Living with Crohn s Disease

Transcription

1 Another ebookwholesaler Publication Living with Crohn s Disease By Lois Fordham Proudly brought to you by JacobEducation.com Recommended Resources Web Site Hosting Service Internet Marketing Affiliate Program

2 Living with Crohn s Disease by Lois Fordham Please Read This First This Electronic book is Copyright 2007 ebookwholesaler. All rights are reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means; electronic, mechanical, photocopying, recording or otherwise, without written permission from the copyright holder(s). You do not have any right to distribute any part of this ebook in any way at all. Members of ebookwholesaler are the sole distributors and they must abide by all the terms at No Ebookwholesaler Exclusive product may be offered or distributed through Auctions or similar events on the Internet or elsewhere. Disclaimer The advice contained in this material might not be suitable for everyone. The author provided the information only as a broad overview by a lay person about an important subject. The author used information from sources believed to be reliable and from his own personal experience, but he neither implies nor intends any guarantee of accuracy. The results you obtain will depend largely on your own efforts and other factors beyond the knowledge and control of the author, publisher and distributors. No particular result or outcome is promised or guaranteed in any way. New theories and practices are constantly being developed in this area. The author, publisher and distributors never give legal, accounting, medical or any other type of professional advice. The reader must always seek those services from competent professionals that can

3 Living with Crohn s Disease by Lois Fordham apply the latest technical information and review their own particular circumstances. The author, publisher and distributors particularly disclaim any liability, loss, or risk taken by individuals who directly or indirectly act on the information contained herein. All readers must accept full responsibility for their use of this material. All pictures used in this book are for illustrative purposes only.

4 Living with Crohn s Disease by Lois Fordham About the Author Lois Fordham is the pen-name of a person whose life has been affected by Crohn s Disease. She has enjoyed writing fiction with some success for several years and never thought of writing non-fiction. But she found that people who had this condition or whose immediate families included sufferers were often unable to discuss their situation or get answers to common questions about the disease. Lois hopes that her ebook, though only an informed lay-person s opinion, will help people that have or care for those with Crohn s Disease.

5 Living with Crohn s Disease by Lois Fordham TABLE OF CONTENTS Please Read This First... 2 Disclaimer... 2 About the Author... 4 TABLE OF CONTENTS... 5 Crohn s Disease - An Overview... 8 What is Crohn s Disease? What Happens with Inflammation of The Bowels? Effects of Crohn s Disease Who Named Crohn's Disease? What Causes Crohn's Disease? Other Factors Signs and Symptoms of Crohn s Disease Signs and Symptoms of Crohn s Disease Who Gets Crohn s Disease? Common Complications of Crohn's Disease Common Crohn s Disease Complications Types of Crohn s Disease Crohn s Disease in Children Crohn's Disease Symptoms in Children Effects of Crohn s Disease in Children Treatments for Crohn s Disease in Children Crohn s Disease in the Elderly Crohn s Disease and Women... 30

6 Living with Crohn s Disease by Lois Fordham Effect of Crohn s Disease on Reproductive Abilities of Women Osteoporosis How is Crohn s Disease Diagnosed? Blood Tests Stool Samples Endoscopy Barium X-rays White Blood Cell Scan CT scan What to Expect During Testing for Crohn s Disease How is Crohn s Disease Treated? Need for Treatment of Crohn s Disease Treatment Options of Crohn s Disease Drug Therapy Nutrition Supplements Surgery Alternative Therapies Surgery for Crohn's Disease Surgery and Crohn s Disease Partial bowel resection Correction of Fistulas Strictureplasty Draining of Abscess Medication for Crohn's Disease Types of Medication for Crohn s Disease Inflammation Reducing Drugs Symptom Treating Drugs Cure Research for Crohn's Disease Complementary and Alternative Treatments for Crohn s Disease 54

7 Living with Crohn s Disease by Lois Fordham Living with Crohn's Disease Diet and Nutrition for Crohn's Disease Nutritional Requirements of Crohn s Disease Diet Patterns of Crohn s Disease Important Foods That You Should Include Foods Better to Avoid Essential Dietary Tips for Crohn s Disease Patients Specific Carbohydrate Diet Important Constituents of the Diet Travel Tips for People with Crohn's Disease Essential Tips Emotional Factors and Coping with Crohn's Disease Coping with Stress and Emotional Factors Simple Treatments and Lifestyle Changes Small Lifestyle Changes and Cures Diet and Nutrition Exercise Special Events Relationships and Physical Intimacy Stress Management Management of Crohn s Disease Support Groups for Crohn's Disease Crohn s Disease FAQ Glossary of Crohn's Disease Medical Terms... 78

8 Living with Crohn s Disease by Lois Fordham Part-I: Introduction Crohn s Disease - An Overview Crohn s disease is an inflammation of the gastrointestinal tract. It is a type of bowel disease, although it can erupt anywhere between the mouth and the anus. Crohn s disease affects the digestive system of the body. However, most incidences of the disease manifest in the lower part of the small intestine or the early part of the large intestine. There can be perfectly normal parts of the bowel between severely affected parts. Crohn s disease normally affects people between the ages of fifteen and thirty years with some instances among people in their sixties and seventies. It does not affect young children. This disease affects around 400,000 and 600,000 people in North America. Estimates suggest that around 27 to 48 people in every 100,000 are affected by Crohn s disease in Northern Europe. The incidence of Crohn s disease is higher in women than in men. This is not an infectious disease. Crohn s disease gets its name from an American gastroenterologist surgeon, Burrill Bernard Crohn. Crohn, with two of his colleagues, described the disease in Together, they explained the presence of the disease in specific patients with inflammation of terminal ileum. A Polish surgeon, Antoni Lesniowski, had also described the disease as early as 1904.

