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Posts Tagged ‘Crohn S Disease’
Crohns Disease
It is also known as regional enteritis is a chronic, episodic, inflammatory bowel disease (IBD) that affects any part of the entire wall of the bowel or intestines. Crohns disease can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohns disease vary among afflicted individuals.
The disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody, though this may not be visible to the naked eye), constipation, vomiting, weight loss or weight gain. Crohns disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.
The disease was independently described in 1904 by Polish surgeon Antoni Lesniowski and in 1932 by American gastroenterologist Burrill Bernard Crohn, for whom the disease was named. Crohn, along with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness.
Crohns disease affects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohns disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age. Although the cause of Crohns disease is not known, it is believed to be an autoimmune disease that is genetically linked. The highest relative risk occurs in siblings, affecting males and females equally. Smokers are three times more likely to get Crohns disease.
Unlike the other major types of IBD, there is no known drug based or surgical cure for Crohns disease. Treatment options are restricted to controlling symptoms, putting and keeping the disease in remission and preventing relapse. Crohns disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932.
It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis. Crohns disease tends to be more common in relatives of patients with Crohns disease. It also is more common among relatives of patients with ulcerative colitis. Crohns disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis.
Together, Crohns disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohns disease have no medical cure.
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Crohns Disease Foods
Although diet cannot cause or cure Crohns disease, some studies suggest that people who eat foods high in saturated fat and sugar or who eat processed foods may be more likely to develop the disease. Certain foods may also reduce symptoms and make recurrences of the disease less likely.
• Eating fruits and vegetables, lowering fat, and eliminating sugar may reduce the risk of developing Crohns disease. Although a low-fiber diet is one of the risk factors for developing Crohns disease, some people with Crohns disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables rather than eating them raw, and avoid high fiber fruits such as apples.
• Certain foods may aggravate symptoms of Crohns disease – most often, dairy products, fats, and spicy foods. People with Crohns disease may want to avoid these foods.
• Eat five or six small meals a day.
• If symptoms are severe, an elemental diet may be recommended. Elemental formulas are liquid diets that contain only the basic building blocks of food and need not be broken down into smaller substances along the digestive tract.
Some people find it difficult to stick to an elemental diet, but after a period of time, often other foods can be reintroduced. One study suggests that adding omega-3 fatty acids to an elemental diet may boost its nutritional content and make it more likely that people with Crohns disease will adhere to it.
Because of decreased appetite, malabsorption, chronic diarrhea, side effects of medication, and surgical removal of parts of the digestive tract, many people with Crohns disease have vitamin and mineral deficiencies. In particular, people with Crohns disease may lack adequate vitamin D, B12, and K, plus folic acid, calcium, and zinc. Your doctor may recommend that you take a multivitamin daily. Zinc (25 mg), folic acid (800 mcg), vitamin B12 (800 mcg) — These vitamins are used by the body to repair cells in the intestine.
In addition, drugs such as sulfasalazine and methotrexate may case levels of folic acid in the body to drop, requiring supplementation. Vitamin D (1,000 IU per day) — is necessary to maintain strong bones. People with Crohns disease, especially those who take corticosteroids, often have low levels of vitamin D and are at risk for osteoporosis. Fish oil (2.7 g per day) — Omega-3 fatty acids found in fish oil may help fight inflammation and reduce the chances of recurrence, but studies have been mixed. The study with the most positive results used a special type of fish oil – “enteric-coated free-fatty-acid form” – that is not sold commercially.
Some researchers suggest that measuring the blood levels of different types of fatty acids may help determine if fish oil would be useful. Do not take high doses of a fish oil supplement if you take blood-thinning medication.
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Crohns Disease Prognosis
Crohns disease is a life-long illness. The severity of the disease can vary, and a patient can experience periods of time when the disease is not active and he or she is symptom free. However, the complications and risks of Crohns disease tend to increase over time. Well over 60% of all patients with Crohns disease will require surgery, and about half of these patients will require more than one operation over time. About 5-10% of all Crohn’s patients will die of their disease, primarily due to massive infection.
