Crohn’s Disease: A chronic Inflammatory Disease Of The Digestive System
Thursday, October 6, 2016
Crohn’s disease is a chronic inflammatory disease of the digestive system, which evolves in spurts (or attacks) and remission phases. It is characterized mainly by attacks of abdominal pain and diarrhea, which can last several weeks or months. Fatigue, weight loss and malnutrition can occur even if no treatment is undertaken. In some cases, non-digestive symptoms that affect the skin, joints and eyes may be associated with the disease.
If Crohn’s disease, inflammation can affect any part of the digestive tract from the mouth to the anus. But more often, it’s moved to the junction of the small intestine and colon (large intestine).
In Canada, Crohn’s disease affects about 50 people per 100,000 of population in industrialized countries, but there is a great variability depending on geographic region. The place in the world where there are the most reported cases is in Nova Scotia, a Canadian province, where the rate climbs to 319 per 100,000 people. Japan, Romania and South Korea, the rate is less than 25 100.00029.
The disease can occur at any age, including in childhood. It is usually diagnosed tasks people from 10 to 30 years.
Crohn’s disease is due to a persistent inflammation of the walls and the deep layers of the digestive tract. This inflammation may result in a thickening of the walls in some areas, cracks and sores to others. The causes of inflammation are unknown and possibly multiple, involving genetic, autoimmune and environmental.
genetic factors. Although Crohn’s disease is not entirely a genetic disease, certain genes can increase the risk of developing it. In recent years, researchers have discovered several susceptibility genes, including the gene NOD2 / CARD, which multiplies by 4 or 5 the risk of suffering from disease. This gene plays a role in the body’s defense system. However, other factors are necessary for the disease to occur. As in many other diseases, it seems that a combination of genetic susceptibility to environmental factors or lifestyle triggers the disease.
autoimmune factors. Such as ulcerative colitis, Crohn’s disease autoimmune disease characteristics. Researchers believe that the inflammation of the digestive tract may be related to excessive immune reaction of the organism against viruses or bacteria present in the intestine.
Environmental factors. Note that the incidence of Crohn’s disease is higher in industrialized countries and tends to increase since 1950. This suggests that environmental factors, possibly related to the Western lifestyle, could have a significant influence on the appearance of the disease. However, no specific factors have yet been identified. Several tracks are however under investigation. Exposure to certain antibiotics, especially the tetracycline class, is a risk factor potentiel. Smokers are at higher risk of developing the disease. Too sedentary people are more affected than people who are more actives.
It is possible, but there is no absolute proof that the rich too bad fat diet, meat and sugar increases the risk. It was long thought that stress could trigger seizures. However, studies to date seem to refute this hypothesis.
Researchers are looking especially on the possible role of infection by a virus or bacteria (Salmonella, Campylobacter) in triggering the disease. Besides infection by “outside” microbe, an imbalance of the intestinal flora (that is to say bacteria naturally present in the digestive tract) could also be in cause.
Furthermore, some elements seem to have a protective effect. This is the diet rich in fiber and fruits, the contact before the age of one year with cats or farm animals, appendectomy, as well as having gastroenteritis or infections respiratory. There was also no association between the MMR (measles-mumps-rubella) and Crohn’s disease.
Obstruction of the digestive tract. Chronic inflammation can lead to thickening of the wall of the digestive tract, which can lead to a partial or total blockage of the digestive tract. This can lead to bloating, constipation, vomiting or feces. Emergency hospitalization may be necessary to avoid a perforation of the intestine.
Ulcers in the gut wall.
Sores around the anus (fistulas, deep cracks or chronic abscess).
Bleeding of the digestive tract, rare but sometimes severe.
People with Crohn’s disease in the colon have a slightly increased risk of being victims of colon cancer, especially after many years of illness, even if they are in treatment. It is therefore advised to have an early and regular screening for colon cancer.
Other Possible complications
Under nutrition, , patients tend to eat less because of the pain. Also the ability to absorb food through the intestinal wall is compromised, in medical language we speak of malabsorption.
Delayed growth and puberty in children and adolescents.
Iron deficiency anemia because of bleeding in the digestive tract, which can occur at low noise and be invisible to the naked eye.
Other health problems, such as arthritis, skin disorders, inflammation of the eyes, mouth ulcers, kidney stones or gallstones.
Crohn’s disease, when in phase “active” increases the risk of miscarriage in pregnant women with cancer. It can make it difficult fetal growth. It is therefore important that women who wish to become pregnant well control their disease using treatments and discuss with their doctor.
Can we prevent this disease?
As it is uncertain what causes the disease, no way to prevent it is known.
A study published in 2010, conducted among more than 67,000 women in France, however, showed that high intake of animal protein (meat and fish) was associated with an increased risk of suffering from disease. These data need to be confirmed for men and children.
Measures to prevent worsening and recurrence
Treatment, if it is suitable and followed, to reduce the frequency of attacks and prevent further damage.
