Crohn's Disease

Crohn's disease is a chronic inflammation of the small or large intestine or both. The majority of cases involve the terminal ileum the lowest part of the small intestine. The inflammation can cause pain and make the intestines empty frequently resulting in diarrhea. About 6 to 7 out of 100 000 people develop Crohn's disease.

Signs and Symptoms

Crohn's disease is often accompanied by these signs and symptoms.

• Diarrhea
• Abdominal pain swelling
• Fatigue
• Weight loss malnutrition
• Fever

What Causes It?

While a specific cause of Crohn's disease is not known the most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine.

Who's Most At Risk?

The following categories of people are at higher than average risk for Crohn's disease.

• People 15 to 25 and 55 to 65 years of age
• Jews (three to eight times more common than the general population)
• Caucasians are more at risk than blacks
• Females are slightly more at risk than males.
• People with a family history
• Smokers

What to Expect at Your Provider's Office

Your health care provider can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you. A physical exam may reveal signs of malnutrition an abdomen that is tender or distended hyperactive bowel or openings in the intestinal wall. In addition your health care provider may have laboratory tests done on your blood and may send you for barium X rays ultrasound radiography or other types of imaging.

Treatment Options

Treatment Plan

Some treatments including surgery may delay recurrence of the disease or provide temporary relief from symptoms but there is no cure for Crohn's disease.

Drug Therapies

Your provider may prescribe the following medications.

• Corticosteroids such as prednisone or parenteral corticosteroids to prevent or suppress inflammation
• Sulfasalazine in oral form or enema or suppository to help control inflammation
• Immunosuppressives to block the immune reaction that contributes to inflammation
• Antidiarrheal drugs
• Antibiotics
• Psychotropic agents such as antidepressants

Surgical and Other Procedures

Seventy percent of patients with Crohn's disease undergo surgery to correct abscesses openings in the intestinal wall obstruction and other problems caused by the disease. Repeated surgeries are sometimes necessary.

Complementary and Alternative Therapies

A comprehensive treatment plan for Crohn's disease may include a range of complementary and alternative therapies. Mind-body therapies such as meditation yoga and tai chi may help reduce the frequency and severity of symptoms during active disease.

Nutrition

Following these nutritional tips can help minimize effects of the disease and promote better health.

• Eliminate all known allergens in addition to highly allergenic foods linked to Crohn's disease specifically wheat corn and dairy.
• Avoid saturated fats and foods that tend to cause inflammation such as caffeine animal products sugar and alcohol.
• Eliminate refined and processed products.
• Increase fiber and omega-3 oils (for example take 1 tablespoon of flaxseed oil daily).

Potentially beneficial nutrient supplements include the following.

• Acidophilus (1 capsule with meals)
• Vitamin A (50 000 IU a day)
• Vitamin E (400 to 600 IU a day)
• B₁₂ (1 200 mcg a day)
• Folate (800 mcg 1 200 mcg a day with sulfasalazine use)
• Vitamin C (1 000 mg three times a day)
• Calcium (1 000 mg a day)
• Magnesium (400 mg a day)
• Zinc (30 to 40 mg a day)
• Selenium (200 mcg a day)

Herbs

The use of certain herbal remedies are also known to minimize effects of the disease and promote better health. These herbs include the following.

• Robert's Formula a combination of a variety of herbs for soothing intestinal tissues restoring the integrity of the intestinal barrier and reducing inflammation
• Flavonoids such as quercetin (500 mg) before meals to help reduce inflammation and minimize reactions to food sensitivities
• Marshmallow (Althea officinalis) tea (1 quart a day). Make a cold water extraction by soaking one heaping tablespoon of root in one quart of cold water overnight. Drink throughout the day.

Homeopathy

An experienced homeopath can prescribe a regimen for treating Crohn's disease that is designed especially for you. Some of the most common acute remedies for diarrhea are listed below.

• Aloe
• China officinalis
• Podophyllum
• Mercurius vivus

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Acupuncture

Acupuncture may help normalize digestive function.

Massage

Massage may help relieve stress.

Prognosis/Possible Complications

Within 10 years of a diagnosis of Crohn's disease 60 to 70 percent of patients have surgery with 70 percent requiring a second surgery one year later. Patients can expect to have periods of remission. However the mortality for people with Crohn's disease is twice that of the general population. Complications from the disease include bowel obstruction abscesses and openings as well as a younger onset and higher incidence of colon cancer than the general population.

Following Up

Patients should be closely monitored during periods of active disease. Due to the chronic nature of this disease and its long duration counseling and support may be helpful.

Supporting Research

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore Md: Lippincott Williams & Wilkins Inc.; 1999.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison' s Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:15 121 305.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:243 250.

Rakel RE ed. Conn's Current Therapy. 50th ed. Philadelphia Pa: W.B. Saunders; 1998.

Yamada T. Textbook of Gastroenterology. 2nd ed. Philadelphia Pa: Lippincott-Raven Publishers; 1995.

Washington Manual of Medical Therapeutics. 29th ed. Philadelphia Pa: Lippincott-Raven Publishers 1998.

Werbach M. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing Inc; 1987: 142-148.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.