Crohn’s disease is a chronic disorder characterized by severe inflammation leading to ulceration of the interior of the intestines. It most often affects the lower part of the small intestine, but it can involve the entire digestive tract, from the mouth to the anus. Unlike ulcerative colitis, which affects the top two layers of tissue lining the intestines, the ulceration in Crohn’s disease involves all four layers of the intestinal wall. When affected areas heal, scar tissue often narrows the passageway. In some cases, the bowel becomes partially or completely obstructed. When an area closes, one or more fistulas- abnormal passageways -may develop that join one part of the intestine to another, or even to another organ.
Crohn’s disease is a chronic transmural inflammatory disease of the gastrointestinal tract of unknown etiology. Crohn’s disease involves acute and chronic granulomatous bowel disease with a cobblestone effect. Onset is generally between 15 and 30 years of age. Crohn’s disease differs from ulcerative colitis by affecting the gastrointestinal tract from oral cavity to rectum; Ulcerative Colitis involves the mucosal tissue of the colon and rectum. In Crohn’s disease, the intestinal lumen decreases; peristalsis from food intake cause cramping pain, especially in the right lower quadrant. Other symptoms include fever, weight loss, debility, nausea, mouth sores, anal fissures, vomiting, abdominal pain, intestinal bleeding, and sporadic flare-ups.
Cause of Crohn’s Disease
There are various theories for causes of Crohn’s disease, but none has been proven. The most popular theory is that the body’s immune system reacts to a virus or bacterium by causing ongoing inflammation in the intestine. People with Crohn’s disease tend to have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or result of the disease. Crohn’s disease is not caused by emotional distress.
Mycobacterium para-tuberculosis and measles virus have been proposed as potential cause of Crohn’s disease.
Similar to UC. Focal ischemia due to autoimmune reaction also has been considered.
Single strongest risk factor for development of Crohn’s is a relative with Crohn’s disease.
High intake of refined sugar and low intake of fibre from fruits and vegetables have been reported in patients with Crohn’s disease.
Smokers are more likely to develop the disease than non smokers. Also the disease has a more unfavorable course in smokers.
The disease is often insidious, slowly progressive with protracted course, commonly affects young adults in the second or third decade of life.
Intermittent colicky lower abdominal pain, diarrhoea, weight loss, is common.
Disease site: Ileum
- Abdominal pain
- Obstructive symptoms
- Mass in right iliac fossa
- Acute ileitis
Disease site: Colon
- rectal bleeding
- Perianal disease
- Extraintestinal manifestation
Disease site: Rectum
Other sites mouth, stomach, duodenum are occasionally affected.
Symptoms of Crohn’s disease
- Abdominal pain
- Weight loss
- Rectal bleeding, especially in colonic disease
- Perianal disease
- Obstructive symptoms of colic and vomiting, especially in ileal disease.
- Tiredness and shortness of breath if anaemic Bone pain secondary to Osteomalacia if Malabsorption of vitamin D
- Excessive bleeding if Malabsorption of vitamin K (rare)
Signs of Crohn’s disease
- Mouth ulcers
- Clubbing of nails
- Abdominal tenderness
- Palpable abdominal mass, particularly right iliac fossa
- Anal fissures, fistulae and skin tags
Complications of Crohn’s disease
Stricture – more common in small intestine. May cause obstructive symptoms.
Fistulas – may develop between loops of bowel adjacent to the bladder or vagina.
Perianal disease – fissures, fistulas, and abscesses.
Carcinoma – may complicate long standing colonic disease.
The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohn’s disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases, they may require surgery.
Nutritional complications are common in Crohn’s disease. Deficiencies of proteins, calories, and vitamins are well documented. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (Malabsorption).
Other complications associated with Crohn’s disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other disease or the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.
Diagnosis of Crohn’s disease
As the symptoms of Crohn’s disease vary from person to person and can often be confused with those of other illness, such as ulcerative colitis (an inflammatory bowel disease that affects the colon and rectum), diagnosis can take weeks. Doctors start by testing the patient’s blood and feces to rule out other possible illnesses.
Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the physician can tell if there is bleeding or infection in the intestine.
An upper gastrointestinal Barium X-Ray series may be done at the small intestine. For this test, the patient drinks barium, before X-rays are taken. The barium show up white on X-ray film, revealing inflammation or other abnormalities in the intestine.
The patient may then be examined using an endoscope that is inserted into either the mouth or the anus to study the inflamed digestive tract. This process can reveal ulcers, areas where the digestive track has narrowed, or patterns of “cobblestones,” which are seen where the intestinal wall has thickened and cracked. All these features are typical characteristic of Crohn’s disease.
Doctors can also use endoscope to perform a biopsy, which involves removing tiny bits of the digestive tract of be examined under microscope. If the biopsy shows that the whole thickness of the gastrointestinal wall is inflamed, with deep cracks and pockets where immune cells have collected (called granulomoas), then the patient has Crohn’s disease.
The patient may also be given liquid barium, either by mouth or by infusing it through the rectum. The barium will then shows up on X-rays and reveal certain abnormalities in the digestive tract, such as the regions where the tract has narrowed.
Investigations of Crohn’s disease
- Small bowel enema: absence of peristalsis in terminal ileum, multiple strictures and dilated segments in between can be demonstrated.
- Sigmoidoscopy and colonoscopy may demonstrate inflamed mucosa, which is granular with apthoid ulcers, which are discrete.
