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Crohn's Disease Medication - Symptoms And Treatment

Crohn's disease is an inflammation of the alimentary tract. It can affect any portion of the tract from the mouth to the anus. In 50% of cases, the disease involves the colon and small bowel. About 33% of cases involve the terminal ileum, and 10% to 20% of cases involve only the colon. The disease can extend through all layers of the intestinal wall and may also involve regional lymph nodes and the mesentery.

Crohn's disease is most prevalent in adults ages 20 to 40. It's two to three times more common in people of Jewish ancestry and least common in blacks.

Causes

Signs and symptoms

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth. The range and severity of symptoms varies.

Diagnosis

Upper GI series with small-bowel follow-through may demonstrate ulcerations, stricture, and fistulas.

Laboratory findings often indicate increased white blood cell count and erythrocyte sedimentation rate, hypokalemia, hypocalcemia, hypomagnesemia, and decreased hemoglobin level related to anemia from chronic inflammation, blood loss from the mucosa, and iron deficiency. Leukocytosis can be related to corticosteroid therapies, inflammation, or abscess formation. Sedimentation rate is increased in patients with active inflammation. Hypoglobulinemia may result from intestinal protein loss. A barium enema showing the string sign (segments of stricture separated by normal bowel) supports the diagnosis.

Flexible sigmoidoscopy and colonoscopy may show patchy areas of inflammation, ulcers, strictures, and granulomas, thus helping to rule out ulcerative colitis. However, a definitive diagnosis is possible only after a biopsy.

Treatment

No cure for Crohn's disease exists; treatment is symptomatic. In debilitated patients, therapy includes I. V. hyperalimentation to maintain nutrition while resting the bowel.

Medication can in many cases control the inflammation, keep the symptoms down, and reduce the probability of relapse.

Promising results have been obtained with the use of budesonide (Entocort), a corticosteroid with high topical anti-inflammatory activity and low systemic activity (because of extensive hepatic metabolism). This medication , though costly, can reduce the intestinal inflammation while minimizing the side effects that would commonly be experienced with prednisone.

Effective treatment requires important changes in lifestyle: physical rest, low-residue diet, and elimination of dairy products for lactose intolerance.

Surgery may be necessary on poor response to medical therapy to correct bowel perforation, massive hemorrhage, intra-abdominal abscess, stricture, fistulas, or acute intestinal obstruction. Colectomy with ileostomy is often necessary in patients with extensive disease of the large intestine and rectum.

Diet for crohn's disease

Paying close attention to diet can help reduce the number and severity of flare-ups for many sufferers. Patients are encouraged to follow a nutritious diet and limit any foods that seem to worsen symptoms. Individual reactions vary. Some foods commonly avoided by Crohn's patients are:

• Foods associated with inflammation (alcohol, hot spices, and caffeine).
• Simple sugars.
• Dried fruits or high-sugar fruits, such as grapes, watermelon, or pineapple.
• Products containing corn or gluten (those made from wheat, oats, barley, or triticale).

The patient is advised to eat a well-balanced diet, with adequate protein and calories. A multivitamin and iron supplement may be recommended by the physician.

Stress, anxiety, and extreme emotions may aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic disease can produce a serious emotional reaction, which can usually be handled through discussion with the physician.