9 Living with Crohn s Disease by Lois Fordham There is no specific cause of Crohn s disease. It could have a genetic cause. Siblings and relatives of people with Crohn s disease have a higher than average chance of suffering from the disease at some time. Most gastroenterologists are of the opinion that Crohn s disease could be due to overreaction of the body s immune system to any specific virus or bacteria. Once you develop Crohn s disease, it becomes your lifelong companion, although with periods of remission. Doctors hint at various environmental factors and dietary habits that could be the main cause for Crohn s disease. Smoking is an inherent risk factor. Other than that, foods rich in sugar, fats, and refined products could cause this disease. High intake of shellfish with low intake of fruits, potassium, water, magnesium and vitamin C-rich products could encourage Crohn s disease. Regular intake of oral contraceptives might also be a factor with this disease. Common symptoms of Crohn s disease includes abdominal pain, diarrhea, weight loss, loss of appetite, rectal bleeding and, in some cases, fever. Additionally, it causes mouth ulcers, eye inflammation, joint pains, and inflammation or ulcer-like eruptions on the skin. In severe cases, Crohn s disease could cause inflammation of neighboring body parts like the other bowels, vagina or bladder. It could also cause infections of the urinary tract. Sometimes, it causes bowel cancer. Crohn s disease could also cause osteoporosis, arthritis, and a thinning of bones leading to bone fractures.

10 Living with Crohn s Disease by Lois Fordham Perianal discomfort with itchiness and inflammation around the anus is common. Fecal incontinence with twenty to thirty bouts of fecal discharge, sometimes even in the middle of night, is common with Crohn s disease. Teenagers developing this disease could exhibit retarded growth. Symptoms of Crohn s disease are very similar to those of ulcerative colitis. Both diseases cause inflammation of the bowels. However, a clear distinction in the diagnosis of the disease is essential to decide a definite pattern of treatment. Doctors can diagnose the presence of Crohn s disease after studies of various tests. These tests include blood tests, stool tests, X-rays, gastroscopy, colonoscopy, CT, ultrasound, and MRI scans. There is no single cure for Crohn s disease. You can take drugs or medications, undergo surgery, and follow a specific dietary routine to combat the disease. All medications and surgeries can only reduce the effects of this disease. Nothing can completely clear your system of Crohn s disease at this time. However, it is possible to live a full life with Crohn s disease. It does not cripple you in any way. You can continue with the normal routines of your life. You only need to follow a strict diet regimen and take regular medications. There can be flare-ups of Crohn s disease. Since these are most unpredictable, it is best to stay within reach of medical help.

11 Living with Crohn s Disease by Lois Fordham Part-II: Understanding Crohn s Disease What is Crohn s Disease? Crohn s disease is a specific disorder of the digestive tract. It affects the gastrointestinal tract. Although Crohn s disease can affect any part of the intestine, it mostly affects the ileum or the lower part of the small intestine. Inflammation causes swelling of the ileum which, in turn, causes immense pain and discomfort. You feel increasing intensity and frequency to empty your intestines. This causes a diarrhea-like situation. This disease is the same as enteritis or ileitis. Inflammation of the bowel can occur at any age. However, this mostly starts in the teens and extends into adulthood. Crohn s disease can lead to various other diseases like colon cancer, arthritis, kidney stones, gallstones and skin ailments like eruptions and eczemas. What Happens with Inflammation of The Bowels? Crohn s disease can affect any part of the bowel, although it primarily affects the lower part of the small intestine and the upper part of the large intestine. Inflammation causes the formation of various muscular layers in-between. Additionally, this inflammation causes swelling of the mesentery, a fan-shaped tissue containing lymph glands and intestinal blood vessels. The mesentery connects the small intestine to the back abdominal wall. It may cause total dysfunction of the intestinal tract.

12 Living with Crohn s Disease by Lois Fordham Inflammation of the intestine causes redness and swelling of the small intestine. It also disrupts functioning of the small intestine immensely. The disease may not affect the entire small intestine. There could be some good patches. Other parts of the intestine could appear as pits. These pits are Crohn s disease. It has caused tissues to shed in this region. Inflammation can also occur at the mouth, stomach, or esophagus. The affected areas are regional enteritis while normal areas are skip areas. Effects of Crohn s Disease Crohn s disease symptoms keep coming and going. There are periods of intense symptoms while sometimes you may not feel any symptoms at all. There is no permanent cure for Crohn s disease at this time. The disease causes irritation of the inner walls of the intestine. This, in turn, causes cracks, ulcers and fissures. Inflammation could also cause formation of abscesses. In between attacks, the intestine tries to rebuild tissues damaged due to the disease. Such healing could be in the form of a new lining. Sometimes during the healing process, the intestine is unable to distinguish between the inside and outside of different parts of the intestine. This could lead to the formation of lining across ulcer edges. This is called a fistula. This causes an irregular connection between different parts of the intestine. This could lead to further complications. Crohn s disease is primarily due to inappropriate reactions of the immune system. The body s immune system mistakes the bacteria

13 Living with Crohn s Disease by Lois Fordham for foreign substances and turns hostile towards them. Therefore, white blood cells attack the intestine walls and causes chronic inflammation. This causes bowel dysfunction, inflammation and all the misery associated with Crohn s disease.

