The Enid News and Eagle, Enid, OK

Enid Features

April 11, 2014

Crohn’s: Another type of urgency

Crohn’s disease is another form of the “gotta go” syndrome that you may have seen on TV ads. In this case, the urgency to go involves the bowels rather than the bladder, and symptoms can involve pain and cramping, as well as discomfort.

Unfortunately, Crohn’s disease often strikes during the young adult years when the urge to go can seriously interfere with career plans and goals.

Probably because of an autoimmune reaction, the gastrointestinal tract becomes chronically inflamed, causing symptoms such as abdominal pain, cramping and diarrhea. These vary in severity and are usually unpredictable, occurring in a flare/remission cycle. But they can be quite severe, eventually causing rectal bleeding, unwanted weight loss and malnutrition.

Other inflammatory bowel diseases such as ulcerative colitis have similar symptoms but affect different areas of the digestive tract. With Crohn’s disease, the inflammation can occur anywhere, but most commonly near the end of the small intestine and the beginning of the large intestine. Crohn’s disease frequently attacks the whole thickness of the bowel wall, whereas ulcerative colitis inflames only the inner lining.

These diseases are easy to confuse with irritable bowel syndrome, which also involves abdominal pain and diarrhea, but is not caused by an inflammatory process.

The inflammation causes cells to secrete large amounts of water and salt that can’t be absorbed by the intestinal walls. The result: frequent soft stools or diarrhea, usually accompanied by cramping and pain. Ulcers can form, and eventually the bowel walls become thickened and scarred, affecting the normal movement of contents and causing additional pain, often severe. Small sores on the surface of the intestine wall can develop into large ulcers that penetrate deep into the wall or even all the way through it. A common complication is blockage of the bowels resulting from swelling, scar tissue and thickening of the bowel walls.

If bleeding occurs, as it often does, you may notice it in your stool – either as bright red blood or hidden (occult) blood that is mixed with the feces. Severe disease is likely to depress appetite and cause other symptoms such as fatigue, aching joints, eye inflammation and mouth sores. These should prompt a visit to your doctor.

A blood test and a stool sample can be helpful in ruling out bacterial or other infections. A colonoscopy may be performed to make a diagnosis and, later, to monitor the disease. The entire length of the large intestine is examined using a thin, flexible lighted tube. A similar scope inserted through the mouth and esophagus can be used to look for abnormalities in the gastrointestinal tract.

Once doctors are certain that the symptoms are caused by inflammatory bowel disease, anti-inflammatory medications are usually prescribed. These include sulfasalazine, mesalamine and corticosteroids.

Immune system suppressants such as azathioprine (Imuran) reduce inflammation primarily by inhibiting the immune response. Biologic medications, typically given by injection, have a more focused approach, targeting the specific substances that are involved in the inflammation.  Biologics include infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). These have been approved for moderate to severe disease that has not responded adequately to other therapies. There is some evidence that combining one of these biologics with an immunosuppressant medication can be more effective than either one by itself.

For about 60 percent of cases, surgery eventually becomes necessary, either to relieve symptoms or to treat complications such as bowel blockage, perforation, bleeding or abscesses. Removal of part of the intestine can help but does not always get rid of the disease.

Diet and nutrition are always crucial to successful treatment, although there is no one diet that has been proven effective. When the disorder causes poor absorption in the small intestines, patients have to be careful to ensure they are getting proper nutrition to maintain weight and good health.

The disease is not believed to be directly caused by foods, but high-fiber grains, alcohol and milk products sometimes increase diarrhea and cramping. A plan that systematically eliminates certain foods, then re-introduces them can help identify foods that are contributing to diarrhea and cramping.

Smokers have more pronounced symptoms and more severe complications.  Quitting can have a positive effect toward managing the disease.

Crohn’s disease is a complex disorder with no known cure. With medical help, however, the most troubling effects can be managed.

The Long Term Care Authority of Enid Caregiver program makes no distinctions on the grounds of race, color, sex, age, ancestry, nation origin, religion, or disability; and a portion of the project cost is met by state and federal Older American Act funds from the Long Term Care Authority of Enid and OKDHS Aging Services.

Rupp is care coordinator for Long Term Care Authority of Enid Aging Services. Contact her at 237-2236.

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