What is Crohn’s Disease?

Crohn’s disease is one among many digestive disorders in which the lining becomes inflamed. That inflammation produces ulcers (lesions or open sores in the lining) that produce abdominal pain and diarrhea. It is often progressive and leads to even more serious health consequences.

The cause(s) of the disease are not known, but an abnormal immune system response to a bacterium (known as MAP or Mycobacterium avium subspecies paratuberculosis) is suspected. Despite the lack of a clear cut culprit several risk factors are known. Diet and stress can affect the course and impact of the disease but have been ruled out as causes.

Genetics is near the top of the list, not surprisingly given the immune system response aspect of the disease. Roughly 20% of those with Crohn’s have a parent or close relative similarly afflicted. Those with an affected sibling are 30 times more likely to develop Crohn’s than the general population. Unlike many diseases, Crohn’s tends to occur in younger people, usually between the ages of 20-30.

The intestinal inflammation of the disease produces diarrhea by causing cells to secrete large amounts of salt and water. The colon is unable to absorb all this fluid (part of its natural role in the digestive system). The result is diarrhea.

One effect is swelling of the intestinal tissue and scaring as the ulcers heal. That results in less efficient movement of the chyme (the semi-fluid mass of digested food) through the colon. The effects are felt as cramping and abdominal pain. In more advanced or severe cases nausea and vomiting are common. Bloody stool is common, as well, as moving chyme causes inflamed tissue to rupture, allowing blood to flow into the colon. The ulcers can become enlarged, moving deep into intestinal tissue, worsening the problem.

The net result, apart from the pain, is often reduced appetite and unhealthy weight loss. The symptoms lead to a desire not to eat, but the weight loss is exacerbated by less efficient digestion of food. In extreme circumstances such low intake and absorption of calories and nutrients leads to many secondary consequences.

Diagnosis is fairly straightforward. Blood tests check for anemia and during a colonoscopy a physician can see the distinctive signs directly. A biopsy (tissue samples that can be removed during the procedure) are used to confirm the presence of Crohn’s.

A less invasive procedure known as a flexible sigmoidoscopy uses a lighted tube to examine only the lower two feet of the colon and rectum while a colonoscopy involves inserting a tube all the way into the intestine. It takes only a few minutes to complete.

A physician may recommend a barium enema as well. A safe, mildly radioactive barium fluid is introduced into the colon where it provides a contrast dye for an X-ray. The fluid coats the lining of the intestine to create a silhouette of the colon and rectum. In a variation, X-rays can also be taken if the patient ingests the barium fluid.

A more modern diagnostic procedure, known as capsule endoscopy, involves swallowing a tiny camera in the form of a pill, which makes its way down the digestive tract. It takes photos along the way, which the physician examines.

Unfortunately, there is no cure known for Crohn’s disease as yet, but drug therapy to reduce inflammation is a common treatment. Surgery has helped many afflicted by removing ulcerated tissue (sometimes sections of the bowel), reducing symptoms. Unlike ulcerative colitis, Crohn’s infected tissue may occur in spots with healthy tissue in between, not throughout an entire length. That allows for a more targeted repair of affected tissue.

Diverticulosis

The title is a little misleading. Diverticulosis is a condition in which a person has developed diverticula – small pouch-like structures – in the digestive system. Normally, they’re harmless and may persist for long periods, even a lifetime. It’s only when they become infected or inflamed that diverticulitis, the actual illness, occurs, generally to about 15% of those with diverticulosis.

The symptoms include abdominal pain, fever, nausea, and a radical change in bowel habits. The pain is often severe and may come on suddenly, usually in the lower left side of the abdomen. Vomiting is possible and constipation and/or diarrhea are common.

Those symptoms result when those marble-sized pouches rupture or become infected. The causes of the change are not known but several factors that make it more or less likely have received careful study. Simple aging is one risk factor, since it tends to produce both a weakening in portions of the intestine as well as changes in elasticity of the bowel. However, there are several risk factors that are within our control.

Lack of exercise and the often associated obesity contribute to the chances of developing diverticula, and for them to change in a harmful way. But the major cause is thought to be diet, in particular too low an intake of fiber. Fiber helps lend bulk to stools while at the same time absorbing water to keep them soft.

When the condition is allowed to develop, there are several secondary complications that may result from diverticulitis. A blockage may occur, caused by scarring. Abscesses are possible when pus collects in the pouch. But the most common and most serious, at least when the condition progresses, is peritonitis.

If a diverticulum ruptures, the contents of the digestive system spill into the abdominal cavity, which is lined with tissue called a peritoneum. The resulting inflammation is called peritonitis. When this happens, immediate care is a must, usually surgery. The toxins can poison the body in a short period, marked by symptoms such as spike in the white cells and an associated high fever.

Fortunately, that is far from a foregone conclusion. Changes to the diet – the addition of fiber mentioned above – are the simplest method of prevention and ‘treatment’. A temporary liquid diet, typically only for a few days, is another effective alternative. Antibiotics may be recommended to prevent or treat infection.

In more severe or advanced cases, corrective surgery may be required. In some cases that involves what is known as a primary bowel resection, a procedure in which the affected area is removed and the bowel sewn back together, minus that part.

What is required can, of course, only be determined by a professional diagnosis. That is typically as painless (and harmless) as having a CT (computer tomography) scan. A radiologist directs a series of computer-controlled X-ray bursts at the abdomen and the results are recorded and analyzed. A CT scan may also be performed as part of treatment, in order to guide a physician to drain any abscess that has occurred.

To head all that off, be sure to exercise regularly in an age-appropriate way, eat plenty of fiber, and drink plenty of fluids. Fiber supplements (such as Metamucil or Citrucel), properly used, are also beneficial.