14 Living with Crohn s Disease by Lois Fordham Who Named Crohn's Disease? Crohn s disease is an inflammatory disease of the small intestine. The disease started as a disease of the terminal ileum. The very first reported case of the disease dates from the time of Giovanni Battista Morgagni, between 1682 and The patient died due to severe colic pains. The next reported cases of this colon disease were by John Berg in Stockholm in 1898 and by Antoni Lesniowsky from Warsaw in Again, in 1913, Scottish physician T. Kennedy Dalziel, reported thickening of the patients small intestine in around nine cases. Subsequently, American clinician and pathologist Eli Moschowitz and A. O. Wilensky of the Mount Sinai Hospital published a work, Nonspecific granulomata of the intestine, in This paper discussed thickening of the distal ileum. On May 13, 1932, Burrill Bernard Crohn, Gordon Oppenheimer, and Leon Ginzburg gave a lecture on, Terminal ileitis: A new clinical entity at a meeting of the American Medical Association in New Orleans. This discussion reported fourteen cases of inflammation of the distal ileum. However, since all patients were alive, the name was changed to Regional ileitis - a pathologic and clinical entity. Publication of this article in a medical journal caused widespread attention. Although Oppenheimer and Ginsburg were more experienced, Crohn s name appeared first on the publication due to alphabetical reasons. Therefore, the name of the disease also stayed as Crohn s disease.

15 Living with Crohn s Disease by Lois Fordham What Causes Crohn's Disease? There is no specific and proven cause for Crohn s disease. There are several theories indicating possible causes of Crohn s disease. The most popular among them is adverse reactions by the body's immune system. Your body's immune system consists of various body cells containing various proteins. These cells help fight off infections and harmful elements from your body. Scientists claim that your body s immune system for some unknown reason recognizes bacteria, food, and similar substances in your intestine and digestive system as foreign. It therefore attacks these foreign particles. Such attacks cause white blood cells to form a lining on the intestine walls. This leads to chronic inflammation and resultant bleeding, ruptures, and ulcers. These injure your bowels extensively. Some scientists claim such functioning of immune system as the result of Crohn s disease within your system. Therefore, there is no clear evidence if your immune system is the cause or result of Crohn s disease. Nevertheless, the majority of scientists are of the opinion that such mysterious functioning of your body's immune system causes Crohn s disease in your intestines. In normal and healthy intestines, there are specific bacteria, enteric microflora. There are around a billion and a trillion such bacteria in every gram of intestinal content. These help digestion and prevent abnormal bacteria coming in through water and food to invade the intestines.

16 Living with Crohn s Disease by Lois Fordham If by any chance abnormal bacteria thrive within your intestines, your immune system does not attack them at once. Instead, it has a certain level of tolerance. However, such tolerance level is absent in persons affected by Crohn s disease. Therefore, it causes inflammatory damage to intestinal cells. Other Factors Among other possible factors for the cause of Crohn s disease are environmental factors and the genetic history of the patient. In many cases, genetic build-up could be the cause for Crohn s disease. Of course, there is no simple relation for this disease to pass on to offspring from parents. Yet, the disease could manifest in families. This is especially true in cases of intermarriage between close relations. As for instance, Crohn s disease has a high-level of incidence in Jewish families of Eastern Europe. There are disputes regarding inheritance of Crohn s disease. In more than eighty percent of people having Crohn s disease, there is no incidence of any of their close relatives having any ulcerative colitis or similar disease. Crohn s disease is common and prevalent among the industrialized sections of society in western countries. Therefore, scientists are of the view that specific environmental factors and features coupled with diet patterns of such societies could be behind the occurrence of this disease in large numbers among members of the society. Your body's immune system produces a protein, anti-tumor necrosis factor. This could cause inflammation as present in Crohn s disease. Yet, there is no clear evidence to prove this fact.

17 Living with Crohn s Disease by Lois Fordham Signs and Symptoms of Crohn s Disease Crohn s disease affects more than a million Americans. There are various signs and symptoms of this disease. Different people report different symptoms. Nevertheless, the most common symptom is loose bowel movements with blood. Signs and Symptoms of Crohn s Disease Abdominal pain: Most suffer from severe abdominal pain, specifically in the lower right area. This is the position of the ileum within your intestine. Many confuse Crohn s disease for appendicitis in the initial days due to such pain. Pain could range from severe to unbearable. It could be a steady pain or occur after meals. Sometimes, it could start while eating. Pain could occur in bouts while doing physical exercises like jogging. Diarrhea: Diarrhea could range from mild loose motions to severe and uncontrollable loose motions. Sometimes, fecal discharge could have blood or mucus with it. Sometimes, it could be a tendency to go to toilet but without passing anything. However, if your Crohn s disease is concentrated only in the small intestine, you may not suffer from diarrhea. Weight Loss and Malnutrition: If Crohn s disease affects the major part of your intestines, your body cannot absorb any nutrients from your food intake. This causes sudden and huge weight loss. In children, it manifests as malnutrition. This is due to the absence of essential vitamins and nutrients. It also causes stunted growth and delayed development of body tissues and mental health.

