Crohn’s Diseaseaka regional enteritis

Overview of Presentation

General historical background information

Description of the condition

Management of the Disease

Nutrition’s role in stabilizing the condition

Conclusion

Ethical dilemmas (M.D. vs Nutritional)

Opinion for managing the disease

What the audience should know

The naming of regional enteritis

• First Chief of Gastroenterology at Mount Sinai in New York. Practiced medicine until he was 90.

• 1932 Crohn, with two colleagues, described a series of pateints with inflammation of the terminal ileum.

• Colleagues, Dr. Ginzburg and Dr. Oppenhimer, helped publish the seminal paper, “Terminal Ileitis: A new clinical entity”. Disease was known as regional ileitis upon publication.

• Believed the disease was caused by Mycobacterium paratuberculosis, which is responsible for a similar condition that afflicts cattle known as Johne’s disease.

• Unable to isolate the pathogen- undetectable under an optical microscope.

Dr. Burril Bernard Crohn

Inflammatory Bowel Disease

Behavioral Classification

•Stricturing

•Penetrating

•Inflammatory

Regional Tract Classification

Three most common sites of intestinal involvement are:

• Ileititis ~30% of cases

• Ileocolic ~50% of cases

• Colitis ~20% of cases

• Gastroduoldenal and Jejunoileitis are also common sites

Crohn’s Disease

Crohn's disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.

Anorectal fistulas

The lining of the intestine may ulcerate and form channels of infection, called fistulas. Fistulas tunnel from the area of ulceration, creating a hole which may continue until it reaches the surface of the organ, or the surface of nearby skin. These holes typically spread the infection that creates them, and life-threatening conditions such as peritonitis (inflammation of the lining of the abdomen) may occur.

Is it Crohn’s or Ulcerative Colitis?

Crohn’s Disease Ulcerative Colitis

Defecation Often porridge-like Often mucus-like and with blood

Terminal Ileium involved

Commonly Seldom

Colon involved Usually Always

Fever Common Indicates severe disease

Fistuleae Common Seldom

Weight Loss Often More Seldom

Endoscopy Deep snake like ulcers Continuous ulcer

Is it Crohn’s or Ulcerative Colitis?

Symptoms

Main symptoms include:

Crampy abdominal pain

Fever

Fatigue

Loss of appetite

Pain with passing stool

Diarrhea

Weight loss

Other symptoms may include:

Constipation

Eye inflammation

Fistulas

Joint pain and swelling

Mouth ulcers

Rectal bleeding Bloody stools

Skin lumps or sores

Swollen gums

What’s causing Crohn’s disease?

Mycobacterium paratuberculosis

Diet and stress

Environmental stressors

Autoimmune disorder

Who’s at risk for Crohn’s disease?

Younger than 30

Elevated risk for whites and Eastern European Jewish descent

A close relative diagnosed

Smokers

Live in an urban area

Live in a northern climate

Diet high in fat or refined foods

Bio-medical Interventions

DIAGNOSIS

Colonoscopy most effective at detection (70%)

Endoscopy

Blood tests

MEDICATIONS

Anti-inflammatory drugs

Corticosteroids

Antibiotics

NUTRITION THERAPY

Vitamin B-12

Iron

Calcium

Vitamin D

Bio-medical Interventions

Surgery

Strictureplasty

Colon restructure

Colectomy

Treat symptoms

Pros

May lead to long-term remission

Cons

Disease often recurs

Treatm

en

t

Diet & Lifestyle

Exclusion Diets

Food Journal

Avoid gas inducing foods:

High Fiber

Dairy

Stimulants

Spicy

High fat

Stop smoking

Do’s Drink lots of water

Multi-vitamin and mineral

Anti-inflammatory foods Fish oil

Ginger

Raw foods

Prebiotics

Regular exercise

Stress-relief activities

Don’ts

Vitamin Do Qualitative research on 57

yr. old woman

o Deficient while supplimenting

o Tanning bed for 10 min., 3 times a week for 6 months at Boston University Med. Center

o Serum Vit D increase of 357%

o Maintained adequate levels 6 months later

o Hypovitaminosis D

Alternative Therapy

YogaTai ChiMeditationBiofeedbackSupport Groups

Ethical Dilemma – Food v. Medicine

Nutrition

Acute episodes often triggered by food

Poor absorption of nutrients requires intravenous feeding

No side effects from proper nutrition

Medicine

Strong, possible quick reduction of symptoms

Lots of negative side effects and adverse reacations

Only potent solution to potent problems

Conclussion

Treatment requires a multi-faceted approach

Support groups and experts necessary for proper education

Beware of snake-oil and testimonials

Get outside, get active, and gain control of your body

Need to know for the test

How ulcerative colitis differs from Crohn’s disease.

Nutritional guidelines for patients with Crohn’s disease.

Most common areas affected by Crohn’s disease.

What’s the lesser known name for Crohn’s disease.

Possible causes of Crohn’s disease

High risk categories

Likelihood of contracting a IBD if family has been diagnosed.

The End