Endoscope
A medical instrument that can be passed into an area of the body (the bladder or intestine, for example) to allow examination of that area. The endoscope usually has a fiber-optic camera that allows a greatly magnified image to be shown on a television screen viewed by the operator. Many endoscopes also allow the operator to retrieve a small sample (biopsy) of the area being examined, to more closely view the tissue under a microscope.
Fistule
An abnormal channel that creates an open passageway between two structures that do not normally connect.
Gastrointestinal tract
The entire length of the digestive system, running from the stomach, through the small intestine, large intestine, and out the rectum and anus.
Immune system
The body system responsible for producing various cells and chemicals that fight infection by viruses, bacteria, fungi, and other foreign invaders. In autoimmune disease, these cells and chemicals turn against the body itself.
Inflammation
The result of the body’s attempts to fight off and wall off an area that is infected. Inflammation results in the classic signs of redness, heat, swelling, and loss of function.
Obstruction
A blockage.
Ulceration
A pitted area or break in the continuity of a surface such as skin or mucous membrane.
Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.)
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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Constipation and Crohns Disease
Constipation in Crohns disease is usually a symptom of obstruction in the small intestine. Constipation can be a symptom of UC, but not as common as diarrhea. Can occur during flare-ups. May occur when the inflamed rectum triggers a reflex response in the colon that causes it to retain the stool.
Patients with irritable bowel syndrome often have fluctuating symptoms over long periods of time. Patients may experience gas, bloating, dyspepsia, constipation, diarrhea, flatus, diarrhea alternating with constipation, and the passage of mucous in the stools. Crampy abdominal pain may be present. It is the goal of physicians to assess these complex symptoms and address these complaints by performing appropriate medical tests.
Patients with constipation predominant irritable bowel syndrome should be treated with an increase in fiber. If the fiber content of their stool is increased and patients continue to experience constipation, addition of non-stimulant laxatives can be instituted. These are stool softeners, such as Colace or Surfak. Others such as milk of Magnesia or lactulose may be useful.
Patients with constipation, and the above complaints, are usually not treated with tricyclic antidepressants because of the possibility of exacerbating their constipation. Constipation means different things to different people. For many people, it simply means infrequent stools.
For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these “types” of constipation probably is different, and the approach to each should be tailored to the specific type of constipation. Crohn’s disease, ulcerative colitis, chronic constipation, GERD, irritable bowel syndrome, dyspepsia and other gastrointestinal problems can cause pain, discomfort, adverse complications and disruption of your normal activities.
Clinical trials allow you to play an active role in your healthcare and give you access to new research treatments before they are available to the general public. Mitamins custom make quality formulas for the treatment of Constipation & Crohn’s Disease with vitamins. A Constipation & Crohn’s Disease formula will be made to suit you, using quality brand name ingredients. Mitamins produce custom made vitamin and supplement formulas to suit your individual health needs conveniently in one formula, one bottle and one dosage. Constipation is a symptom of Crohn’s disease but it’s not as common as diarrhea. It often occurs during a flare up, and is characterized by having a bowel movement less than three times within a week.
Constipation can be very uncomfortable and cause bloating, straining and the feeling of a full bowel.Constipation is quite common, and is something the average person experiences regardless if they suffer from an inflammatory bowel disease (IBD), or other digestive condition. Constipation results when the colon absorbs too much water from the waste material or the colon’s muscle contracts slowly or is sluggish. This causes stool to dramatically slow down on its journey through the colon.
The outcome of constipation is often dry, hard, pebble-like stool that is difficult to pass. Causes of constipation may differ depending on the person. For instance, while constipation may be a result from a poor diet in one person, it could be the result of taking medication in another. Therefore, in order to treat constipation, a Crohn’s sufferer should first learn about the most common causes of constipation and then assess their condition.
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Colitis Ulcerosa
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. The disease may be triggered in a susceptible person by environmental factors. Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors. Although ulcerative colitis is treated as though it were an autoimmune disease, there is no consensus that it is such.