Stop smoking. Smoking, even slight, increases the intensity of symptoms, number of recurrences and surgeries related to the disease.
Avoid anti-inflammatory drugs-prescription or prescription. They are cons-indicated because they can trigger an attack or worsen symptoms. As a painkiller, acetaminophen favor. At recommended doses, acetaminophen (Tylenol®) is safe for the digestive system.
Several studies have examined the utility of various dietary changes to prevent recurrence. Some tested the effect of a reduced supply in refined sugars and increased omega-3. Others have tested the exclusion of certain foods. These experiences, however, have revealed a special diet that would prolong periods of remission in the majority of patients.
In some cases, however, it appears that certain foods aggravate symptoms, but these foods vary from person to person. It can be red meat, cereals (wheat or corn), dairy products, certain fruits or vegetables, etc. It is recommended that each person discover these foods, e.g noting in a book meal composition and intensity of symptoms after each meal. Some doctors suggest to exclude the “trigger” foods for 2 to 4 weeks to see if symptoms improve or not. Indeed, reactions to foods are not necessarily immediate.
Possible Medical Treatments
There is no treatment to cure Crohn’s disease. The goal of treatment is to correct nutritional deficiencies and control inflammation which will effectively relieve pain, diarrhea and other symptoms. During periods of remission, it is often necessary to follow a maintenance treatment to reduce the frequency of relapses and reduce the progression of lesions. In most cases, it should be emphasized that current treatments can well control the disease.
As the disease progresses in spurts interspersed with periods of remission, it is sometimes difficult for the doctor to assess the effectiveness of treatments undertaken. To better judge the effectiveness of a treatment, it is recommended to keep a journal where there is daily:
– The number of bowel movements;
– The state of stool (liquid or solid);
– The frequency, duration and intensity (on a scale of 1 to 10, for example) abdominal pain or stomach cramps;
– The quality of appetite;
– Foods that aggravate symptoms;
– The times of day when symptoms are most present;
– The weight (weekly).
These treatments prescribed in the forefront calm inflammation in a crisis. The choice of the drug and its route of administration depend on the intensity of symptoms and their location in the digestive system.
Aminosalicylates (or salicylates), including sulfasalazine (Azulfidine®) and mesalazine or mesalamine (Rowasa®, Canasa®, Asacol® Pentasa, Apriso ™, Lialda®, Mezavant®) are administered orally, rectally ( suppositories) or by enema. They are used both to calm the outbreaks and to maintain remission. The most common side effects are nausea, vomiting and headaches.
If aminosalicylates intestinal are not enough to relieve the symptoms, the doctor suggests more powerful anti-inflammatory, such as oral corticosteroids, which have a general anti-inflammatory effect. The most commonly prescribed corticosteroids to treat Crohn’s disease are prednisone and prednisolone. They are usually used for a few weeks, until remission is achieved. The dose is then reduced gradually. In some cases where the disease is localized and moderately active, budesonide, a corticosteroid which acts locally in the gastrointestinal tract, so with fewer side effects, can be provided.
Oral corticosteroids systemic effect, however, carry risks of more pronounced side effects, which limit their long-term use. These include a weight gain, acne, increased hair growth, mood disorders and insomnia. In the long term, corticosteroids can also induce osteoporosis.
Immunomodulators and biologics
Immunomodulators (including immunosuppressants) act very selectively on certain players of the immune system to calm the inflammatory reactions. These drugs are usually used to maintain remission after treatment “attack” by aminosalicylates or corticosteroids. They also contribute to the healing of fistulas. The 6-mercaptopurine (6-MP, Purinethol®) and azathioprine (Imuran®) immunomodulators are most often prescribed for people with Crohn’s disease. Methotrexate (Rheumatrex®) may also be employed. These drugs can cause side effects (nausea, vomiting, diarrhea) and lower resistance to infections if the dose is not adjusted.
The anti-TNF alpha agents such as infliximab (Remicade) or adalimumab (Humira), are recent drugs that target tumor necrosis factor (TNF), a substance with a role in inflammation. These drugs are reserved for patients with moderate to severe symptoms and in whom other drugs are ineffective or cause too many side effects. They can also be used as maintenance therapy.
Antibiotics may be prescribed in cases of sudden worsening of symptoms caused by an intestinal infection. Antibiotics are also used to treat abscesses and wounds located in the anal area.
In some cases, anti-diarrhea may help reduce diarrhea. Psyllium or methylcellulose possible in particular to regulate transit. However, antidiarrheal or laxative may also irritate the digestive tract and cause serious complications in people with inflammatory bowel disease. It is imperative to consult your doctor before taking an antidiarrheal, antispasmodic or laxative whatsoever.
iron supplements, to be taken orally, may be necessary in cases of anemia.
Analgesics relieve mild abdominal pain. Favoring acetaminophen (Tylenol®).
Thursday, October 6,2016-22:00:25[London]
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