Crohns Disease Causes » Risk Factors http://crohnsdiseasecauses.com Help, Cures and Support for Crohns Disease Sun, 13 Jun 2010 21:07:04 +0000 en hourly 1 http://wordpress.org/?v=3.0.4 Pseudomembranous Colitis http://crohnsdiseasecauses.com/pseudomembranous-colitis/ http://crohnsdiseasecauses.com/pseudomembranous-colitis/#comments Fri, 16 Apr 2010 04:57:00 +0000 Dr Joe Stevenson http://crohnsdiseasecauses.com/?p=162 Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression “C. diff colitis” is used almost interchangeably with the more proper term of pseudomembranous colitis.

The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can besevere,causing toxic megacolon, or even fatal. The use of broad-spectrum antibiotics such as clindamycin and cephalosporins causes the normal bacterial flora of the bowel to be altered. In particular, when the antibiotic kills off other, competing bacteria in the intestine, any bacteria remaining will have less competition for space and nutrients there.

The net effect is to permit much more extensive growth than normal of certain bacteria. Clostridium difficile is one such type of bacterium. In addition to proliferating in the bowel, the C. diff also elaborates a toxin. It is this toxin that is responsible for the diarrhea which characterizes pseudomembranous colitis. n most cases a patient presenting with pseudomembranous colitis has recently been on antibiotics.

Antibiotics disturb the normal bowel bacterial flora. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition. Even though they are not particularly likely to cause pseudomembranous colitis, due to their very frequent use cephalosporin antibiotics (such as cefazolin and cephalexin) account for a large percentage of cases.

Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors. Other risk factors include increasing age and recent major surgery. There is some evidence that proton pump inhibitors are a risk factor for pseudomembranous colitis, but others question whether this is a false association or statistical artifact (increased PPI use is itself a marker of increased age and co-morbid illness).; indeed, one large case-controlled study showed that PPI’s are not a risk factor.

Recently, evidence has emerged to suggest that the use of ciprofloxacin (in addition to a primary causative antibiotic such as clindamycin) is associated with increased mortality in patients with pseudomembranous colitis.)

As noted above, pseudomembranous colitis is characterized by diarrhea, abdominal pain, and fever. Usually, the diarrhea is non-bloody, although blood may be present if the affected individual is taking blood thinners or has an underlying lower bowel condition such as hemorrhoids. Abdominal pain is almost always present and may be severe.

So-called “peritoneal” signs (e.g. rebound tenderness) may be present. “Constitutional” signs such as fever, fatigue, and loss of appetite are prominent. In fact, one of the main ways of distinguishing pseudomembranous colitis from other antibiotic-associated diarrheal states is that patients with the former are sick.

That is, they are often prostrate, lethargic, and generally look unwell. Their “sick” appearance tends to be paralleled by the results of their blood tests which often show anemia, an elevated white blood cell count, and low serum albumin.

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]]> http://crohnsdiseasecauses.com/pseudomembranous-colitis/feed/ 0 Crohns Disease Foods http://crohnsdiseasecauses.com/crohns-disease-foods/ http://crohnsdiseasecauses.com/crohns-disease-foods/#comments Wed, 12 Aug 2009 15:45:21 +0000 Dr Joe Stevenson http://crohnsdiseasecauses.com/?p=48 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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