18 Living with Crohn s Disease by Lois Fordham Ulcers: This refers to the raw lining of the gut that causes bleeding. Ruptures on intestinal walls could cause ulcers. It is also common to develop mouth ulcers with Crohn s disease. This causes passing of blood with stools. Fatigue: Insufficient nutrition and lack of proper absorption of food causes a lethargic and tired feeling. You lose your appetite overtime and at times develop irritable moods. All such factors together could cause a fever. Anal fissures: These are cracks around your anus. These cause pain and lot of discomfort. Sometimes small tag like skin or small skin lumps could appear around the anus. Anemia: Loss of a lot of blood over a period of time could lead to anemia. Loss of blood is due to excessive flow of blood with stools. Inflammation of Joints: Severe pain in the joints of hands, knees, ankles, wrists, elbows, and legs could be a precursor of Crohn s disease. Pain could seem to be shifting from one joint to another. This could be with inflammation and reddening of the eyes and in some cases of the liver. Although there is no specific reason for occurrence of such a symptom, there are various reported cases of prevalence of such symptoms with people affected by Crohn s disease. Fever: Fever could sometimes be a slight increase in body temperature. In some other cases, it could manifest as a high rise in body temperature due to a flare-up. It could be a daytime fever or occur at night causing sleep disturbances and night sweats. Swelling: Some people experience a swelling in the lower right part of the abdomen. This swelling is of the size of a small grapefruit.

19 Living with Crohn s Disease by Lois Fordham Sometimes it is firm while at other times it is soft. Softness indicates its presence in the small intestine while firmness indicates its presence in the large intestine, enlarged lymph glands, and surrounding tissue. Constipation: This is among the rare symptoms of Crohn s disease. Obstructions in the intestinal passage restrict thorough clearance of waste materials from your body. This leads to build up of such materials. It then causes nausea, pain, vomiting, and constipation. Intestinal Hole: This is rare. This is due to increased thickness of the intestinal wall. This causes a hole to form on the outer wall of the intestine. This is very dangerous as outside bacteria could enter through this hole and cause severe infections, some of which could be life threatening. Symptoms of Crohn s diseases range from mild to severe. They could occur in isolation or in bouts. You enjoy perfect health in between bouts.

20 Living with Crohn s Disease by Lois Fordham Who Gets Crohn s Disease? Crohn s disease is a common ailment among Americans. Normally, it affects people between the ages of fifteen and thirty-five. Additionally, it can affect people over the age of seventy. Ten percent of the total people affected by Crohn s disease are under the age of eighteen. It can affect males and females alike, although there is a higher incidence among females. Crohn s disease affects ethnic groups more than other people. American Jews of European descents have a higher incidence of the disease. It can affect people of any race although some specific ethnic groups like Jews, whites, and blacks of European descent report more cases than Hispanics and Asians. Crohn s disease is predominant among people of the developed world. Similarly, it affects urban people more than rural people. People living in northern climates report more cases of Crohn s disease than people living in the southern climates do. In some cases, family members develop Crohn s disease. Normally, around twenty percent of people with Crohn s disease have family members having the same disease. Genes do play a part in this disease, although there is no supportive evidence. Most patients with Crohn s disease have a close relation suffering from the disease or similar form of ulcerative colitis. You cannot exactly predict which family member would contract the disease. Contraction of the disease is high in the teenage years and it develops further in the early twenties and thirties.

21 Living with Crohn s Disease by Lois Fordham Common Complications of Crohn's Disease People suffering from Crohn s disease over a prolonged period develop various complications. Crohn s disease primarily affects the intestine. Therefore, most complications arise in this area. Common Crohn s Disease Complications Strictures: These are blockages in the intestine. Crohn s disease causes inflammation of intestines. This results in swelling of parts of the intestine with formation of scar tissue along the intestinal walls. This swelling interrupts smooth movement of food and waste materials through the intestines. This results in severe abdominal pain and instances of throwing up. Fistulas: Inflammation causes formation of channels between different parts of the bowel. These are fistulas. Such fistulas can exist between different parts of the bowel or between the intestine and any other organ. It could form a connection between the intestine and the bladder or between the skin surface and intestines. This is most common around the anus. It could also form tunnels around surrounding organs like the vagina, rectum, bladder, and others causing serious infections in these organs. Bowel contents could pass to other organs and thereby cause infection and other related complications and diseases. Abscesses: These develop as fallout of fistulas formation. Sometimes fistulas around the anus could develop pockets containing pus. These are abscesses. These cause immense pain and discomfort around the anus. They could also lead to serious infections.

