eroded), leading to flare-ups (bouts or attacks) of bloody diarrhea, abdominal cramps, and fever. The long-term risk of colon cancer is increased. Ulcerative colitis may start at any age but usually begins between the ages of 15 and 30.

A small group of people have their first attack between the ages of 50 and 70.Ulcerative colitis usually does not affect the full thickness of the wall of the large intestine and hardly ever affects the small intestine. The disease usually begins in the rectum or the rectum and the sigmoid colon (the lower end of the large intestine) but may eventually spread along part or all of the large intestine.

Ulcerative proctitis, which is confined to the rectum, is a very common and relatively benign form of ulcerative colitis. In some people, most of the large intestine is affected early on.

The cause of ulcerative colitis is not known for certain, but heredity and an overactive immune response in the intestine seem to be contributing factors. Cigarette smoking, which is detrimental in Crohns disease, seems to decrease the risk of ulcerative colitis.

However, smoking in order to reduce the risk of ulcerative colitis is ill-advised in light of the many health problems that smoking can cause. Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD).

Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine.

Because of the name, IBD is often confused with irritable bowel syndrome (“IBS”), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohns disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.

Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America. The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility.

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Pathophysiology of Crohns Disease

05.28.10

Crohns disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Transmural spread of inflammation leads to lymphedema and thickening of the bowel wall and mesentery. Mesenteric fat typically extends onto the serosal surface of the bowel. Mesenteric lymph nodes often enlarge.

Extensive inflammation may result in hypertrophy of the muscularis mucosae, fibrosis, and stricture formation, which can lead to bowel obstruction. Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle.

Fistulas may even extend to the skin of the anterior abdomen or flanks. Independently of intra-abdominal disease activity, perianal fistulas and abscesses occur in 25 to 33% of cases; these complications are frequently the most troublesome aspects of Crohns disease.

Noncaseating granulomas can occur in lymph nodes, peritoneum, the liver, and all layers of the bowel wall. Although pathognomonic when present, granulomas are not detected in about half of patients with Crohns disease.

The presence of granulomas does not seem to be related to the clinical course.Segments of diseased bowel are sharply demarcated from adjacent normal bowel (“skip areas”); hence, the name regional enteritis. About 35% of Crohns disease cases involve the ileum alone (ileitis); about 45% involve the ileum and colon (ileocolitis), with a predilection for the right side of the colon; and about 20% involve the colon alone (granulomatous colitis), most of which, unlike ulcerative colitis (UC), spare the rectum.

Occasionally, the entire small bowel is involved (jejunoileitis). The stomach, duodenum, or esophagus is clinically involved only rarely, although microscopic evidence of disease is often detectable in the gastric antrum, especially in younger patients. In the absence of surgical intervention, the disease almost never extends into areas of small bowel that are not involved at first diagnosis.

There is an increased risk of cancer in affected small-bowel segments. Patients with colonic involvement have a long-term risk of colorectal cancer equal to that of UC, given the same extent and duration of disease.

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Treatment for Crohns Disease

04.29.10

Crohns Disease treatment is a life-long commitment, as this chronic condition is marked by flare-ups and remission periods that sufferers will unfortunately be forced to deal. Crohns Disease symptoms, and possibly one or more stays in a hospital.

All of that works together with the general stress of life to affect the course of your disease. When it all combines together — you get fatigue. You feel tired, listless. I know. I’ve been there. Proper Crohns Disease treatment is crucial, and it is important to learn everything you can about this debilitating condition.

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohns disease usually involves drug therapy or, in certain cases, surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease.

They include:
• Sulfasalazine (Azulfidine). Doctors have used this drug for many years to treat Crohns disease. Although it can be effective in reducing symptoms of the disease, it has a number of side effects, including nausea, vomiting, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications.
• Mesalamine (Asacol, Rowasa). This medication tends to have fewer side effects than sulfasalazine has. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected.
• Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity.

More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

Also, these medications don’t work for everyone with Crohns disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments.

