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Crohen's disease

Updated on May 6, 2014

Crohn's Disease

Introduction

In 1932 Dr. Burrill B. Crohn published his famous paper along with his colleagues Oppenheimer and Ginzburg that revealed what is known today as Crohn's disease, named after the famous physician. The two major inflammatory diseases of the bowel are Crohen's disease and the ulcerative tolitis. This is a transmural inflammatory disease of the bowel where the terminal ileum and right colon preferentially, but also bowel colon, rectum and the perineal area. Abdominal pain, severe to mild diarrhoea, anemia and loss of appetite etc are the usual symptoms associated with this disease. Weight loss also occurs which is accompanied with extra digestive manifestations such as fever, aphtosis, arthralgia, erythemandosa. This disease is perceived to be the result of hyperactivated intestinal immune system which is the consequence of some environmental factors genetical susceptibility, still unknown. More than the Southern countries this disease is more prevalent in Northern countries.

Causes of the disease:

Most experts think there is a multifactorial explanation. There a various factors which are linked together in bringing about Crohn’s disease. The major factors are:

(1) Environmental (2) Genetic (3) Malfunctioning of the body’s immune system.

Definition

The patient with this disease suffers pain and weight loss. The pain occurs usually after meals and may include partial intestinal obstruction. It prominent symptoms are diarrhea and bleeding. Extra digestive indications may occur parallel with digestive symptoms during its attacks like fever, arthralgia, arthritis, erythema, noose, pyoderma, iritic, gangrenous etc. Each year 30,000 or more cases of Crohn's disease including the ulcerative colitis are diagnosed and normally people between the ages of 15 and 20 are more prone to this disease. Crohn’s and ulcerative colitis diseases are mostly found in the urban areas of developed countries, so this disease like many others, is also due to the urban lifestyle. Researchers have discovered that Crohn’s disease tends to run in families

Physical examination

The symptoms to look are oral apodosis, abdominal tenderness and masses, anal tags, fissure andfistulae. In children growth retardation is highly evident. Rigid or flexible procto-sigmoidos copy will establish the diagnosis of Crohn's proctitis. Mild inflammation may consist of erythema, aphtousulcers, granularity with increased contact bleeding but with intervals of the preserved normal mucosa (Loftus EV Jr 2007). Biopsies both rectal and colonic are usually helpful in finding the type of the inflammation, collagenous colitis or microscopic inflammation, CD histology is known by preserved mucosal architecture. While in acute colitis a plain abdominal radiograph is helpful in diagnosing the extent of the attack. Patients with Crohn's

disease may complain sometime about urgent bowel movements and abdominal pain, but these symptoms vary from person to person. Loss of appetite resulting in weight loss or another symptoms along with anemia (Abakar-Mahamat A 2007)

Types of Crohn’s disease

-Crohn’s (granulomatous) colitis: Affects the colon only.

-Gastroduodenal Crohn’s disease: Affects the stomach and duodenum

-Ileitis: Affects the ileum.

Management

This disease is managed with drugs like Corticosteroids Steroids which are considerably effective in severe attacks of the CD. The optimum initial dose of oral Prednisolone for acute episodes of inflammatory bowel disease (IBD) is 1mg/kg /day in a single morning dose resulting in a control of symptoms in 60-80 % of patients in 2 to 4 weeks of treatment. Oral steroids are tolerated well by most patients, including weight gain, insomnia, acne, hypertension, etc. These effects can be reduced by weaning off the dose quickly as an acute episode is controlled. (Anderson CA, et al. 2011). It is not really known what causes Crohn’s Disease. However, over the past few years major advances have been made, particularly in genetics.

Conclusion

It is still not understood what causes Crohn's disease and its prediction as to how it is going to affect an individual. It has been noticed that most individuals do not show any symptoms while others show regular flare-ups. The one aspect that is sure about Crohen's is that it is a chronic disease which means that it can be controlled by interventions but not cured. Crohen's is a long term condition.

References

Abakar-Mahamat A, Filippi J, Pradier C, Dozol A, Hébuterne X.Incidence of inflammatory bowel disease in Corsica from 2002 to 2003. Gastroenterol Clin Biol 2007; 31: 1098–103.

Anderson CA, Boucher G, Lees CW, et al. Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47. Nat Genet 2011; 43: 246–52.

Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: 1504–17.

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