22 Living with Crohn s Disease by Lois Fordham Perforation: Deep swelling in the bowel often causes formation of a small hole in the intestine. This is a perforation. Food and bowel contents leak out through such perforations causing serious infections. Perforations require immediate treatment. Otherwise, it could turn fatal. Fissures: These are deep cuts in the soft skin around the anus. These affect bowel movements extensively and cause deep pain disallowing free bowel movements. These are open wounds and therefore cause infection through bowel contents. These are difficult to heal. Similar fissures include formation of external skin tags and hemorrhoids. These cause immense irritation. Frequent bowel movements also increase incidences of bleeding with bowel movements. Malnutrition: Chronic inflammation of the intestine causes loss of appetite, nausea, and fatigue. These conditions accumulate as severe malnutrition, as you are unable to eat and digest properly. Inflammation in the intestines restricts thorough absorption of vitamins through the intestine. This causes extensive weight loss due to high nutritional deficiency. Anemia: Lack of sufficient nutrition could cause anemia. In children, this complication manifests as retarded growth, excessive and unexplained weight loss, and consequent poor physical health. Inflammation of joints: Crohn s disease could cause serious arthritis complications with inflammation of joints of legs, elbows, knees, ankles, wrists, and arms. It could cause inflammation of the eyes with various eruptions of pus on the skin surface. Sometimes, it could also cause inflammation of the spine, bile ducts, and pelvic joints.

23 Living with Crohn s Disease by Lois Fordham Osteoporosis: Osteoporosis is another important complication arising from Crohn s disease. This condition causes severe brittleness of bones and you become very susceptible to bone fractures. People with Crohn s disease should undergo regular tests for osteoporosis. Cancer: People with Crohn s disease have a higher chance of developing colon cancer. Cancer can develop in the intestines as bowel cancer. This is due to various strictures and fistulas in the colon area causing disruptions with easy bowel movements. These also increase the chances of infection through improper absorption of food and lack of thorough discharge of waste materials. Other complications due to Crohn s disease could be kidney stones, gallstones, and various diseases of the liver and biliary system.

24 Living with Crohn s Disease by Lois Fordham Types of Crohn s Disease Crohn s disease affects your intestines. There are five different types of Crohn s disease according to the part of intestine affected by the disease. Gastro duodenal Crohn s Disease: The affected part is the stomach and start of the small intestine popular as duodenum. Often, Crohn s disease here is misinterpreted as an ulcer. Correct diagnosis could be possible only after the disease spreads into the lower parts of the small intestine. Common symptoms of this disease include nausea, stomach pain, vomiting, loss of appetite, and therefore excessive weight loss. Jejunoileitis: This is Crohn s disease of the larger part of the small intestine, jejunum, lying between the ileum and duodenum. Your body absorbs maximum nutrients in the jejunum area. Crohn s disease in this area could cause fistulas. Such fistulas could form a connection with other organs like the bladder and cause infections in associated organs. Symptoms of Jejunoileitis include diarrhea, mild to intense abdominal pain with cramps after meals, and malnutrition due to insufficient absorption of nutrients. Ileitis: Ileum is the longest and last part of the small intestine, Crohn s disease affecting this part of the intestine is Ileitis. Crohn s disease here could cause fistulas due to serious inflammation. These cause severe pain the lower right part of abdomen with serious cramps. Insufficient and irregular absorption of nutrients could cause tingling of toes. Folate deficiency could cause anemia due to irregular development of red blood cells.

25 Living with Crohn s Disease by Lois Fordham Ileocolitis: This is the most common type of Crohn s disease. It affects the lowest part of the small intestine, ileum, and the large intestine, colon. Since the ileum continues into the colon, Crohn s disease also affects the ileocecal valve. Symptoms include severe pain in the abdomen area, anemic conditions, and diarrhea. Crohn's Colitis (Granulomatous Colitis): This is Crohn s disease affecting the colon. This type of Crohn s disease may not affect the rectum. It causes inflammation in various parts of the colon. Common symptoms include rectal bleeding, diarrhea, fistulas, abscess, ulcers, and irritation around the anus. Joint pains and skin lesions also result due to this type of Crohn s disease.

26 Living with Crohn s Disease by Lois Fordham Crohn s Disease in Children Crohn s disease affects children and teenagers. Normally, this disease is common among people of ages from fourteen to thirtyfive. Yet, young children could also suffer from this disease. Crohn s disease could occur with a gap of a few years or months. However, Crohn s disease in children is non-contagious. Crohn's Disease Symptoms in Children In the early stages of Crohn s disease in children, most symptoms go unnoticed. Children may exhibit any or a combination of these symptoms: Pain in the abdominal region, sometimes causing: abdominal cramps abdominal swelling anemia incessant diarrhea loss of appetite sudden constipation with difficulty in passing gas unexplained and constant fever pain and redness in joints inflammation of eyes rectal bleeding

27 Living with Crohn s Disease by Lois Fordham rashes and openings on skin surface for no apparent reason Effects of Crohn s Disease in Children Childhood is the growing period for children. This period requires special care and attention to ensure a healthy life. Crohn s disease can cause: Growth Retardation: Children with Crohn s disease could project a slow growth. Lack of sufficient nutrition slows the growing process. Such children may not grow to the required height or develop proper weight. You can monitor this deficiency by recording your child s height and weight every six or twelve months. You can then compare it with a growth chart that shows national average growth rates of children of the same age. Growth retardation could also translate into late onset of puberty. Emotional Issues: Crohn s disease causes severe changes in the normal routines of children. It prevents them from doing and taking part in normal childhood and adolescent activities. This segregates them from the normal crowd. Parents, teachers, relatives, and doctors should provide extensive sensitive support and help them overcome their health shortcomings. Dietary Patterns: Children with Crohn s disease should follow strict diets to manage and overcome this disease. Crohn s disease over many long years could cause serious damage and ruptures to your child s colon. Restrict its effects by adhering to a proper diet plan. Supplement diet with nightly feeds of liquid diet. Children could use small feeding tubes and slip them through the nose to the stomach. This helps them feed while they are asleep.

