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 ClassificationThree 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 AlwaysFever Common Indicates severe

diseaseFistuleae Common SeldomWeight Loss Often More SeldomEndoscopy 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

Trea

tmen

t

Diet & Lifestyle

Exclusion Diets Food Journal Avoid gas inducing

foods:High FiberDairyStimulantsSpicy 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 womano Deficient while

supplimentingo 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 educationBeware 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