Crohn's Disease Health Article

Diagnosis

Diagnosis is first suspected based upon a patient's symptoms. Blood tests may reveal an increase in certain types of white blood cells, an indication that some type of inflammation or infection is occurring in the body. The blood tests may also reveal anemia and other signs of malnutrition due to malabsorption (low blood protein; variations in the amount of calcium, potassium, and magnesium present in the blood; changes in certain markers of liver function). Stool samples may be examined to make sure that no infectious agent is causing the diarrhea, and to see if the waste contains blood.

A colonoscopy may be performed to view the interior of the colon. During colonoscopy, a doctor passes a flexible tube with a tiny, fiber-optic camera device (an endoscope) through the rectum and into the colon. The doctor can then carefully examine the lining of the intestine for signs of inflammation and ulceration that might suggest Crohn's disease. A tissue sample (a biopsy) of the intestine can also be taken through the endoscope to examine under a microscope for evidence of Crohn's disease.

Both an upper and lower GI (gastrointestinal) x ray series can be helpful in determining how much of the intestine is involved in the disease. In the upper GI (also called a small bowel series), the patient drinks a chalky solution called barium, which acts as a contrast agent to illuminate the gastrointestinal tract on x-ray film. After the barium is ingested, x rays are taken at specific time intervals as the barium passes through the stomach and into and through the small intestine. The lower GI series provides an x-ray study of the large intestine. The patient is given an enema containing barium, and in some cases, air is also pumped into the rectum to provide a clearer view of the large intestine. This is called a double-contrast barium enema.

Treatment

Crohn's disease is a chronic, often progressive, illness. A correct diagnosis and appropriate treatment with anti-inflammatory medications is critical to controlling the disease.

Some Crohn's patients find that certain foods are hard to digest, including milk, large quantities of fiber, and spicy foods. Dietary adjustments are usually necessary to minimize pain, diarrhea, and other symptoms.

Acupuncture and guided imagery may be useful tools in treating any pain associated with Crohn's disease. Acupuncture involves the placement of thin needles into the skin at targeted locations on the body known as acupoints in order to harmonize the energy flow within the human body. To treat chronic pain, such as that involved with Crohn's disease, an acupuncturist will frequently place the acupuncture needles along what is known as the large intestine meridian.

Guided imagery involves creating a visual mental image of one's pain in one's mind. Once the pain can be visualized, the patient can adjust the image to make it more pleasing, and thus, more manageable.

Several herbal remedies are also available to lessen pain symptoms and promote relaxation and healing. These include peppermint oil, slippery elm (Ulmus rubra), marsh mallow (Althaea oficinalis), and Chinese herbs. However, Crohn's patients should consult with their healthcare professional before taking them. Depending on the preparation and the type of herb, these remedies may aggravate the digestive tract or interact with any prescription drugs that are being taken to control the inflammation of Crohn's disease.

Allopathic treatment

Treatments for Crohn's disease try to reduce the underlying inflammation, the resulting malabsorption/malnutrition, the uncomfortable symptoms of crampy abdominal pain and diarrhea, and any possible complications (obstruction, abscesses, and fistulas).

Inflammation can be treated with a drug called sulfasalazine. Sulfasalazine is made up of two parts. One part is related to the sulfa antibiotics; the other part is a form of the anti-inflammatory chemical, salicylic acid. Sulfasalazine is not well-absorbed from the intestine, so it stays mostly within the intestine, where it is broken down into its components. It is believed that the salicylic acid component actively treats Crohn's disease by fighting inflammation. Some patients do not respond to sulfasalazine, particularly those with more severe disease. These patients require steroid medications (such as prednisone). Steroids, however, must be used carefully to avoid the complications of these drugs, including increased risk of infection and weakening of bones (osteoporosis)

In 2001, the Food and Drug Administration (FDA) approved use of budesonide capsules for mild and moderate cases of Crohn's disease involving the small and large intestines. Although a steroid, the makeup of budesonide allows the drug to release into the intestines, where it can be mostly metabolized. As a result, less of the drug enters the patient's system, meaning fewer undesirable side effects. Some potent immunosuppressive drugs that interfere with the products of the immune system and hopefully decrease inflammation may be used for those patients who do not improve on steroids.

Serious cases of malabsorption/malnutrition may need to be treated by providing nutritional supplements. These supplements must be in a form that can be absorbed from the damaged, inflamed intestine. When patients are suffering from an obstruction, or during periods of time when symptoms of the disease are at their worst, they may need to drink specially formulated, high-calorie liquid supplements. Those patients who are severely ill may need to receive their nutrition through a needle inserted intravenously.

A number of medications are available to help decrease the cramping and pain associated with Crohn's disease. These include loperamide, tincture of opium, and codeine. Some fiber preparations (methylcellulose or psyllium) may be helpful, although some patients do not tolerate them well.

The first step in treating an obstruction involves general attempts to decrease inflammation with sulfasalazine, steroids, or immunosuppressive drugs. A patient with a severe obstruction will have to stop taking all food and drink by mouth, allowing the bowel to "rest." Abscesses and other infections will require antibiotics. Surgery may be required to repair an obstruction that does not resolve on its own, to remove an abscess, or to repair a fistula. Such surgery may involve the removal of a section of the small intestine. In extremely severe cases of Crohn's disease of the colon that do not respond to treatment, a patient may need to have the entire large intestine removed (an operation called a colectomy). In this case, a piece of the remaining small intestine is pulled through an opening in the abdomen. This bit of intestine is fashioned surgically to allow a special bag to be placed over it. This bag catches the body's waste, which no longer can be passed through the large intestine and out of the anus. This opening, which will remain in place for life, is called an ileostomy. However, as an alternative to ileostomy, small intestines are now often shaped into substitute rectal pouches, and the patient may not always need the ileostomy.