Treatment is with anti-inflammatory drugs, immunosuppression (suppressing the immune system), and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease. Ulcerative colitis is a relatively uncommon, chronic, recurrent inflammatory disease of the colon or rectal mucosa. Often a lifelong illness, the condition has profound emotional and social impact on the affected individual. Ulcerative colitis is defined as continuous idiopathic inflammation of the colonic or rectal mucosa.
The rectum is involved in more than 95% of cases. Some authorities believe that the rectum is always involved in an untreated patient. Partial healing may occur in a patient treated with topical therapy, creating diagnostic confusion. Ulcerative colitis occurs more frequently in white people. The incidence of ulcerative colitis is reported to be 2-4 times higher in Jewish people. However, recent population studies in North America do not completely support this assertion. Ulcerative colitis seems to have a female preponderance. Ulcerative colitis affects 30% more females than males. The incidence of ulcerative colitis peaks in people aged 15-25 years and in people aged 55-65 years, although it can occur in people of any age.
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Colitis and Crohns
Inflammatory bowel disease, or IBD, describes two similar yet distinct conditions called Crohns disease and ulcerative colitis. These diseases affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily. Symptoms include abdominal pain, cramping, fatigue and diarrhea.Crohns disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Patches of inflammation occur, with healthy tissue between the diseased areas.
The inflammation can extend through every layer of affected bowel tissue. Crohns disease can not be cured by drugs or surgery, although either or both can help relieve symptoms.Ulcerative colitis affects only the inner layer of the colon, or large bowel. It always starts in the rectum and may extend as a continuous inflammation from there into the rest of the colon. Usually ulcerative colitis can be controlled with medication. The disease can be completely eliminated by surgically removing the colon, but afterward, waste material may have to be stored and expelled through an external appliance.
While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohns disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.The patterns of inflammation in Crohns disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform. (All of the lining in the affected segment of the intestine is inflamed.) Unlike ulcerative colitis, the inflammation of Crohns disease is concentrated in some areas more than others and involves layers of the bowel that are deeper than the superficial inner layers. Therefore, the affected segment(s) of bowel in Crohns disease often is studded with deeper ulcers with normal lining between these ulcers.
The most common disease that mimics the symptoms of Crohns disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
Currently there is no cure for Crohns disease and remission may not be possible or prolonged if achieved; in cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes and in some cases, surgery. Adequately controlled, Crohns disease may not significantly restrict daily living. Treatment for Crohns disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.
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Celebrities With Crohns
Singer Anastacia was diagnosed with Crohns disease at age 13 and with breast cancer at age 29, but she has resolved to let neither disease defeat her. Her two albums, Not That Kind and Freak of Nature have earned a total of 42 platinum albums. She is an international sensation and has won several awards including awards as MTV Europe’s Best Pop Artist and Best New Artist at the World Music Awards.
Born in Chicago, Anastacia was introduced to the entertainment business at an early age by her parents; her father is a singer and her mother an actress. Anastacia started her career as a dancer in music videos and on Club MTV. She landed a recording contract with Epic Records after singing on MTV’s The Cut. Anastacia co-wrote the songs on her second album and has performed with legends such as Elton John and Luciano Pavoratti.Instead of being embarrassed by, or hiding her disease, Anastacia speaks openly about Crohns disease and the profound influence it has on her life and her music. She does not hide the scars on her abdomen, a reminder of the surgery she had for Crohn’s when she was just 13 years old. She feels that her disease helps her to understand herself and her motivations. Crohn’s also inspires her to live her life to the fullest.heoren
(Theo) Fleury was picked 188th in the 1987 National Hockey League draft. In the 1998-99 season, he scored 53 assists, the six highest number of assists in the league. He placed seventh in the league for goals and points, with 40 and 93, respectively.He was acquired as a free agent by the Rangers in July, 1999. At 5 foot 6 inches tall, he has become a role model for hockey players under 6 feet tall (6 feet considered to be the standard size for the NHL).
Theo is known for his fiestiness on the ice, and his determination. Diagnosed with Crohn’s Disease in 1996, he has been determined not to let the disease rule his lifeUnfortunately, on April 11, 2003, Theo was suspended indefinitely by NHL for violating the terms of his substance abuse aftercare program. He played the 2005-06 season with the Belfast Giants of the British Elite Ice Hockey League, and was named 2006 Kingdom of the Giants Most Valuable Player, but decided not return for the 2006-07 season.
