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Crohn S Disease

 

Crohns Disease Introduction

:crohns.gif Crohn’s disease is a chronic inflammatory disease of the GI tract. It is also known as Regional Enteritis, Granulomatous Ileitis, and Ileocolitis. It mainly affects the ileum and the colon, but it can occur at any site along the digestive tract. Crohn’s disease causes ulcerations in the wall of the intestine. These ulcerations are patchy (skip lesions) and not confluent like the lesions of Ulcerative Colitis. As a result of the damage to the wall, individuals may experience bleeding (anemia), malabsorption (malnutrition), fissures and fistulas (infection), and obstruction of the GI tract. [1]

There is no known cause of Crohn’s disease. It is, however, thought to be mediated by autoimmune reactions. These reactions directly impact the GI tract and can be due to environmental, dietary, and infectious agents. The immune response, or reaction, often causes inflammation in the affected area. It is this inflammation that leads to ulcer formation in the lining of the intestine. Over time, the ulcers proliferate and inflammation occurs in nearby tissues.[2]

Crohn’s disease affects both men and women equally. Peak incidence is between the ages of 14-24, though it can occur for the first time in the 50-70’s (known as second wave). Over the past few decades, this condition has become more common in Western societies, with the Jewish population being the most affected. As with many chronic conditions, there are increases in the prevalence of Crohn’s disease in families with one member already diagnosed. [3]

Crohns Disease Symptoms

The most common presenting features of Crohn’s disease are; chronic diarrhea, weight loss, abdominal pain, fever, and right lower quadrant fullness. Patients may complain of loss of appetite and fatigue. Some patients may be diagnosed after presenting to the ER with an acute abdomen. Rectal bleeding and blood in the stool are also common symptoms. [4]

On examination, individuals with Crohn’s disease may have fissures or fistulas in the perianal area. These persons may also have anemia, or suffer from a concurrent infection in the GI tract. Enlarged lymph nodes are common and are caused by an inflammatory response. Children who are diagnosed with Crohn’s disease may also suffer from severe malnutrition and growth retardation. If obstruction is the primary presenting sign, individuals may exhibit constipation, fullness, nausea, and even vomiting. [5]

The worst complication of Crohn’s disease is the perforation of the bowel, which results in fecal material entering the abdominal cavity. This causes severe infection and inflammation in the nearby organs, as well as a risk of severe bleeding. [6]

Crohns Disease Statistics

  • At least 500,000 Americans have been diagnosed with Crohn’s disease.
  • 10% or 50,000 of those diagnosed will be less than 18 years old.
  • 20-25% of individuals diagnosed will also have a relative with the disease.
  • An individual has 10 times the risk of developing Crohn’s disease if a relative has the disease.
  • If a brother or sister has the disease the risk increases to 30 times.[7]

Crohns Disease Treatment

Conventional Crohns Disease treatment aims to prevent further inflammation and to decrease pain. Corticosteroids (Prednisone) are used to decrease inflammation. However, this treatment option may only be beneficial for a short duration, as its long-term use has significant side effects, such as osteoporosis, decreased healing, and increased risk of infection. If corticosteroid therapy is not adequate immunosuppressive drugs can be used with the hopes of inducing a remission of the disease. Anti-cholinergic medications are often used over NSAIDs for controlling pain. These drugs work by decreasing the pain signal from the gut to the brain, although these too can affect other systems in the body, leading to unwanted side effects. [8]

Patients with Crohn’s disease suffer from extreme malabsorption. Treatments should begin by replacing the depleted nutrients. In addition, programs should be equally focused on reducing the inflammation, while providing the necessary nutrients for the regeneration of healthy tissues. Treatment goals are to tonify the GI tract and support healing.

Supplements helpful for Crohns Disease

Omega 3 Fatty Acids Omega 3 fatty acids are a polyunsaturated fatty acid (PUFA). They act as a natural anti-inflammatory by decreasing the production of inflammatory prostaglandins and leukotrienes. These inflammatory molecules are instigated in the damage to the intestinal wall in Crohn’s disease. Omega 3 fatty acids are located in fish oils (EPA and DHA), flaxseed oils, and borage oil. Essential fatty acids, like Omega 3, are often deficient in patients with Crohn’s disease. [9]

Fish oil was compared against placebo in a study focused on remission rates after treatment. Treatment with fish oils resulted in 41% greater improvement in remission rate when compared to placebo. In addition, 2/3 of the patients in the fish oil group responded favorable to supplementation, as compared to 1/3 in the placebo group. Remission was also maintained for greater than one year in the fish oil group. [10] Another significant study examined the anti-inflammatory mechanism of fish oil. It was found that certain constituents of fish oil lowers the levels of cell signaling molecules, which stimulate inflammatory mechanisms in the tissues. [11]