A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohns disease that involves the lower small intestine and the first part of the large intestine (ileocolitis).

Corticosteroids aren’t for long-term use. They can be used for short-term symptom improvement for about three to four months. They’re also used in conjunction with other medications as a means to induce remission.

For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

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Teens with Crohns

04.24.10

Welcome! I was first diagnosed with Crohn’s Disease nearly ten years ago and, being a teenager at the time, I found it difficult to talk to others about the disease that did not have it. I created this site as a place to share stories and information – for teens, by teens – with Crohn’s Disease, Colitis, or IBS.

Apparently I’ve made a big impact here. I’m glad to do what I can to make a difference.Any advice you may wish to pass on to others is also welcome. Since most all of us follow special diets, there is a recipe section. I have tried many of the recipes listed here, and several have become my favorites.

Try them and let me know what you think. You might be saying to yourself at this point, “But I’m not a teenager!  What can TWC do for me?”  In the past seven years I’ve received e-mail from Crohn’s patients of all ages who have had plenty of advice to offer and stories to share. 

No matter what your age group, be it preteen, teen, or used-to-be-teen, there is all sorts of useful information here that easily applies to all ages. If you feel good there’s no reason you can’t go out with your friends. You may feel more tired than you did before you were diagnosed with IBD, so you’ll want to be sure you can leave and go home if you need to.

You may not be able to eat the same foods you did before, so plan ahead to make sure that if food is involved, there is something that you can eat available. If you aren’t feeling well but you still don’t want to pass up a big date or party, you’ll have to do a bit more planning.

If you can, try to go out somewhere that you can easily make it to a bathroom. A restaurant, a movie, or at your house or your friends’ house are probably the easiest places.

• Eat something at home before you go so you can avoid eating any of your no-no foods.
• Bring your medication with you in case you need to take it while you’re out.

You shouldn’t feel pressured to eat something that is going to make you sick later. Your friends wouldn’t want you to feel badly. So if you explain to them that a food may make you sick, they will understand, I’m sure. If you’re in a situation where food is being served that you can’t eat, you have a few choices available to you.

1. Call ahead or look online to find out the menu. The restaurant may have their menu online, or they may be able to fax or email it to you. You might be able to find something on the menu that would be OK for you to eat. Even just a little something to order and nibble on so you don’t feel out of place.
2. Eat before you go. Have something to eat that’s OK for you, and you won’t be so hungry at the party or event

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Pediatric Crohns Disease

04.08.10

Delayed growth is a well-established feature of pediatric Crohns disease. Several factors have been shown to affect growth, including disease location, severity, and treatment. The recently discovered NOD2 gene has been correlated to ileal location of Crohns disease and subsequently could affect growth through the resulting phenotype or as an independent risk factor.

The aim of our study was to determine if growth retardation is affected by genotype independently of disease location or severity. Crohns disease is an inflammatory bowel disease of the gastrointestinal tract.

Approximately 500,000 Americans suffer from Crohn’s, and it is estimated that at least 150,000 of them are children under age 17.  In children, the disease usually presents between 12 and 16 years of age; however, it has been detected in children as young as 7 years old.

Both adult and pediatric Crohn’s patients may experience a number of symptoms, including diarrhea, abdominal cramps and pain, fever, rectal bleeding, loss of appetite, and weight loss. However, each individual may experience symptoms differently. If your child has been diagnosed with pediatric Crohn’s disease, talk to your child’s doctor about treatment with REMICADE.

Individual results may vary. Talk to your child’s doctor to see if REMICADE is right for your child.REMICADE is for children (ages 6-17) with moderate to severe Crohns disease who haven’t responded well to other therapies.

REMICADE has been approved for the treatment of pediatric Crohns disease, based on clinical research. Children with pediatric Crohn’s disease may have to deal with things that other children don’t — painful and sometimes embarrassing physical symptoms, eating and treatment regimens, doctor visits, and even occasional hospital stays.

