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Crohn's disease is a chronic inflammatory bowel disease that causes ongoing inflammation of the intestinal tract. It is similar to ulcerative colitis, another inflammatory bowel disease. But ulcerative colitis usually is confined to the innermost layer of the large intestine and rectum. Crohn's disease can occur anywhere in the intestine, often in patches surrounded by healthy tissue, and can spread deeper into the tissues. Symptoms include chronic bloody or watery diarrhea, abdominal pain, fever, and loss of appetite. Symptoms tend to come and go, with the disease becoming active or going into remission several times during the person's lifetime.
Crohn's disease can cause intestinal obstructions, ulcers (most often in the lower part of the small intestine, the large intestine, or the rectum), fistulas (hollow passages from one part of the intestine to another), and anal fissures (a crack in the anus or the skin around the anus that can lead to infection). In addition, people with Crohn's disease are at risk of malnutrition, because their intestine cannot absorb all the nutrients they need from their diet.
Crohn's disease affects 2 - 7 out of 100,000 people and researchers believe that these numbers are growing. It develops mostly between the ages of 20 - 40, although children and older adults may also develop the condition. There is no cure for Crohn's disease. Medication and diets can help control the condition and sometimes bring about long term remission. Some people with Crohn's disease will require surgery to remove part of the digestive tract at some point in their lives. However, surgery does not cure the disease.
Signs and Symptoms
The most common signs and symptoms of Crohn's disease are diarrhea and abdominal pain. Symptoms can range from mild to severe.
Crohn's disease can also be associated with other medical conditions, including arthritis, osteoporosis, eye infections, blood clots, liver disease, and skin rashes.
What Causes It?
No one is sure what causes Crohn's disease. Theories include a faulty immune system response triggered by bacteria or a virus; genetics, since about a quarter of people who have Crohn's disease also have a close relative with the disease; and a diet high in saturated fat and processed foods, since Crohn's disease is more common in the developed world. Most likely, several factors may be involved.
What to Expect at Your Provider's Office
Your doctor will perform a thorough physical exam, as well as a series of tests to diagnose Crohn's disease. Blood tests may show anemia (due to a significant loss of blood) and a high white blood cell count (a sign of inflammation somewhere in the body). Stool samples may show whether there is bleeding or infection in the colon or rectum.
The following procedures may help your doctor distinguish between ulcerative colitis, Crohn's disease, and other inflammatory conditions.
Although there is no known way to prevent Crohn's disease, people can usually manage the condition with medication, diet, and lifestyle changes. Exercise can help prevent the stress and depression that often accompany Crohn's disease, and quitting smoking can reduce symptoms. Eating a diet rich in fruit and vegetables can also help ease symptoms.
The primary goal in treating Crohn's disease is to control acute flares of the disease and to maintain remission for as long as possible. The specific type of treatment often depends on how severe the symptoms are. For example, people with mild to moderate symptoms are usually treated with medications that reduce swelling and suppress the immune system. More severe cases may require surgery.
Many people with inflammatory bowel diseases use complementary and alternative remedies in addition to prescription medications. Preliminary studies suggest that lifestyle changes, dietary adjustments (such as eating a rich variety of fruits and vegetables and avoiding saturated fat and sugar), and specific herbs and supplements may be useful additions to treatment.
Many people with Crohn's disease report that stress makes their symptoms worse. Relaxation techniques and mind/body exercises, such as yoga, tai chi, and meditation, are worth considering, particularly when used with other forms of treatment. In addition, studies suggest that hypnosis may improve immune function, increase relaxation, decrease stress, and ease feelings of anxiety.
Exercise helps people with Crohn's disease, both in terms of maintaining health and reducing stress. Exercise is considered safe for people with Crohn's disease, but anyone with a chronic illness should talk to their doctor before starting a new exercise or fitness regimen. It is especially important for people with Crohn's disease to drink water before and during exercise to prevent dehydration. Avoid extreme changes in body temperature during exercise.
Cigarette smoking is a risk factor for Crohn's disease and studies have shown that it may worsen symptoms. If you smoke, you should quit. Ask your doctor for help.
Although medications cannot cure Crohn's disease, they can reduce symptoms and help you control your condition. Sometimes, they can bring on remission of the disease for a while. Medications commonly used to treat Crohn's disease include:
Although surgery will not cure Crohn's disease, 3 - 4people with the condition will eventually have resections (parts of their colons removed) to close fistulas or to remove a severely damaged part of the intestine. In some cases, laparoscopic surgery (which uses a smaller incision) can be done, leading to fewer complications and shorter hospital stays. Strictureplasty, in which a balloon is inserted into the intestine and expanded, is sometimes done when the intestine has become too narrow from scar tissue.
Complementary and Alternative Therapies
People with Crohn's disease often cannot absorb all the nutrients their bodies need, due to damage in the intestine. Or abdominal pain and nausea may make it hard for them to eat. Some medications may also lower important nutrients in the body. For example, sulfasalazine reduces the body's ability to absorb folate, and corticosteroids can reduce calcium levels. Making sure you get enough nutrients is a crucial part of treating Crohn's disease. People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral (intravenous) nutrition.
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.
Vitamins and Minerals
Because of decreased appetite, malabsorption, chronic diarrhea, side effects of medication, and surgical removal of parts of the intestine, many people with Crohn's disease don't get enough of some vitamins and minerals. 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.
Because of the presence of inflammation and the nature of the disease, Crohn's disease should not be treated with herbs alone. However, herbs may be a useful complement to traditional medical treatment. Remember that herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.
The evidence for using herbs to treat Crohn's disease is mostly lacking. Among the herbs that have been used traditionally to treat inflammation within the digestive tract are:
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of Crohn's disease symptoms (such as diarrhea) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each person.
Acupuncture has long been used in Traditional Chinese Medicine to treat inflammatory bowel disease. One study in Germany found that acupuncture and moxibustion were effective specifically for treating Crohn's disease. Acupuncturists treat people with inflammatory bowel disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is sometimes used because it is thought by some to reach deeper into the body than using needles alone.
Women who are in remission at the time of conception generally have normal pregnancies and healthy babies. However, women with active disease are more prone to miscarriages, spontaneous abortions, and stillbirths. Symptoms often get worse during pregnancy. For this reason, women with active Crohn's disease who are or wish to become pregnant should continue medications under the guidance of their doctor. Pregnant women should avoid high doses of vitamins. An obstetrician and/or a nutritionally oriented physician can provide instructions about taking multivitamins during pregnancy and while breastfeeding. Specifically, the herbs cat's claw (Uncaria tomentosa) and turmeric (Curcuma longa) should never be used while breastfeeding, but any herb or supplement should only be used by a nursing mother under the guidance of her physician.
Prognosis and Complications
A number of complications can develop from Crohn's disease. Many can be treated successfully.
Although there is no cure for Crohn's disease, many people with the disease lead active lives by controlling their symptoms with medication. Over time, however, Crohn's disease is less responsive to treatment. It is estimated that 75% of people with Crohn's disease will eventually undergo surgery. About 30% of people who have had surgery for Crohn's disease will require another operation for recurrence within 5 years. In general, morbidity and mortality rates are higher for people who have Crohn's disease compared to the unaffected population.
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Review Date: 12/31/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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