DHEA DHEA is a steroid/hormone precursor made by the body. Recently, it has been studied in the treatment of Crohn’s disease. Clinical tests show that DHEA is deficient in patients with inflammatory bowel disease. Studies indicate that the supplementation of DHEA for a minimum period of 8 weeks, may result in a decrease of disease activity. More so, 85% of the participants in one study responded favorably to DHEA treatment by entering into a state of remission. [12]

Vitamin D Vitamin D is a necessary addition to any therapeutic plan for Crohn’s disease. Vitamin D is deficient in Crohn’s disease because of the decreased absorption of all fat-soluble vitamins. Its supplementation is recommended to ensure adequate levels are retained in the blood. Because Vitamin D is poorly absorbed in individuals with Crohn’s disease, persons with this condition are at increased risk for developing osteoporosis. This risk is further enhanced if patients are being treated with corticosteroids.

Supplementation with Vitamin D has been shown to enhance bone mineral density in patients with Crohn’s disease. One particular study measured the bone mineral density of the hip and spine in patients with Crohn’s disease. Persons with this condition were found to have an extremely low bone mineral density in both areas of the body. After supplementation with Vitamin D and calcium took place, there was a notable increase in the bone mineral density at both hip and spine. [13]

Vitamin A, Vitamin C, and Vitamin E These vitamins are often deficient in individuals with Crohn’s disease. Vitamin A is both an antioxidant and protective nutrient for the cells lining the digestive tract. Vitamin E acts as an anti-inflammatory and potent antioxidant. Vitamin C is also an antioxidant and assists with increased immunological functioning and wound healing.

Oxidative stress is a contributing factor to the inflammatory process in Crohn’s disease. A study was carried out to measure the oxidative stress in patients with Crohn’s’ disease. During the study, Vitamin E, A, and C amounts were measured in the participants. The study concluded that oxidative stress markers were, in fact, elevated in the blood of patients with Crohn’s disease, and that antioxidants were decreased. After the dietary supplementation of antioxidant rich nutrients, like Vitamins E, A, and C, were reintroduced to deficient test subjects, serum levels of antioxidants increased and oxidative stress decreased. [14]

Vitamin B12 and Folic Acid Both Vitamin B12 and folic acid are deficient in individuals with Crohn’s disease. This is, in large part, due to the decreased absorption resulting from damage to the GI tract. Patients with Crohn’s disease are prone to anemia, which can be a direct result of the lack of absorption of both these vitamins. Homocysteine is elevated in the blood of individuals with Crohn’s disease as well. [15] Homocysteine levels become elevated by a lack of Vitamin B12 and folic acid. However the supplementation of these nutrients adequately reduces the homocysteine levels in the blood.

High Potency Multi-vitamin Because Crohn’s disease manifests with malabsorption, a high potency multi-vitamin is recommended to provide extra nutrients that may not be obtained from whole food sources. Many minerals will be deficient, and the majority of sufferers will benefit from the supplementation of minerals. Some minerals known to be deficient in patients with Crohn’s disease include; iron, copper, zinc, magnesium, and selenium. [16]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[2] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[3] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[4] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[5] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[6] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[7] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml Crohn’s and Colitis Foundation of America. November 2004.

[8] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages:302-307.

[9] Kuroki F et al. Serum n 3 polyunsaturated fatty acids are depleted in Crohn’s disease. Dig Dis Sci. 1997 Jun; 42(6): 1137-1141.

[10] Belluzi A et al. Effect of enteric coated fish oil preparation on relapse in Crohn’s disease. N Engl J Med. 1996 Jun 13; 334(24): 1557-1560.

[11] Simopoulos AP. Omega 3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002 Dec; 21(6): 495-505.

[12] Andus T et al. Patients with refractory Crohn’s disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study. Ailment Pharmacol Ther. 2003 Feb; 17(3): 409-414.

[13] Bartram SA, Peaston RT, Rawlings DJ, Francis RM, Thompson NP. A randomized controlled trial of calcium with vitamin D, alone or in combination with intravenous panidornate, for treatment of low bone mineral density associated with Crohn’s disease. Aliment Pharmacol Ther. 2003 Dec; 18(11-12): 1121-1127.

[14] Aghdassi E et al. Anti-oxidant vitamin supplementation in Crohn’s disease decreases oxidative stress, a randomized controlled trial. Am J Gastroenterol. 2003 Feb, 98(2): 348-353.

[15] Chowers Y et al. Increased levels of homocysteine in patients with Crohn’s disease are related to folate levels. Am J Gastroenterol. 2000 Dec; 95(12): 3498-3502.

[16] Ames S, Pinchbeck BR, Dunwoody A, Walker K, Thomson AB. Iron, folate hydroxycobalamin, zinc, and copper status in outpatients with Crohn’s disease: effect of diet counseling. J Am Diet Assoc. 1987 Jul; 87(7): 928-930.