Thirty-two years ago Ginger Gray walked into her doctor’s office complaining of abdominal pain, diarrhea, severe weight loss, and overwhelming joint pain. At 19, she hadn’t grown an inch since the sixth grade. But her doctor said there was nothing physically wrong with her, and even suggested she seek psychiatric counseling.

Fortunately for Gray, she sought another physician’s opinion.

Based on tests he conducted, the doctor recommended the 4-foot-11-inch Pennsylvania resident begin full-time treatment for Crohn’s disease.”Crohn’s disease robbed me of my stamina,” Gray says. “It took two years for me to fully regain my strength and weight so that I could begin working again.”Until now, treatment for Crohn’s has relied on surgery and anti-inflammatory and other drugs also used to treat other conditions.

In August 1998, the Food and Drug Administration licensed the first treatment specifically for Crohn’s disease, an incurable and sometimes debilitating inflammation of the bowel.Remicade (infliximab) is a genetically engineered antibody that blocks inflammation caused by a protein called tumor necrosis factor. After clinical trials showed benefit from Remicade treatment within a two-to-four week period following a single dose, FDA approved the drug for patients with moderate to severe Crohn’s disease who have not found relief with other treatments.

“We recognized that [Remicade] had such a dramatic effect on patients,” says Barbara Matthews, M.D., a medical officer in FDA’s Center for Biologics Evaluation and Research, “that it was given accelerated approval.”Remicade, which is taken intravenously, can decrease the amount of inflammation along the lining of the intestine.

Clinical trials also show that Remicade is effective in closing fistulas (abnormal passages or sores between the bowel and skin). Although not a cure, the drug reduces the symptoms in patients who have not responded well to traditional treatments.”This is an exciting development for two reasons,” says R. Balfour Sartor, M.D., professor of medicine, microbiology and immunology at the University of North Carolina, and chairman of the National Scientific Advisory Committee for the Crohn’s & Colitis Foundation of America (CCFA). “It is the first therapy for Crohn’s disease derived by molecular techniques, and it has the possibility of improving the quality of life for [Crohn's] patients.”

But Sartor also cautions that the long-term toxic effects of Remicade are unknown and that the drug is not needed by every Crohn’s disease patient. “Two-thirds of the people will have near immediate results,” he says, “but only those patients who do not respond to other therapies” are eligible to take the drug. The next step is to maintain a patient’s remission after the drug’s initial effect has worn off.

Currently, studies are being done to better define the risks and longer-term benefits of Remicade because drug reactions and potential adverse effects from suppressing tumor necrosis factor require further clarification. Crohn’s disease is one of two major types of inflammatory bowel diseases (IBD)–the general term for diseases that cause inflammation in the intestines–and has no cure and a high rate of recurrence following treatment.

It usually occurs in the lowest portion of the small intestine (ileum), and the large intestine (colon or bowel), but it can occur in other parts of the digestive tract. Crohn’s usually involves all layers of the intestinal wall.

The disease can be difficult to diagnose because its symptoms, which include chronic diarrhea, crampy abdominal pain, loss of appetite, and weight loss, often mimic those of the other IBD type–ulcerative colitis–which affects only the colon. (See “Is It Crohn’s Disease?”)

Although diet cannot cause or cure Crohn’s 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 Crohn’s disease. Although a low-fiber diet is one of the risk factors for developing Crohn’s disease, some people with Crohn’s 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 Crohn’s disease – most often, dairy products, fats, and spicy foods. People with Crohn’s 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 Crohn’s 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 Crohn’s disease have vitamin and mineral deficiencies. In particular, people with Crohn’s 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 Crohn’s 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.

The main treatment for Crohn’s 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 Crohn’s 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 Crohn’s 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 Crohn’s disease. Infliximab is also used to treat fistulas if antibiotics do not heal them. Another TNF antagonist that may be used to treat Crohn’s 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.

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 Crohn’s 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 Crohn’s 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 Crohn’s 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 Crohn’s disease, and they say medications like the erectile dysfunction drug Viagra may prove useful for treating the bowel disorder if they are right.In Crohn’s 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 Crohn’s 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 Crohn’s 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.