28 Living with Crohn s Disease by Lois Fordham Treatments for Crohn s Disease in Children Crohn s disease in children is similar to that in adults. The major concern is that it restricts normal growth. Ideal treatments include use of strong drugs like steroids. Nevertheless, such drugs should be according to their body weight. This will prevent any adverse effects of steroids on normal growth patterns. Surgery to reduce inflammation is also another treatment option for Crohn s disease in children. However, it is better to use this treatment option as a last resort.

29 Living with Crohn s Disease by Lois Fordham Crohn s Disease in the Elderly Although Crohn s disease is primarily a disease affecting the young population, it does affect the elderly. Recent cases of Crohn s disease indicate its prevalence among people in their sixties and seventies. Often, diagnosis of Crohn s disease in the elderly poses certain problems. Symptoms of the disease are similar to other common ailments of the elderly like diverticulosis, eschemic colitis, and colon cancer. This could delay diagnosis of Crohn s disease in the elderly. Treatment options available for Crohn s disease in the elderly are the same as those available for younger patients. However, elderly people are usually unable to tolerate the required doses of medications. They therefore have to have reduced doses of medications. Further, elderly people with Crohn s disease may already be on medications for other ailments. Therefore, they need to consult their health-care providers to assess possible medicine reactions. This can prevent any unnecessary flare-ups of adverse reactions between different medical treatments. Flare-ups can also be due to stress, cigarettes, or food. Crohn s disease requires extensive regulation of diets. This could pose problems with the elderly, as they may have to limit salt and sugar intakes to combat other ailments. However, Crohn s disease is not fatal. Most patients respond positively to available treatment. You can live full lives with Crohn s disease even if you are in the elderly group.

30 Living with Crohn s Disease by Lois Fordham Crohn s Disease and Women Crohn s disease affects men and women alike. Symptoms and preconditions of this disease could prove very difficult for women at times. Excessive diarrhea and rectal bleeding could be very painful. Further, Crohn s disease affects normal reproductive functioning of women and causes disruptions in menstruation, reproduction, and other areas. Effect of Crohn s Disease on Reproductive Abilities of Women Menstruation: Crohn s disease causes severe disruptions in the normal body mechanism. It causes inflammation, swelling, pain, and malnutrition. Therefore, Crohn s disease also affects your menstrual cycles. The disease could be very severe before or after menstrual periods. Sexual Intercourse: Sexual intercourse could cause excessive pain around the vaginal area in women with Crohn s disease. This could be due to formation of fistulas. Fistulas are small channels connecting intestines to different adjacent organs. Formation of such fistulas could cause serious infections with abscesses. Availing early medical treatment is essential to prevent any serious cases of infections through fistulas. Pregnancy: If you are a Crohn s disease patient, you should consider your health conditions before trying to conceive. Crohn s disease causes restrictions in diet and sometimes leads to serious malnutrition and dehydration. These factors could affect your pregnancy.

31 Living with Crohn s Disease by Lois Fordham However, women with Crohn s disease can conceive and give birth. There are many cases of women with this disease having full term pregnancies and delivering perfect babies. Children may not get the disease from their mothers. Sometimes, children do get Crohn s disease from their mothers. These children show retarded growth and development in later years. If Crohn s disease causes flare-ups and necessitates surgical treatment, it could prove dangerous to undergo surgery while you are pregnant. It could cause complications for your baby. Besides, most medications for Crohn s disease are unsuitable for intake by pregnant women. They could cause problems for lactating mothers. Crohn s disease causes anemic conditions in your body due to inflammation. These restrict growth of the fetus. Such women face higher chances of premature delivery or stillbirth. You need to consult a gastroenterologist and obstetrician right from the time you conceive to have a full and perfect term and smooth delivery. A gastroenterologist could suggest special diets with relevant minerals and vitamins that prove beneficial for your health and that of your baby. Nevertheless, since every pregnancy is unique, if you suffer problems with one, it does not mean you will suffer similar problems in future pregnancies. Osteoporosis Women have a higher incidence of osteoporosis than men do. Further, women with Crohn s disease could develop this ailment early in life. This is due to insufficient absorption of calcium through their intestines. Osteoporosis could also occur as the result of prolonged steroid treatment for Crohn s disease.

32 Living with Crohn s Disease by Lois Fordham Part-III: Treatment of Crohn s Disease How is Crohn s Disease Diagnosed? Doctors conduct various tests to diagnose the presence of Crohn s disease. There is no single test, which can determine the disease immediately. It is a series of pathological tests, radiological tests, and biopsies. Further, symptoms of Crohn s disease are very similar to those of various other diseases. Therefore, correct diagnosis could take some time. Doctors suspect the presence of Crohn s disease in patients with diarrhea, and a high fever coupled with abdominal pain and tenderness. Blood Tests Blood tests indicating high white blood cell count indicate inflammation of any kind in the body. Further, blood tests also indicate if you are anemic or lack essential nutrients due to malabsorption of nutrients. It can bring out vitamin deficiencies like those of B12 or even show blood loss due to passing of blood with stools. This test can detect bleeding within the intestines. A low presence of minerals and blood cells indicate excessive discharge of these essential nutrients through diarrhea. Stool Samples Stool samples can indicate the presence of blood and help identify if any infectious agent is the cause behind continued diarrhea. Certain digestive disorders could have similar symptoms as that of Crohn s disease. Examination of stool samples can indicate the presence of