Pediatric Crohn’s can have an impact of all aspects of a child’s life, including school, relationships with friends and family, and self-esteem. But by learning how to cope with the disease, they can still lead an otherwise happy, productive life. If your child has been diagnosed with pediatric Crohn’s disease, it is only natural to feel overwhelmed and scared.

Since this is a chronic illness (meaning that it doesn’t go away) that can involve painful and sometimes embarrassing symptoms, you may have questions:
• How will pediatric Crohn’s disease affect my child’s health and well-being?  Will it affect me and the rest of my family as well?
• Will this disease change my child’s appearance or interfere with normal growth?
• Will my child have to go on a special diet?
• What treatment is available for pediatric Crohn’s disease?

Crohn’s disease can have physical, social, and emotional effects on a child.  Physical symptoms of pediatric Crohn’s disease include growth problems, frequent diarrhea, abdominal pain, loss of appetite, and weight loss.

Children and teenagers may find it especially hard to deal with a chronic disease like Crohn’s and its symptoms since they are already in the process of both physical and emotional development.
Because of the physical manifestations of pediatric Crohn’s, a child may face challenges both socially and emotionally. Below are some of the social and emotional challenges a child with pediatric Crohn’s may face.

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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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Laparoscopic Surgery For Crohns Disease

03.21.10

The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes. Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days  and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days .

The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days. Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37-0.87). The rate of disease recurrence was similar for both laparoscopic and open surgery.

Laparoscopic surgery for Crohns disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohns disease is both safe and feasible.

An effort was made to assess the feasibility, safety, and outcome of laparoscopic procedures performed in patients with Crohns disease. Methods: A prospectively maintained laparoscopic database was analyzed regarding operation time, intra- and postoperative complications, conversion to laparotomy, and length of hospitalization.

Fifty-one patients (23 males and 28 females) with a mean age of 36 (20-79) years underwent a laparoscopic or laparoscopic-assisted procedure for Crohns disease. The indications included terminal ileitis in 31 patients, colitis in 11, perianal disease in four, duodenal Crohns disease in three, and rectovaginal and rectourethral fistula in one patient each.

Thirty-two patients underwent an ileocolic resection; total abdominal colectomy with ileorectal anastomosis was performed in six patients with end ileostomy in one, take down of end ileostomy and ileorectal anastomosis in three, duodenal bypass gastrojejunostomy in three, and loop ileostomy in six patients.

Results: The mean operating time was 2.4 (0.6-4.5) h and the mean length of hospital stay was 5.1 (3-18) days. Eight complications were noted in seven patients (14%), which included enterotomy in two patients, bleeding in two, stoma obstruction in two, pelvic sepsis in one, and efferent limb obstruction in one. The procedure was converted to laparotomy in seven patients (14%) due to a large inflammatory mass in five and to bleeding in two patients; there was no mortality.

Conclusion: Laparoscopic surgery is a feasible, versatile, and safe modality in the surgical management of Crohns disease. Despite the often-malnourished state of these steroid-dependent patients with intraabdominal inflammatory conditions, morbidity, procedural length, and length-of-hospitalization data are all similar to results previously reported for less-challenging laparoscopic colorectal procedures.

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Gastroduodenal Crohns Disease

02.27.10

In anatomy, the gastroduodenal artery is a small blood vessel in the abdomen.It supplies blood to the pylorus (distal part of the stomach) and the proximal part of the duodenum.It arises from the common hepatic artery and terminates in a bifurcation, when it splits into the right gastroepiploic artery and the anterior superior pancreaticoduodenal artery.

Crohns disease involving the gastric outlet and proximal duodenum, resulting in gastric outlet obstruction. Image on the right shows a view of the stricture as seen through a translucent dilating balloon, which has been inflated in the stricture.

1. Melatonin protection against ethanol-induced gastroduodenal injury was investigated in duodenumligated rats.
2. Melatonin, injected i.p. 30 min before administration of 1 ml of absolute ethanol, given by gavage, significantly decreased ethanol-induced macroscopic, histological and biochemical changes in the gastroduodenal mucosa.
3. Ethanol-induced lesions were detectable as haemorrhagic streaks. Ethanol administration damaged 36% and 25% of the total gastric and duodenal surface, respectively.

