Causes
Complications
Diagnosis
Latest discoveries
Crohn’s disease, ileitis or enteritis is a medical condition that is known to cause inflammation of the digestive system also known as gastrointestinal (GI) tract. This condition affects any part of the gastrointestinal tract, starting from the mouth to the anus, but it mostly affecting the ileum (USFDA,2008). The inflammation may penetrate deep into the lining of the organs affected thereby causing pain making the intestines occasionally empty, resulting in diarrhoea.
Similarity in symptoms with other intestinal disorders, like irritable bowel syndrome and ulcerative colitis, makes Crohn’s disease difficult to diagnose. Ulcerative colitis results in inflamed ulcers on the top lining of the large intestine while in Crohn’s disease all the layers of the intestines are involved, and healthy bowel may be occur in between parts of the affected bowel. Other symptoms include, fever, unintentional weight loss, fatigue, tenesmus, and persistent, watery diarrhoea.
The disease is known to affect both genders in equal measures though it may be genetic thus 20% of people with Crohn’s disease inherits it from blood relations with inflammatory bowel condition mostly a sibling or the parents It affects people of all age groups but is more pronounced in people of ages 20-30 and those of Jewish background in while it is less diagnosed in the African-American population (NDDIC, 2006).
Causes
Several hypotheses have been forwarded in an attempt to explain the causes of Crohn’s disease. One such theory states that the immune system of people with this condition reacts exceptionally with food, bacteria, and other substance recognizing them as antigens therefore responding by attacking them. The white blood cells accumulate intestinal layers Another Theory states that either the body’s reaction to the foreign substances or the substances themselves may be the root cause of inflammation and that the genes, the environment, the immune system and other factors may be responsible.
Environmental factors
It has been suggested that Crohn’s disease’s incidence in the industrialized world can be attributed to certain environmental causes. This is because it has for sometime been associated with an increased uptake of food containing animal protein as well as milk protein .The individuals who consumer foodstuffs containing vegetable proteins appear to have lowered incidences of the Crohn’s disease
Immune system
The opinion that Crohn’s disease is technically an autoimmune disorder of T cell means that it could be as a result of an impaired immune system (Marks & Segal,2008,p.263)
Complications
Crohn’s disease has got several complications that may include the blocking of intestines due to thickening of the walls that is caused by swelling and scar tissues hence narrowing the passage. The condition is also responsible for sores and ulcers found on the affected parts and the surrounding tissues, like the bladder, reproductive system, and epidermis. Fistula is also one of the complications and may require medication and in some cases surgery. Fissures may also be found developing in the mucal membrane of the anus.
Nutritional complications are also familiar with Crohn’s condition and may include deficiency of proteins, vitamins and calories. This is as a result of malabsorption, poor intake of diets and loss of proteins by the intestines. Other complications include; arthritis, skin/epidermal complications, eyes and mouth inflammation, kidney stones, gallstones, liver and biliary system problem.
Diagnosis
To diagnose Crohn’s disease, physical examination and several clinical tests are carried out. These includes blood tests to look out if the patient suffers from anemia, which could in turn be indicative of intestinal bleeding, The tests may also reveal a high white blood cell count, which is a sign of inflammation in the gastrointestinal tract. Conducting stool sample tests may also indicate intestinal bleeding or infection. Albumin test may also be necessary when presented with symptom such as fatigue, weight loss, swelling around the eyes, belly and legs in order to distinguish the condition from diseases that present the same symptoms such as liver disorders and nephritic syndrome. A medical practitioner may also undertake an upper gastrointestinal test using barium solution and x rays in order to indicate presence of inflammation in the small intestines. Sigmoidoscopy and colonoscopy may also be conducted for visual examination of the colon and small intestines respectively. Other test that may be conducted includes computed tomography of the abdominal area, endoscopy, enteroscopy and magnetic resonance imaging.
Treatment
To treat Crohn’s disease, a lot of options are available, these may include the use of drugs, surgery, nutritional supplements or a combination of all the above in severe cases .The objectives of treatment are to curb inflammation, correct nutritional challenges and alleviate symptoms like abdominal pain, diarrhoea and intestinal bleeding. It must be noted that treatment only inhibits the condition by reducing the number of times of recurrence but does not cure it as there is no cure. Treatment largely relies on the extremity of the disease, its location, complications and a patient’s response to former medication when treated for recurrence.
