Avoiding problems is key in Crohn's disease
Posted April 21, 2010
By Kathrin Mayer Troppmann, M.D.
Cramping pain. Diarrhea. Feeling miserable. Most people have a couple of mild bouts of such symptoms every year. For others, the symptoms are severe, prolonged and recurring and may become a central focus of their lives. Such people need to see a doctor — perhaps numerous times — until they are properly diagnosed and treated.
One abdominal condition that was often overlooked for too many years is Crohn’s disease. Its symptoms are common to many diseases: pain (often on the right side and occurring just after eating), diarrhea that may contain blood, and feeling sick and tired. A doctor, usually a gastroenterologist, must carefully consider the patient’s history and symptoms and perform several tests before being certain of the diagnosis.
An inflammatory response
Crohn’s disease most often starts in childhood or early adulthood. It tends to run in families and has an especially high incidence among people of Jewish descent. Although the cause has been variously attributed to infectious agents, genetics and dietary factors, no theory offers a clear-cut explanation. The notion that it is caused or exacerbated by personality traits has been completely discredited.
The physiology of Crohn’s disease is somewhat better understood. The body mounts an inflammatory response, causing pain, swelling, redness and ulceration. Most people have involvement of the lower part of the intestine, known as the ileum, but any part of the digestive system, from the mouth to the anus, can be affected.
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Without treatment, complications are common and can be severe. The process of ulceration can lead to the formation of fistulas, which are openings or passageways between the intestine and the outside skin or other internal organs. Infections and abscesses may result. Frequently, the area around the anus and rectum are involved. Fistulas often require surgical repair.
The inflammatory process can lead to other problems as well. Swelling and scar tissue can obstruct the narrow tube of the intestine. This often must be corrected with surgical removal of the blocked area and reconnection of the intestine.
A lifelong priority
Crohn’s disease tends to be a lifelong recurring problem. Patients must take special care of their health and seek medical advice before flare-ups become severe. During bouts, top priorities are keeping ahead of the diarrhea by eating and drinking enough and getting adequate rest.
Medications can be invaluable in controlling flare-ups and prolonging remissions. Corticosteroids, aminosalicylates, antibiotics and immunosuppressant drugs all have important uses. Infliximab is a newer type of medication for autoimmune diseases that has shown great promise in treating Crohn’s disease. Treatment is always highly individualized to obtain maximum benefits with a minimum of side effects.
"If you have a problem such as Crohn's disease, work closely with a specialist — and expect to need regular adjustments of your treatment as your condition fluctuates."
— Kathrin Mayer Troppmann
Despite best efforts to control the disease with medications, surgery is sometimes unavoidable to correct complications. The decision to operate is often a difficult one and must be considered carefully by the patient in consultation with doctors experienced with the disease. I usually recommend the most conservative surgery possible, taking out only what can’t be repaired. But I often must advise patients that prompt surgical intervention is often in their best interests and that delaying treatment for too long can have serious consequences.
Coping and support
Chronic bowel syndromes such as Crohn’s disease are not easy to live with. Symptoms can be unpredictable, making it easy to feel that one’s health is beyond control. Friends and family members — and sometimes even doctors who are inexperienced with the disease — may convey impatience and frustration. It’s no wonder that Crohn’s sufferers are prone to depression, especially when the disease is severe. Some turn to alcohol or drugs, which only exacerbate the problem.
If you are suffering from an unknown problem, I urge you to seek help until you have a diagnosis and feel certain that you are being treated properly. If you have a problem such as Crohn’s disease, work closely with a specialist — and expect to need regular adjustments of your treatment as your condition fluctuates. Consider joining a Crohn’s disease support group, which can provide invaluable emotional support and help keep you abreast of new medical developments.