33 Living with Crohn s Disease by Lois Fordham bacteria like parasites and Clostridium difficile. This helps in easy diagnosis. Endoscopy This involves passing or insertion of a tiny fiber-optic camera fitted to a flexible tube through the rectum into the colon. This allows the doctor to examine the intestine lining thoroughly for any signs of inflammation and ulceration. Doctors look at a magnified image on a television screen. Endoscopy can the detect presence of small intestinal bumps, strictures that obstruct digestive tract, and fistulas forming channels within the intestines or with other organs. Endoscope can bring out a tiny sample of your intestine for thorough examination under a microscope. This can detect the presence of immune cells in your intestine. This is a biopsy. Endoscopy consists of various procedures within itself. These tests are according to the part of the colon examined. Other endoscopic tests include Colonoscopy, Sigmoidoscopy, ERCP, Endoscopic Ultrasound, and Capsule Endoscopy. These endoscopic examinations take between five to twenty minutes only. There is no need for any sedation for all tests. Some of them can be done at a doctor s clinic itself. Colonoscopy examines the entire large intestine and sometimes a small part of the small intestine. Colonoscopy requires a mild sedative state. This is conscious anesthesia. Doctors induce certain sedative and pain medications before starting such tests. It could take around thirty minutes to complete the test. This test is normally done in a hospital only.

34 Living with Crohn s Disease by Lois Fordham Sigmoidoscopy examines the lower portion of the large intestine. This is the sigmoid colon. Normally, sigmoidoscopy tests do not cause any discomfort. However, if you are already experiencing serious complications, these tests can add to your woes. It could be painful for some time. ERCP is Endoscopic retrograde cholangiopancreatography. This examines the pancreatic duct and bile ducts and liver. Endoscopic ultrasound uses an endoscope with attached ultrasound probe to collect images of the gut. This can detect the presence of fistulas as present in Crohn s disease. Capsule Endoscopy requires you to swallow capsules and a camera produces images of your intestine. Barium X-rays Before starting with such x-rays, you need to drink a chalky solution of barium. Otherwise, doctors administer a barium enema through your rectum. Barium is a white agent that helps light up your intestine for clear x-rays. It helps in bringing out clearer details on your x-rays. X-rays can determine the extent of Crohn s disease in your intestines. Barium acts like a dye for x-rays. Plain x-rays cannot show light tissues clearly. A clear view of the bowel lining is essential for correct diagnosis. Plain x-rays can only detect blockages in your intestines. White Blood Cell Scan This test detects accumulation of white blood cells within intestinal inflammation. Inflammation is a common symptom of Crohn s disease.

35 Living with Crohn s Disease by Lois Fordham CT scan This test takes different x-rays of your intestine from different angles to form images of your intestine and other internal organs. Doctors use these tests to diagnose the presence of Crohn s disease.

36 Living with Crohn s Disease by Lois Fordham What to Expect During Testing for Crohn s Disease Doctors prescribe and conduct different laboratory tests and imaging procedures to diagnose Crohn s disease. Laboratory tests consist of blood and stool tests. Imaging procedures consist of X- rays and endoscopies. X-rays project a picture while endoscopies offer magnified pictures of the inside of your intestine. This helps doctors detect the presence of inflammation, strictures, or fistulas that could indicate the presence of Crohn s disease. Sigmoidoscopy: This requires insertion of a fiber-optic tube with a camera lens through the anus, rectum, and into the colon. This process causes discomfort and pain to most patients. The procedure lasts between five and twenty minutes and can be done at a doctor s clinic. Doctors prescribe a couple of premixed enemas two hours before sigmoidoscopy. This cleanses the sigmoid colon and rectum of any stool. Colonoscopy: Although similar to a sigmoidoscopy, a colonoscopy allows the doctor to get images of the colon up to the end of the ileum. This procedure takes around half an hour and you are under conscious anesthesia with sedative and pain medications. Colonoscopy should be performed in a hospital or endoscopy clinic only. As it takes quite some time for sedative to wean off, it is best stay away from work to overcome associated drowsiness. Barium Enema: Barium acts like a dye and allows clear viewing of soft bowel tissue. This helps in thorough bowel examination to diagnose Crohn s disease. Doctors prescribe a few laxative

37 Living with Crohn s Disease by Lois Fordham treatments around twelve hours before barium tests and colonoscopy. This helps in purging the colon thoroughly. You can take only clear fluids in the twelve hours before the tests. You should stay away from milk or any other food products. Blood cells also help in diagnosing the presence of Crohn s disease. Increased count of white blood cells and increased ESR rate point add towards Crohn s disease. ESR shows the rate at which blood separates into its components of red blood cells, plasma, and others. Low count of red blood cells indicates anemia, chronic illness, or excessive internal bleeding. These factors indicate the presence of Crohn s disease.