Drug therapy for Crohn’s disease includes the use of anti-inflammatory drugs with mesalamine as an ingredient such as Sulfasalazine, Pentasa, Dipentum and general 5-ASA agents. Documented side effects may include nausea, vomiting, diarrhoea, heartburn and headache. Corticosteroids may also be administered in extreme cases. Drugs such as Pednisone are given and their dosage kept in check and only reduced once the symptoms disappear. Corticosteroids are known to present serious side effects that may include compromising of the patient’s immunity leaving him/her susceptible to pathogenic infections.
Immune suppressors with immunosuppressive agents may be administered to curb inflammation caused by the white blood cells.Remicade drugs are also administered for the same purpose.Other medications may include anti-diarrhoeal drugs to such as Loperamide may be prescribed to stop diarrhoea. Antibiotics such as penicillin and tetracycline can be used to prevent overgrowth of bacteria in the intestines that results from fistula and surgery.For children with retarded growth as a result of Crohn’s disease, doctors are advised to administer nutritional supplements. High calorie and protein rich formulations may be applied while some patients may be fed intravenously.
Latest discoveries
Extant literature has been dedicated to the latest medical and scientific findings on Crohn’s disease. Some of these are; aluminum being an adjuvant to the disease (Leaner,2012,p.231) and Barat et al.’s (2011,p.3270) proposition that the Prodromal Irritable Bowel Syndrome could be reasponsible for the observed delays in the diagnosis of patients who are presenting with an unrecognized cases of Crohn’s disease as well as Celiac disease. Research and latest findings on Crohn’s disease have shown new hope in personalized treatment of the disease. Researchers have successfully mapped out three genes and their locations, associated with Crohn’s. This has provided proof that although Cohn’s condition is hereditary, it is not caused by a single gene and that the genes do mutate. The techniques used in mapping showed DNA stretches that had been passed down to generations thereby localizing genes that are faulty. The project essentially mapped the most possible location of faulty genes for Crohn’s condition in the genome.
It has also been found that loss of NOD2, the gene responsible for Crohn’s condition, increases the risk of developing the disease and increased gene activity exacerbate symptoms of the disease. New discoveries also showed that activation of NOD2 mutations could be responsible for sarcoidosis (an inflammatory condition that affects the lymphoid tissues and the lungs). Two FDA approved drugs were noted to be greatly effective in inhibiting the activity of NOD2 genes’. The most successful pharmacologic agents developed for treatment of both blood and solid cancers have been made to target protein kinases. The two drugs, Tarceva and Iressa that target the cancer cells’ epidermal growth receptor (EGF-Receptor) protein kinase to inhibit development of lung and brain cancers. The researcher screened tyronsine kinase inhibitors and discovered that the two drugs are very effective against RIP2. The medications were found to target RIP2 as efficiently as they targeted EGF-Receptor. Both drugs were found to inhibit and reduce the effects of NOD2 hyper activation.
Conclusion
Crohn’s disease is a dangerous disease which must be carefully treated as well as managed in order to minimize the mortality rates that are associated with it.. Future research is necessary in order to pinpoint the exact causes of the disease.
References
Barratt, S, Leeds, J.Robinson, K.,Lobo, A. McAlindon, M.Sanders, D. (2011)Prodromal Irritable Bowel Syndrome May Be Responsible for Delays in Diagnosis in Patients Presenting with Unrecognized Crohn’s Disease and Celiac Disease, but Not Ulcerative Colitis. Digestive Diseases & Sciences; Nov2011, Vol. 56 Issue 11, p3270-3275.
Leaner, A (2012).Aluminum as an adjuvant in Crohn’s disease induction. Lupus; Feb2012, Vol. 21 Issue 2, p231-238.
Marks DJ, Segal AW. (January 2008). “Innate immunity in inflammatory bowel disease: a disease hypothesis.” J. Pathol.214 (2): 260 — 6. doi:10.1002/path.2291. PMC 2635948.PMID 18161747.
National Digestive Diseases Information Clearinghouse .(2006).Crohn’s Disease
http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/Crohns.pdf
U.S. Food and Drug Administration (2008).Facts Abount Crohn’s Disease
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm107364.pdf
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