CROHN’S DISEASE

CROHN’S DISEASE

Other Names of This Disease
Regional enteritis, regional ileitis, granulomatous colitis, inflammatory bowel disease.

Incidence of Crohn’s Disease

The incidence of Crohn's disease has been ascertained from population studies in Norway and the United States and is similar at 6 to 7.1:100,000. Crohn's disease is more common in northern countries, and shows a higher preponderance in northern areas of the same country. The incidence of Crohn's disease is thought to be similar in Europe but lower in Asia and Africa. It also has a higher incidence in Ashkenazi Jews.

The incidences of Crohn’s disease based on age group; onset from infacy to 25 years of age, 15% to 30% have onset before puberty. Peak incidence is from 10 to 25 years of age. It slightly more common in females. [Long J W, 1993]

What is Crohn's Disease ?

Crohn's disease is a chronic inflammatory disease of the intestines. Crohn's disease is one type of inflammatory bowel disease (IBD). Inflammatory bowel diseases were described by Giovanni Battista Morgagni (1682-1771), by Polish surgeon Antoni Leśniowski in 1904 (leading to the use of the eponym "Leśniowski-Crohn disease" in Poland) and by Scottish physician T. Kennedy Dalziel in 1913.

Burrill Bernard Crohn, an American gastroenterologist at New York City's Mount Sinai Hospital, described fourteen cases in 1932, and submitted them to the American Medical Association under the rubric of "Terminal ileitis: A new clinical entity". Later that year, he, along with colleagues Leon Ginzburg and Gordon Oppenheimer published the case series as "Regional ileitis: a pathologic and clinical entity".

Crohn's disease invariably affects the gastrointestinal tract, and most gastroenterologists categorize the presenting disease by the affected areas.
Ileocolic Crohn's disease, which affects both the ileum (the last part of the small intestine that connects to the large intestine) and the large intestine, accounts for fifty percent of cases. Crohn's ileitis, affecting the ileum only, accounts for thirty percent of cases, and Crohn's colitis, affecting the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis. The disease can attack any part of the digestive tract, from mouth to anus. However, individuals affected by the disease rarely fall outside these three classifications, being affected in other parts of the gastrointestinal tract such as the stomach and esophagus.

IBD and Colon Cancer

Having Crohn's disease increases your risk of colon cancer. Despite this increased risk, more than 90 percent of people with inflammatory bowel disease (IBD) never develop cancer. Your risk is greatest if you've had inflammatory bowel disease for at least eight years and if it has spread through your entire colon. The longer you've had the disease and the larger the area affected, the greater your risk of colon cancer. The risk of other cancers also is increased, including cancer of the anus.

Principal Features of Crohn’s Disease

An intermittent to chronic disorders of the small intestine and colon; one third of cases occur in the lower segment of the small intestine (the ileum), one third in the colon and one third in both. Less than 50% of cases involve the rectum. The onset is usually insidious, but may be rapid and resemble acute appendicitis. Symptoms include loss of appetite, fatigue, fever, loss of weight, abdominal cramps and pain after eating, nausea, vomiting, diarrhea (occasionally bloody), anal sores and retarded growth in children. There may also be inflammatory disorders in the skin, eyes, mouth and large joints. Children may experience fever and joint pains before any indications of disease in the intestine or colon. Adults may have a higher incidence of gallstones or kidney stones. This disorders often recurs throughout life.
Caution: The early manifestations of Crohn’s disease may vary. Loss of appetite and weight may lead to the mistaken diagnosis of anorexia nervosa.

Causes of Crohn’s Disease

The primary cause in unknown. There is a familial clustering in 15% to 20% of cases. It is thought that an inherited susceptibility may predispose to unknown environmental factors capable of inducing the disorder.

Drugs That Can Cause This Disease

By altering the normal balance of bacteria in the intestine, several antibiotics can cause a form of enteritis that might resemble crohn’s disease. These include some of the tetracyclines, penicillin and chloramphenicol. Antibiotic-induced enteritis is transient and easily corrected; no permanent damage occurs. The vitamin A derivative etretinate (Tegison) has been reported to cause Crohn’s disease.

Drugs Used to Treat This Disease

Sulfasalazine, cortisonelike streroids, principally prednisone, azathioprine; 6-mercaptopurine, metronidazole, antidiarrheals (diphenoxylate, loperamide), antispasmodics (belladonna, dicyclomine), antibiotics (ampicillin, tetracycline; used when appropriate for bacterial infections of intestine).

Alternative Medicine

Many people with either Crohn's disease or ulcerative colitis have used some form of complementary or alternative therapy. Some commonly used therapies include:
• Herbal and nutritional supplements
• Probiotics
• Fish oil
• Acupuncture

Treatment Goals of Crohn’s Disease

1. Induction of remission (return to normal) during the active phase of the disease.
2. Relief of symptoms.
3. Protection of bowel, avoidance of complications.
4. Maintenance of general nutrition.

Classification and external resources


The three most common sites of intestinal involvement in Crohn's disease are ileal, ileocolic and colonic