Mike McCready, the lead Guitarist for the very popular rock band Pearl Jam, suffers from Crohns disease. Mike has admitted that, at times, the pain and associated urgency is so great that it affects his ability to perform on stage.
Mike has suffered with Crohns disease since the age of 15, and at times has taken up to 140 pills a week. He kept his disease hidden for several years as his band became popular. In 2003 Mike decided to become a spokesperson for the Crohn’s and Colitis Foundation of America (CCFA) after realizing that the disease affects so many children.Since going public, Mike has made numerous personal appearances and has donated signed guitars and other items to raise funds for the CCFA. Most recently, Mike has made a public service announcement that has been distributed to 1,250 radio stations across the United States.
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Can You Die From Crohns
Crohns disease is a condition where there is inflammation in the gut. The disease flares up from time to time. Symptoms vary, depending on the part of the gut affected. Medication can often ease symptoms when they flare-up. Surgery to remove sections of the gut is needed to treat some flare-ups. Medication taken each day may prevent symptoms from flaring-up.
IF YOU HAVE Crohns disease, you probably already know the bad news: The illness is incurable. If you’re a vegetarian with Crohn’s, the news is even more distressing: The standard medical solution often includes eating meat. Fortunately, though, there is hope. Natural medicine can help you control this potentially debilitating condition, in many cases without becoming a meat eater.
PATRICK DONOVAN, N.D., a naturopathic physician in private practice as well as a professor of gastroenterology at Bastyr University of Natural Health Sciences in Seattle, has seen several dozen cases of Crohns disease in the past 10 years. Donovan is quick to point out that allopathic medicine plays an important role in managing the disease. “There’s a place for prednisone and hospitalization when treating Crohn’s,” says Donovan. “A person can die from this disease, especially during a flare-up. Conventional treatments can save lives.”
In fact, Donovan will treat only those Crohn’s patients who are also seeing a physician with hospital privileges. He also stresses the need for a correct diagnosis. He recently saw a patient who had been treated unsuccessfully for Crohn’s for 10 years; he determined that she in fact had celiac disease, a condition in which gluten, a protein found in various grains, damages the intestinal lining. Crohns disease cannot be prevented but you can reduce your symptoms. We know living with Crohns disease or ulcerative colitis can be difficult, but the right resources and support can make day-to-day living easier.
Crohn’s Disease is not normally fatal, however complications from the disease could be fatal if not seen to. These could be due to infection. Such as a perforated bowel if medical attention to it is not sought out quickly enough. About 1 in 1500 people have Crohns disease. It can develop at any age but most commonly starts between the ages of 15 and 40. It affects women slightly more often than men. The myth was created by the medical system to allow them to profit from those who are chronically ill. The cause and cure remain perpetually just beyond reach.
All they need is more money to keep looking. The elusive search for the cause and cure for Crohns disease is as futile as the elusive search for the cause and cure for Multiple Sclerosis. There is no need to search any further than the word toxicity, the one place the medical profession never looks. That is the smoking gun.
Look where they are not looking and you’ll find it. I was struck down by Crohns disease in the summer of 1993 when I was 44. I nearly died in 1994. I believe the name of an illness should help the person who has it to understand what he or she has, not to disguise the nature of the illness, which is what disease names usually do. Crohn was the name of the doctor who observed and described the disease. He gave his name to it. But, unfortunately, the word Crohn explains absolutely nothing about the nature of the condition.
It merely tells us the name of the person who claimed it for his own and, like Alzheimer and Parkinson and Hodgkin and so many other disease names. Disease naming actually keeps us in the dark. In my opinion, Crohns disease is caused by toxicity. In my case the intestines were poisoned by mercury leaching into the digestive tract from my mercury fillings. The body eliminates mercury extremely slowly. Chelation is the only way to effectively remove mercury at a rate that will allow the body to recover from disease. 90% of the mercury that is excreted from the body is eliminated through the intestines. When it is not eliminated quickly via chelation it is allowed to accumulate in the intestines where it causes tissues to become diseased through mercury poisoning. Mercury destroys the tissues and attracts parasites, unfriendly bacteria and fungus which contribute to toxicity in the intestines.