Melatonin treatment reduced ethanol-induced gastric and duodenal damage to 14% and 8%, respectively. When indomethacin was given together with ethanol, the gastric damaged area was 44% of the total surface, while the duodenal damaged area was 35%; melatonin administration reduced the damage to only 13% of the total gastric surface and to 12% of total duodenal surface.

4. Both stomach and duodenum of ethanol-treated animals showed polymorphonuclear leukocyte (PMN) infiltration. The number of PMN increased more than 600 and 200 times in stomach and duodenum, respectively, following ethanol administration. Melatonin treatment reduced ethanol-induced PMN infiltration by 38% in the stomach and 20% in the duodenum. In indomethacin-ethanol-treated rats, the number of PMN increased by 875% compared to control group in the stomach and by 264% in duodenum. Melatonin administration reduced the indomethacin-ethanol-induced PMN rise by 57% in the stomach and 40% in the duodenum.

5. Gastroduodenal total glutathione (tGSH) concentration and glutathione reductase (GSSG-Rd) activity were significantly reduced following ethanol and indomethacin-ethanol administration. Melatonin ameliorated both the decrease in tGSH concentration as well as the reduction of GSSG-Rd activity elicited by ethanol both in the stomach and duodenum; melatonin was effective against indomethacin-ethanol-induced damage only in the stomach.

6. Ethanol-induced gastroduodenal damage is believed to be mediated by the generation of free radicals. Recently, a number of in vivo and in vitro experiments have shown melatonin to be an effective antioxidant and free radical scavenger; thus, we conclude that the protection by melatonin against ethanol-induced gastroduodenal injury is due, at least in part, to its radical scavenging activity.

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Fistulizing Crohns Disease

02.19.10

Fistulas are common in Crohns disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators.

Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas. The appropriate treatment of patients with fistulas in the setting of Crohns disease requires a knowledge of the specific medical and surgical literature of fistulizing Crohn’s. The patient with symptomatic fistulizing Crohns disease may respond differently to specific medical therapy than a patient with symptomatic obstructing Crohns disease.

Certain medications that are useful for the treatment of patients with obstructive Crohns disease may not be helpful in the treatment of fistulas in patients with fistulizing Crohns disease (e.g., corticosteroids and mesalamine); in fact, some medications are believed to be detrimental (e.g., corticosteroids). Few studies have been performed to assess the efficacy of specific medications on fistulas directly.

To date, there has been only one published prospective randomized controlled trial that was designed to assess the efficacy and safety of a specific medication on fistulas in patients with Crohns disease; it showed clinical efficacy over placebo in a statistically significant manner. The judicious use of surgery remains an integral part of the management of certain presentations of fistulizing Crohns disease, and the appropriate integration of surgical and medical therapy is of paramount importance in the management of these patients.

This review provides an overview of pertinent medical and surgical literature as it pertains to management of patients with fistulizing Crohns disease. Remicade was also shown to be effective in reducing the number of open, draining fistulas, a painful complication of Crohns disease in which deep openings burrow from the bowel wall through the surface of the skin, causing drainage of mucous and/or fecal material. Remicade is the first product documented to reduce the number of open fistulas in a controlled clinical trial.

In a clinical study of 94 patients with fistulizing Crohns disease (42 patients had single fistula and 52 patients had multiple fistulas), 68 percent of those treated at the recommended dose of Remicade experienced closure of at least 50 percent of fistula(s) for four weeks or more compared with 26 percent of placebo-treated patients. More than one-half (55 percent) of patients with single or multiple fistula(s) treated with Remicade experienced a clinical effect demonstrated clinical response to treatment with Remicade developed an abscess in the area of the fistula between eight and 16 weeks after the last infusion.

“Remicade represents a significant advance in the treatment of Crohns disease,” said Stephen Hanauer, M.D., University of Chicago Medical Center, department of gastroenterology, and a principal investigator in the clinical trials. “These patients suffer terribly and we physicians now have an important option available to treat them.”

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