- Fistulograpgy to localize the internal fistula
- CT scan – it is done to detect thickening of bowel and extraintestinal disease.
Treatment of Crohn’s disease
Although diet does not cause Crohn’s disease, some patients may be able to relieve their symptoms by changing the type of food they eat. Eating soft, bland foods, and avoiding dairy products, fats, wheat, and spicy and high-fiber food, may help. However, if the patient becomes malnourished, nutrients should be given intravenously.
Conventional allopathic drugs cannot cure Crohn’s disease, but they can ease the symptoms. Sulfasalazine pills, which contain a sulfa antibiotic and a drug from the aspirin family, reduce inflammation and also help patients who have recovered from a flare-up to stay in good health. The drug has several side effects and may cause the patients to feel nauseated and dizzy. It can also trigger headaches, anemia, and skin rashes. Patients may be able to moderate at least some of the side effects by first taking the drug in small doses and gradually building up to the full daily dose.
If the intestine becomes very badly inflamed, doctors may prescribe corticosteroids. These drugs are given to patients only when their symptoms are severe, because long-term use can produced bad side effects in some patients.
Some patients respond well to azathioprine and 6-mecraptopurine, two drugs that suppress the immune system. However, these drugs should be used cautiously, since they can lead to nausea, fewer white blood cells, and an inflamed pancreas. Laboratory tests have also shown that high doses of these drugs (much higher than the doses patients receive) can occasionally cause cancer in animals.
Correction of dehydration and electrolyte losses through intravenous fluids may often be required which may not be possible at home and need admission to the hospital.
Homeopathic treatment of Crohn’s disease
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat Crohn’s disease symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines are available for Crohn’s disease treatment that can be selected on the basis of cause, condition, sensation and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following medicines which are much helpful for the treatment of Crohn’s disease:
Arsenic album, Nux vomica, Sulphur, Terbium oxydatum, Pulsatilla, Phosphorous, Butyric acid, Ipecac, Nitric acid, Aloes, China, Kali ars, Kali chlor, Lachesis, Crotalus horridus, Elaps, Capsicum, Cantharis, Toxoplasma gondi, Acid muriaticum, Acid sulph, Hammamelis, Ignatia, Natrum mur, Staphysagria and many other medicines.
Merc cor – causes tenesmus of rectum along with tenesmus of bladder. Inflammation with swelling and feeling of constriction; internal burning; in throat, stomach, rectum, neck of bladder, kidneys etc. Discharges acrid. Bloated, painful to least touch. Cutting colic; below navel. Painful flatulence. Continuous urging to stool and urine. Stools bloody, shreddy, slimy, hot with tormenting tenesmus.
Terebintha – Bruised soreness. Flatulence. Tympanitis. Profuse mucous stools; watery, green, foetid. Bloody stools. Bleeding from ulcers in the intestine. Bowels were drawn towards spine. Diarrhoea, with tetanic spasms.
Carcinocinum – Crohn’s disease with family history of cancer. History of grief, domination, abuse. Patient is concentious and creative.
Ignatia – History of grief. Colicky griping pain in one or both sides of the abdomen. Stools painful, difficult although soft. Constrictive sore pain in the rectum, like from blind haemorrhoids, remains one or two hours after stools. Pain shoots up in rectum. Pressure as of a sharp instrument from within outwards. Painless contractions of anus. Haemorrhage and pain worse when stool is loose.
Natrum mur – Ill effects of grief, fright and anger; aggravation by consolation. Cutting pain in abdomen and the abdominal ring, burning and stitching pain in the rectum after a copious diarrhoea. Epigastrium swollen and painful. Sudden distension. Tense abdomen worse groins. Pain in abdominal ring on coughing. Colic with nausea, better by passing flatus. Abdominal viscera feels loose and dragging when walking.
Staphysagria – is a nervous personality with marked irritability. This irritability is reflected in temper as well as in function of the digestion. The peristalsis is aggravated with the emotional outburst. Feeling of weakness in abdomen, as if it would drop, wants to hold it up. Flatus hot, smells like rotten eggs. Dysenteric stools, worse after the least food or drink. Diarrhoea from drinking cold water. Nervous affections with trembling. Morbidly sensitive; the least word that seems wrong, hurts her very much; special senses become irritable. Ill effects of anger and insults; reserved; anger, sexual; abuse, excess; tobacco, mercury.
Nux vomica – It is useful to those persons who lead a sedentary life, doing much mental work; or to those who remain under stress and strain of prolonged office work, business cares and worries. The typical Nux. patient is rather thin, spare, quick, active, nervous and irritable. Craves piquant food; beer; fat food, chalk; stimulants. Bruised soreness of abdominal wall. Ineffectual urging for stool. Strains hard at stools; feeling as if part remained unexpelled; passes small quantity at each attempt. Dysentery; stools ameliorate pains for a time.
Lycopodium – Mentally active but grows weaker. Loss of self confidence; from anticipation; averse to undertaking new things; yet when he undertakes it he goes through with ease and comfort. Hurried. Much noisy flatulance. Gastro enteritis from fright. Diarrhoea from cold drinks. Continued burning in rectum.
Merc sol – Bowels feel weak, holds them. Intestines feel bruised when lying on right side, or as if they fall to side on which one is lying. Stool painful, scanty; greenish slimy; acrid stool; then tenesmus or chill; never get done feeling. Rectal tenesmus, with tenesmus of bladder.
Apart from the treatment through the remedies, a lot of counseling and appropriate diet regimen is required.