In my opinion, it would be more helpful if Crohns disease were called Toxic Intestinal Disease (TID). It is not easy to understand “we don’t know the cause, we don’t have a cure”, so we’ll name it after Dr. Crohn. But it is very easy to understand the word toxicity. Toxicity means poisoning.
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Alternative Crohns Disease Treatment
The main treatment for Crohns disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery.
The type of symptoms you have and how bad they are will determine the treatment you need. Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohns disease. Antibiotics such as ciprofloxacin and metronidazole may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon.
Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped. Corticosteroids (such as budesonide or prednisone) may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection. Budesonide causes remission in mild or moderate Crohns disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.
Prednisone may help if budesonide does not. Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.
If you have tried all the medicines listed above and none of them have worked, your doctor may give you a tumor necrosis factor (TNF) antagonist such as infliximab (Remicade). This drug may work for people who have not had any success with other medicines for Crohns disease. Infliximab is also used to treat fistulas if antibiotics do not heal them. Another TNF antagonist that may be used to treat Crohns disease is adalimumab (Humira). It may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.
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Can Viagra Help Crohns Disease
While well known for its effect on blood flow, until now Viagra has not been used to boost circulation in the intestine. That could change with the finding that Viagra can help treat Crohns disease. People with the long-term, inflammatory condition develop holes and ulcers in the intestine.
A team from University College London wondered whether an overactive immune reaction was the problem.The team carried out biopsies on six Crohns disease patients and nine healthy volunteers. The operation triggered an acute immune response in the healthy people, producing white blood cells to heal damage caused by the removal of cells. But the Crohn’s patients responded by producing far lower amounts of white blood cells. The researchers used Viagra to boost blood flow to the intestine in the patients with Crohns disease, thus increasing the flow of white cells to the damaged area.
Researchers in the U.K. have a new theory to explain the cause of Crohns disease, and they say medications like the erectile dysfunction drug Viagra may prove useful for treating the bowel disorder if they are right.In Crohns disease, chronic inflammation causes ulcers within the digestive tract that can lead to severe gastrointestinal symptoms, including abdominal pain, persistent diarrhea, and rectal bleeding.The most widely accepted theory is that an overactive immune system causes the damaging inflammation.
But researchers from the University College London say the opposite appears to be true.They believe a weaker-than-normal immune response triggers the bowel inflammation that leads to Crohns disease. The researchers tested this theory by treating 10 Crohn’s patients with 50 milligrams of Viagra after injecting them with the killed gut bacteria. They found that blood flow to the infected area improved.
“Increasing blood flow is an important part of the inflammatory response, and that is why this drug may work,” Segal says. “But we don’t yet know if this will give rise to successful treatment. We need to study this further to find out.” The disease usually affects the small intestine and one in every thousand people in the UK is afflicted with this miserable complaint.
But now scientists believe they have found the cause of Crohns disease, and they think it could be treated with Viagra.The team of researchers from University College London say they believe the cause is the opposite of what has been supposed and is triggered by a weak immune system, rather than an overactive one where cells are attacked by the body’s own immune system.
Crohn’s was previously thought to be an auto-immune disease and was treated with immuno-suppressant drugs. But the researchers led by Anthony Segal and colleagues have discovered that people with Crohn’s have a weak and unresponsive immune system which does not repair damage easily. They say the flow of blood to damaged cells is substantially reduced, and a drug such as Viagra, best known for its effects on erectile dysfunction, could help the healing process as it stimulates blood flow.
Since it was identified in the 1920s there have been many theories as to the cause of Crohn’s and it was often compared with tuberculosis, but attempts to find an infectious agent have failed.
The research team compared the immune system response of Crohn’s patients and healthy individuals to minor injuries, such as skin abrasions and discovered a difference in the number of white blood cells called neutrophils produced by the body to heal the damage in the bowel and on the surface of the skin.
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