How is Crohn's Disease Treated?

There is no known cure for Crohn's Disease. The route of treatment varies from one patient to another depending upon the location, extent, and severity of the disease. The goal of treatment is to suppress the inflammatory response, allowing the intestine to heal and also to decrease symptoms. Once symptoms are under control the next goal is to decrease the frequency of flare-ups and increase periods of remission, thus improving the quality of life.

Crohn's Disease can be treated with several different types of medication. Classes of medication for treatment include Aminosalicylates (5-ASA compounds), Corticosteroids, Immuno-Modulators, Antibiotics, and Biologic Therapies.

-Aminosalicylates: 5-ASA Compounds are anti-inflammatory drugs including Asacol, Pentasa, Colazal, Rowasa Enemas, and Canasa Enemas. These medications reduce inflammation in the affected areas and are generally used to treat mild to moderate symptoms. Rare side effects include lung and kidney inflammation and therefore should be used with caution in patients who have known kidney disease. Patients that are allergic to aspirin should also avoid 5-ASA Compounds, as they are chemically similar to one another.

-Corticosteroids: These drugs include prednisone, prednisolone, and hydrocortisone and are generally used to treat moderate to severe symptoms, and also to treat patients where 5-ASA drugs have not been effective. Corticosteroids, unlike 5-ASA drugs, do not require direct contact with inflammation. Corticosteroids stimulate an anti-inflammatory reaction throughout the body, including the areas of the intestine that are affected by inflammatory bowel disease. Although Corticosteroids are faster acting than 5-ASA Compounds they are not effective in maintaining remission or preventing flare-ups from occurring. Side effects depend on the dosage administered and the duration that the patient is on the medication. Common side effects include water retention (mainly in the face), increased vulnerability to infections, high blood pressure, cataracts, glaucoma, muscle weakness, depression, personality changes, mood swings, and osteoporosis (thinning of the bones).

Immuno-Modulators: Azathioprine, 6-MP (6-Mercaptopurine), also known as Purinethol, and Methotrexate are used to maintain remission. They are also used when Corticosteroids are not working in a patient with moderate to severe Crohn's Disease. These drugs reduce inflammation by reducing immune cells and by obstructing the production of their protein cells. Side effects differ with each immuno-modulator. Azathioprine and 6-MP can cause inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), and bone marrow toxicity. Pancreatitis is a less common side effect when using Azathioprine and only occurs in about 3%-5% of all patients.

Antibiotics: The most commonly used antibiotic in inflammatory bowel disease is Flagyl. It is an antibiotic that is used to treat infections caused by parasites and bacteria. It is also effective in treating anal fistulas. Side effects of Flagyl include nausea, loss of appetite, headaches, and a metallic taste. Less common side effects include peripheral neuropathy in which permanent nerve damage causes a tingling sensation in the hands and feet.

Biologic Therapies: A new biologic therapy called Remicade (Infliximab) was introduced by the FDA in 1998. It is used in patients who have moderate to severe inflammatory bowel disease and are not responding to conventional therapies. It is administered through intravenous infusion and is used to maintain remission. Patients are observed throughout their infusion for adverse reactions, which may include nausea, chest pain, and shortness of breath. 

When conventional therapies are not effective a patient has the option of surgery.  Sections of the diseased bowel can be removed to reduce symptoms.  Although surgery may improve the quality of life, it is NOT a cure for Crohn's Disease. 

What is Crohn's Disease?

Crohn's Disease was first discovered and named after Dr. Burrill B. Crohn in 1932. It is a chronic, inflammatory disorder that affects the digestive or gastrointestinal (GI) tract. Crohn's Disease can affect any part of the digestive tract from the mouth to the anus but more commonly affects the small intestine and the colon. It is closely related to another chronic inflammatory condition called Ulcerative Colitis. Together the two make up what is more commonly known as Inflammatory Bowel Disease. They afflict approximately five hundred thousand to two million people in the United States.

Men and women are equally affected by Crohn's Disease and it generally begins in adolescence and early adulthood but can also begin in childhood and later in life. It has been shown that certain ethnic groups are more likely to develop the disease than others. Jews that are of European descent are nearly five times more likely than the general population to develop Crohn's Disease. It is also more common among the Caucasian population than it is among Asians and Africans.

What Causes Crohn's Disease?

Although it is not known what causes the disease it occurs more commonly in patients who have relatives with Crohn's Disease or Ulcerative Colitis, thus suggesting a genetic predisposition. Crohn's Disease is marked by an abnormal response in the immune system. Some scientists believe that the immune system mistakes the bacteria that are normally found in the gastrointestinal tract as foreign or invading substances and therefore initiates an attack. White blood cells are sent into the lining of the intestine where they produce a chronic inflammation leading to ulceration and bowel damage. When this occurs the patient experiences the symptoms of inflammatory bowel disease. It is known that Crohn's Disease is not contagious.

What are the Symptoms of Crohn's Disease?

