Crohn's Disease
Crohn's Disease is a malady causing patchy inflammation of the gastro-intestinal tract. The other major inflammatory bowel disease (IBD) is Ulcerative colitis. Whereas Crohn's disease affects the full thickness of the bowel. Ulcerative colitis merely causes inflammation of the lining (mucosa) of the large intestine. At times it is difficult to distinguish the diseases from one another.
The cause of both these conditions is not known.
Features of Crohn's Disease.
The patchy inflammation results in:
- Ulceration and bleeding from the lining similar to that of ulcerative colitis.(Figure 1.)
Figure 1. Damage to the lining of the colon as seen by colonoscopy. Indistinguishble from Ulcerative Colitis.
- Infection with bacteria can cause abscesses and fistulae.(Tunnels between normally unconnected parts of the gut or with the exterior.) (Figure 2.)
Figure 2. Fistulae at the anus due to Crohn's disease.
- Narrowing of the bowel.
Symptoms :
- Loss of blood leads to anaemia with listlessness.
- Inflammation of the lining causes diarrhoea with loss of fluids and salts (electrolytes) from the body.
- Infection and abscesses cause fever and malaise.
- The narrowing of the bowel may cause blockages with vomiting and further fluid loss.
Investigations:
It is your doctors duty to correlate the symptoms, investigate and come to a rational conclusion.
- Blood tests show anaemia, inflammation as well as loss of salts and the resulting kidney damage.
- Barium Xrays (Barium meal and follow through) can show narrowings (strictures).
- Colonoscopy will show damage to the colon (Figure 1.) It enables the doctor to take samples (biopsies) of tissue for analysis by a pathologist The colonoscopist can often insert the instrument into the lowest part of the small intestine and get a sample from the terminal ileum. This may give a definite diagnosis (Figure 3.)
Figure 3.
Crohns disease in the ileum. One of the lumps was removed at colonoscopy and submitted to pathology. This established the diagnosis.
Treatment and prognosis.
Although it is not possible to cure the disease, treatment can almost always hold it at bay. As a result patients can lead a satisfactory life with a normal life expectancy.
Obstructions are relieved by surgical procedures.
Infections are treated with antibiotics and abscesses are cured by surgical drainage.
The basic inflammation can be improved by medication such as salazopyrene or similar drug .
Steroids (Cortisone like drugs) can be applied locally with enemas or, by mouth in the form of tablets.
A new drug "Infliximab" may prove to be of great value.
Frequently asked questions.
- Can I have a Baby? Speak to your Doctor about this. The answer is usually "Yes"
- What can I eat? A normal diet with plenty of fruit and vegetables is satisfactory. Supplements with vitamins and iron may be recommended.
- Can I drink alcohol? In moderation it is not harmful.
- Can I smoke? Reduce this as much as possible. Stop altogether if you can.
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