Chron’s Disease

According to the Crohn’s and Colitis Foundation of America (2012), there are over 700,000 people in the United States that are currently affected by the debilitating illness known as Crohn’s disease. This disease was originally named after the American physician, Dr. Burrill Crohn, who first described it in 1932 as “a chronic inflammatory bowel disease of unknown origin, usually affecting the ileum, the colon, or another part of the GI tract” (Zonderman & Vender, 2000, p. 3). After Dr.

Crohn and his collages made this discovery, Crohn’s disease gained the attention of researchers worldwide in hope to gain a better understanding as to why or how this inflammatory bowel disease develops. Typically, when the inflammatory response is initiated in the body, there is a precipitator or cause; but with Crohn’s disease, this has yet to be discovered. Despite researchers unsuccessful attempts in finding the exact cause of Crohn’s disease, many believe it is initiated by an inappropriate immune response that creates inflammation in individuals who are genetically predisposed (Zonderman & Vender, 2000).

This inflammation occurs in the gastrointestinal tract, mainly in the ileum (end of the small intestine) or the colon (large intestine), where it has the potential to go through the thin mucosa lining and involve the full thickness of the bowel wall, making it very painful for the individual. These inflamed and diseased areas may be discontinuous, separated by segments of healthy intestine, giving it a “cobblestone” appearance (Potter, 2004, p. 10).

According to Zonderman and Vender (2000), this is what helps categorize the Crohn disease in one of the three forms; inflammatory (may cause an inflammatory mass), obstructing (intestinal opening is closed off possibly due to scar tissue), or fistulizing (loops of bowel are connected by a fistula). When it comes to Crohn’s disease, the modifiable and nonmodifiable risk factors an individual should be concerned with include one’s environment, age, ethnicity, family history, and smoking. According to Potter (2004), Crohn’s disease has a tendency to be more prevalent in industrialized or urban areas and among individuals who use tobacco, but the exact reasoning for this is still not fully understood.

What researchers do understand is that genetics and age may play a key role in determining risks for acquiring Crohn’s disease. There is about a 30 percent higher risk of developing Crohn’s if a parent, sibling, or child has the disease. It mainly develops in individuals before the age of 30 or between the ages of 50 to 70, and puts the people of Jewish heritage of European descent to have the highest incidence (Zonderman & Vender, 2000, p. 31).

The clinical symptoms of Crohn’s disease vary from person to person and from mild to severe. According to Zonderman and Vender (2000), there are three classical manifestations to look for in individuals that may be suffering from inflammatory bowel disease, such as Crohn’s; diarrhea, pain, and fever (p. 5). First, if one’s diarrhea persists longer than a few days, this is something to be concerned about. Knowing how many days the diarrhea has persisted, the time of day it mainly occurs, and the characteristics are key things to determine as to why it may be occurring.

Second, pain may be an indicator of where within the bowel the disease is located, which may also indicate the severity of the disease. Third, if one has a fever, it is usually very mild, but it can cause one to become irritable or have “night sweats” which may also be good indicators if one is suffering from symptoms of an inflammatory bowel disease (p. 8). Other signs and symptoms may include nausea, appetite loss, fatigue, joint pain, weight loss, and malabsorption, which can also lead to malnutrition (p. 9). Unfortunately, people with Crohn’s disease may be misdiagnosed a few times before they actually have a diagnosis of Crohn’s disease.

This is due to similarity of symptoms in other diseases such as appendicitis, irritable bowel syndrome, and especially ulcerative colitis, which is the “sister” disease of Crohn’s, only differing in a few characteristics (Wood, 2006, p. 86). With this being said, if one believes they are at risk and are presenting the signs and symptoms of Crohn’s disease, diagnostic procedures may be necessary in order to correctly diagnose an individual. These diagnostic procedures may include a sigmoidoscopy, colonoscopy, barium enema, upper-GI X-Ray, blood test, endoscopy, or a stool test (p.85).

Complications from Crohn’s disease can fall into two categories; local problems that occur in the digestive tract and systemic issues that affect other parts of the body. The main complications that occur include strictures, obstructions, fistulas, perforation of the bowel, and toxic megacolon (Potter, 2004, p. 17). One of the most common complications is forming a stricture, which is a narrowed segment of intestine usually caused by scarring from inflamed tissue that may be identified through and X-ray or endoscopy.

Another common complication of Crohn’s disease are fistulas, which occur when the ulcerations extend completely through the intestinal wall and form a channel from one section to another. These form when the intestine grows so thick from inflammation that it gets to close to another organ it causes a small passage to open and connect the two (p. 17). Since there is still no total cure for Chron’s disease, using a combination of treatments is the best way to maintain and manage one’s symptoms.