Common symptoms of Crohn's Disease include abdominal pain, persistent diarrhea (loose, watery, or frequent bowel movements), and weight loss. Less common symptoms include loss of appetite, weight loss, fever, night sweats, rectal pain, rectal bleeding, and bowel obstruction. The symptoms of Crohn's Disease are generally dependent on the severity of the inflammation. Symptoms may range from mild to severe with periods of active disease, also known flare-ups, and periods of remission in which symptoms decrease or disappear.

Up to 30% of patients will also develop conditions that affect the anal area. These include:

-Ulcers and Fissures (tears): These cause pain and bleeding in the anus, especially during bowel movements.

-Fistulas: Anal fistulas are abnormal tunnels between the anus and the rectum. A fistula may also be defined as a tunnel that goes from one loop of intestine to another. Fistulas can attach the intestine to the bladder, vagina, or skin. When this occurs a patient may notice pus or drainage from the area.

-Abscesses: An abscess is a pocket of pus that is collected in the anal and rectal area. Abscesses will cause a patient to have fevers and experience pain and tenderness around the anus.

-Swelling: The muscle at the end of the colon that controls bowel movements is called the anal sphincter. Patients may experience swelling of the anal sphincter and thus have a problem with being able to control their bowel movements.

Crohn's Disease is not limited to the gastrointestinal tract. It can affect several other aspects of a person's well being. Patients may be subjected to joint problems, including arthritis and osteoporosis, skin and eye problems, and difficulty with liver function. 

There are many other complications that can happen with Crohn's Disease and with Ulcerative Colitis.  The symptoms listed here are only the most common symptoms that occur in most patients.  

How is Ulcerative Colitis Treated?

The course of treatment for colitis depends upon the severity of the illness in an individual. Most patients can be treated with medication and remain in remission for long periods of time. Other patients experience severe enough symptoms that surgery may be required to remove the diseased parts of the intestine. There is no medication that can cure Ulcerative Colitis. The goals of treatment consist of improved quality of life, inducing and maintaining periods of remission, and minimizing the symptoms of the disease. Some of the medications used to treat colitis include:

5-ASA Compounds

These are anti-inflammatory medications including Asacol, Pentasa, and Rowasa Enemas. These medications are only effective if they come in direct contact with the inflammation in the tissue. 5-ASA Compounds are similar to aspirin and should be used with caution in patients who are known to have kidney disease or are at risk for kidney disease.

  

Corticosteroids

These drugs include prednisone, prednisolone, and hydrocortisone. They may also be used to treat inflammation but these drugs usually have undesired side effects with long-term use. Common side effects consist of water retention (mainly in the face), glaucoma, cataracts, diabetes, high blood pressure, muscle weakness, weight gain, increased body hair, insomnia, depression, and osteoporosis. Because these drugs have so many side effects they should be used for the shortest length of time possible. 

Immunomodulators

These are medications that are designed to weaken the body's immune system. Because inflammatory bowel disease is thought to be an autoimmune disease, meaning that a patient's immune system attacks it's own body, weakening the immune system is effective in reducing symptoms and inducing and maintaining remission. The two most common drugs in this class are Azathioprine (Imuran) and 6-Mercaptopurine (Purinethol). These drugs weaken the immune system by reducing a category of immune cells known as lymphocytes. Immunomodulators are used as a last resort, before surgery, because of the seriousness of side effects. Side effects may include inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), vulnerability to infections, and bone marrow toxicity.

  

Methotrexate

This drug is an immunomodulator and an anti-inflammatory. It is used when Azathioprine, 6-MP, and Corticosteroid drugs do not have any effect. It can be taken orally or administered by injection either under the skin or in a muscle. Injections are usually administered on a weekly basis. A major complication of Methotrexate is cirrhosis of the liver when medication is used for a prolonged period of time.

What is Ulcerative Colitis?

Ulcerative Colitis is an inflammatory bowel disease that causes inflammation and ulcers in the colon and the lining of the rectum. Inflammation in the colon causes it to empty frequently resulting in diarrhea. Ulcerative Colitis, also known as UC, usually occurs in people between the ages of fifteen and thirty but can occur at any age. It affects men and women equally but does appear to have a higher incidence in Caucasians and people of Jewish descent. It afflicts between one and two million people in the United States and many more worldwide. It is, however, more common in the United States, England, and Northern Europe. It is rarely see in Eastern Europe, Asia, and South America.

What are the Symptoms of Ulcerative Colitis?

The most common symptoms of UC are abdominal pain, bloody diarrhea, rectal bleeding, weight loss, anemia, fatigue, loss of appetite, loss of body fluids and malnutrition, and joint pain. The majority of people diagnosed with UC experience mild symptoms; others suffer from severe abdominal cramps, nausea, vomiting, and frequent fevers. The inflammation produced by the immune system is also thought to cause other symptoms and conditions including osteoporosis, arthritis, and liver disease. Patients will periodically experience episodes of remission in which they seem to be free of any symptoms of colitis. Although this may occur ongoing treatment is required to maintain remission.

What Causes Ulcerative Colitis?