38 Living with Crohn s Disease by Lois Fordham How is Crohn s Disease Treated? Crohn s disease is a lifelong disease. Patients with this disease can lead normal lives, attend work, raise families, and live like ordinary beings. At times of extreme flare-ups, you need appropriate treatment. In times of remission, you can be completely free of all symptoms. Nevertheless, these are temporary sojourns. Need for Treatment of Crohn s Disease Crohn s disease does not have any permanent cure. All treatments aim to reduce pain, inflammation, diarrhea, and other common symptoms of Crohn s disease. Treatment options are not the same for every patient of Crohn s disease. It all depends on the location of the disease within your intestine and the severity. Some patients develop extreme complications right at the start, immediately after diagnosis of Crohn s disease. Some others are able to sustain and do not suffer unbearable pain or discomfort. Problems are mild and bearable. Therefore, treatments options differ accordingly. Again, treatment could reduce effects of the disease substantially. However, it could come as a flare-up in some other part of your intestine soon. Such changing patterns of Crohn s disease makes it difficult to ascertain the actual benefit received through the treatment. Treatment Options of Crohn s Disease Treatment goals of Crohn s disease center on controlling inflammation and relieving chronic symptoms like abdominal pain, rectal bleeding, and diarrhea. They also aim at correcting nutritional

39 Living with Crohn s Disease by Lois Fordham deficiencies and providing overall relief. Treatments can at the most reduce chances of recurrence. They do not cure your Crohn s disease ailment. It is never possible to know when a remission could occur. You could remain free of any symptoms for many long years. This does not mean it was the success of any specific treatment. Patients with Crohn s disease should visit their doctor regularly and follow medical advice strictly. Drug Therapy Anti-inflammatory drugs like Mesalamine and Sulfasalazine can control inflammation effectively. Sulfasalazine consists of sulfa antibiotics and salicylic acid. As the intestine does not absorb this drug thoroughly, it stays within your intestine. The salicylic acid content fights intestinal inflammation. If you are unable to tolerate these, doctors prescribe other Mesalamine drugs like Dipentum, Asacol, or Pentasa. Common side effects of these drugs include headache, nausea, vomiting, diarrhea, and heartburn. Steroid or Cortisone drugs like Prednisone could prove effective in serious cases. This can cause extensive side effects with becoming infection-prone. Crohn s disease is primarily due to your immune system reacting against you. Immune system suppressors like azathioprine and 6-mercaptopurine can reduce the effects of your immune system. Sometimes, these medications help with better effectiveness of cortisone drugs. Common side effects include vomiting, nausea, and diarrhea. Steroids are very strong drugs and can cause extensive weakening of bones and increase susceptibility to infections.

40 Living with Crohn s Disease by Lois Fordham Taking corticosteroids as a treatment option is a gamble between effective treatment and strong side effects. An efficient combination of immunosuppressive drugs and corticosteroids can bring concerted relief. Additionally, it can also help you control and lower the dosage of corticosteroids over a period of time. Rather, immunosuppressive drugs reduce the effectiveness of corticosteroids. Infliximab is a new drug to control inflammation. This anti-body blocks tumor necrosis factor. This factor is primarily responsible for Crohn s disease. The first dosage of Infliximab is in a series of three injections. Later dosages include giving it every eight weeks. The U.S. Food and Drug Administration have specifically approved this drug for treatment of Crohn s disease. Patients using Infliximab can reduce their intake of steroid medications and need for surgery. However, you cannot use this medicine for long periods. It can predispose you to serious infections. Currently, there is extensive research going on to study the ill effects of this drug so that you can harness the maximum benefits. Antibiotics like sulfonamide, ampicillin, metronidazole, cephalosporin, or tetracycline can prove effective in controlling bacterial growth in the intestines. Diarrhea causes dehydration. Doctors prescribe antidiarrheal agents like loperamide, diphenoxylate, and codeine and lots of fluids and electrolytes to combat diarrhea. Some fiber preparations like psyllium and methylcellulose can help reduce cramps and pain. However, not all can tolerate these medications. Antibiotics prove effective in controlling bacterial growth in the intestine. Bacterial growth increases in cases of various fistulas,

41 Living with Crohn s Disease by Lois Fordham strictures, and surgeries. Doctors prescribe Tacrolimus and cyclosporine as alternative medications if your fistulas do not close. Although these drugs are primarily for patients with organ transplantation, they also provide relief for patients with Crohn s disease. This is specifically true for patients using steroidal medications. Nutrition Supplements Children with Crohn s disease show slow growth due to lack of sufficient absorption of nutrients. Nutritional supplements can prove beneficial for treating such children. Nutritional supplements are available in the form of high calorie liquid formulas. Doctors advise intravenous feeding of such supplements. Such nutritional supplements can prove to be good alternatives for your regular intake of food. You can take this through a catheter, a tiny tube directly inserted into your blood vein in the chest. Otherwise, you can take this intravenously through injections. Such intravenous feeding helps provide sufficient rest to your intestines and helps in thorough absorption of nutrients. Those suffering from Crohn s disease should better stay away from spicy foods, milk products, alcohol, and foods of bulky grains. Surgery Surgery proves necessary at some or other time for all Crohn s disease patients. Rather, it is the only treatment option available after all medications cease to be effective. Surgery can prove effective in treating Crohn s disease in two ways. It can provide relief from inherent symptoms or correct Crohn s disease complications like perforations, blockages, bleeding, and