Beginning with medical treatments, the immediate goal is to reduce the number of symptoms or flare ups one may be experiencing in order to bring on a remission. Once this has been established then the goal shifts to maintaining the disease activity at the lowest possible level in order for the person to have a reasonably good quality of life (Zonderman & Vender, 2000, p. 57). Regarding medical treatment there are four groups of drugs that are generally used to treat Crohn’s disease; 5-aminosalicylate compounds, corticosteroids, immunosuppressives, and antibiotics.

When the standard treatments do not keep the symptoms under control then the doctors may turn to biologics, drugs made from the products of living organisms. Biologics like Infliximab (Remicade), made from human and mouse antibodies, block the production of a chemical called TFN-alpha, which is responsible for inflammation (Potter, 2004, p. 43). If pharmacological agents cannot manage symptoms then surgery may need to be done. Unfortunately, surgery for Crohn’s disease is not curative, only corrective of an immediate complication. Emergency surgeries may need to be done when there is a perforation, toxic megecolon, or bleeding.

Reasons for urgent surgery may include subtotal obstruction, fistulas, or for abscesses that do not respond quickly enough to medical treatment ( Zonderman & Vender, 2000, p. 72). About 75 percent of people with Crohn’s disease eventually need surgery in one of two ways, a strictureplasty to open up a narrowed passageway in the bowel or a resection to totally remove the diseased tissue. Mainly a partial intestinal resection with reanastomosis (reconnection) is the preferred surgery in order to preserve as much of the intestine as possible (p. 73).

While pharmacological interventions may be the main treatments, there are also many non-pharmacological interventions that may help an individual with Crohn’s disease live a better life. There are some people who have had tremendous luck with more natural remedies such as fish or flaxseed oil and zinc supplements as a way to combat inflammation. Also some may benefit from diet additions and modifications like adding probiotics and antioxidants, eliminating alcohol and milk, avoiding greasy fatty foods, and adding psyllium fiber in many cases (Potter, 2004, p.59).

Crohn’s disease is a chronic illness that affects not only the physical aspects of ones life but also the psychological and emotional. Patients deal with issues such as issues self-image, stress and fear of the ramifications of the disease in the future, the physical side effects that may occur, management of medications, numerous doctor visits, and the uncertainty of living with a lifelong illness. It is important to have regimens in daily living to help deal with the long-term stress on the mind and body (Potter, 2004, p.74).

Getting enough sleep, sticking to a diet that works for the individual, taking supplements to ensure one is getting enough nutrient, avoiding smoking, ibuprofen, and aspirin and getting some daily exercise are all helpful in managing a life with Crohn’s disease (p. 90). Those with chronic illnesses such as Crohn’s disease usually feel anger, disbelief, fear, resignation and depression, which may mean they need some type of counseling in order to deal with the difficult feelings.

It will also be beneficial to have a strong support group from family and friends to help an individual make it through the hard times because even though the person with Crohn’s is constantly managing their health issues, the families life is extremely affected also. The patients spouse and children plans can constantly change because of flare ups, hospitalizations, and surgeries which can put a lot of stress on the individual and their family (p. 94). Living with Crohn’s disease can be incredibly challenging and debilitating.

This chronic inflammatory disease of the intestines where the persons own immune system attacks itself and causes inflammation and tissue damage is one of unknown cause and unknown cure. The symptoms come and go and there are effective medications that can help to control the activity of the disease in most cases, but a person living with Crohn’s disease must learn to take it one day at a time. Educating themselves and seeking out others with the disease could be the best therapy. Knowing others are struggling with similar issues and finding out some helpful strategies can help to alleviate anxiety and fear of living with a chronic illness.

Hopefully, with a better understanding of the role of genetics and environmental factors, researchers will be able to find a way of preventing Crohn’s disease some day in the future.

Reference Page Geswell, R. (2012). What is crohn’s disease? Retrieved from http://www. ccfa. org/what-are- crohns-and-colitis/what-is-crohns-disease/ Miskovitz, P. F. , & Betancourt, M. (2005). The doctor’s guide to gastrointestinal health: preventing and treating acid reflux, ulcers, irritable bowel syndrome, diverticulitis, celiac disease, colon cancer, pancreatitis, cirrhosis, hernias and more.

Hoboken, NJ: Wiley. Potter, C. (2004). Coping with crohn’s disease and ulcerative colitis. New York, NY: Rosen Publishing Group. Wood, G. K. (2006). The complete guide to digestive health: Plain answers about IBS, constipation, diarrhea, heartburn, ulcers, and more. Peachtree City, GA: FC&A. Zonderman, J. , & Vender, R. S. (2000). Understanding crohn disease and ulcerative colitis. Jackson, Mississippi. University Press of Mississippi Jackson.

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