Although the cause of UC is not known, up to twenty percent of all cases report having a family member with inflammatory bowel disease, thus suggesting a genetic predisposition. Scientists believe that the immune system is responding abnormally to the bacteria that live in the digestive tract. Ulcerative Colitis is not caused my emotional stress or sensitivity to certain foods. The symptoms of colitis may be exacerbated by these factors but they are not the cause of the disease itself. The risks of UC are reduced when associated with appendectomy, breast-feeding, and smoking cigarettes. Depression and consuming a "western diet" consisting of a large amount of meat may contribute to an increased risk of getting UC.

How is Ulcerative Colitis Diagnosed?

Several tests may be used to diagnose colitis. Blood tests are usually done to test for anemia and to check white blood cell counts. A high white blood cell count usually indicates infection or inflammation somewhere in the body. Stool samples may also be collected and tested for white blood cells present in the stool itself. White blood cells in the stool would be an indicator of inflammatory bowel disease. Stool samples also allow doctors to look for rectal bleeding, bacteria in the intestines, and any viruses or parasites that may be in the digestive tract. The most accurate way of diagnosing inflammatory bowel disease is to perform a colonoscopy. During a colonoscopy the patient is sedated and a long, flexible tube that is lighted is inserted into the anus so that the doctor may examine the rectum and the colon. A colonoscopy also enables a doctor to take samples of tissue from the lining of the colon to do biopsies. CT scans, barium enemas, and other x-rays may also be used to aid in the diagnosis of Ulcerative Colitis.

My Battle With Inflammatory Bowel Disease

To start this blog I’d like to share my story with you.  After I was initially diagnosed I felt that I would never be able to lead a normal life.  Now I want others who suffer from these challenging diseases to know that they are not alone and that there is hope for a better future.

I was initially diagnosed on August 9^th of 2001 at the age of twenty-three.  As I look back I remember all of the medications I was given, the hospital stays, the late nights spent in the emergency room, the surgeries, and most of all the pain and suffering. 

This disease not only caused physical pain for me but it also tormented me mentally.  I quickly fell into a deep depression but pretended it was not there.  And even worse, I wasn’t the only one suffering.  My parents and my siblings endured this pain with me and were heartbroken as they watched me deteriorate physically, mentally, and spiritually. 

My doctors assured me that they would be able to control my symptoms with medications and that I would be able to lead a normal life.  I was started on a regimen of Asacol, a drug that is commonly used to treat the symptoms of UC.  After six months of being on Asacol there was still no improvement in my condition.  My doctors decided to try other drugs and over the next three months I took approximately 10 different prescription medications.  Not one of these medications worked for me and I was still suffering from the same symptoms I had when I was first diagnosed. 

Naturally my parents began to worry and were losing their faith in western medicine.  In June of 2002 they took me home to India to seek other forms of treatment.  Once there a homeopathic doctor took me off all my medications and we began using alternative forms of treatment.  I was taught how to change my diet to accommodate my disease, how to meditate so that I could control my stress levels, and how to exercise after eating to help my body better digest the food it consumed.  I was also put on one “medication” that did not have any man made compounds in it and was completely natural.  I was on this schedule of treatment for only a few days when I saw a dramatic improvement in my condition.  My symptoms virtually disappeared and I began to feel like a normal person again. 

Three weeks later I returned home from my trip and went to see my gastroenterologist for a routine check-up.  He was concerned that I wasn’t on any medications and insisted that I stay at least on Prednisone (steroid) for maintenance purposes and to keep me in remission.  I started taking Prednisone around the beginning of July 2002.  Soon after my symptoms began to reappear only this time worse.  I had a colonoscopy and the results came back showing that I had Toxic Megacolon.  This is a condition that can be life threatening. As a result of this, on August 9^th 2002, exactly one year after my initial diagnosis, I had surgery to have my entire colon removed.  I remember, clearly, going to the hospital that day.  I had never had surgery before and was terrified.  I recall looking at my mom and dad as I was walking away with the nurse and saying to them, “it’s ok, I’ll be fine.”  My operation lasted for nine hours.  When I woke I remember my dad standing there with tears streaming down his face.  I must’ve looked like I was in pain.  I looked at him and said, “it’s ok daddy, it doesn’t hurt.”  After that, my life was never the same again.   

The feelings I had that day, physically and emotionally, are indescribable.  After eleven days in the hospital I was able to go home, but I couldn’t take care of myself.  At the age of twenty-four my mother had to feed me, help me use the bathroom, bathe me, and at times put diapers on me.  More than anything else I was embarrassed and humiliated by my disease.

Six months after my surgery I was still having symptoms.  Following numerous tests and procedures, including several colonoscopies, I was re-diagnosed with Crohn’s Disease in January 2003.  This is a disease similar to UC but afflicts the small intestine and other parts of the digestive system. 

Since August of 2003 I have had an additional nineteen surgeries and countless hospital stays for other complications due to Inflammatory Bowel Disease.  In my surgeries were included the removal of bowel obstructions, removal of my gall bladder, placement and reversal of ostomies (bags worn on the outside of the body), and the scraping away of scar tissue.  I also had minor surgeries for the placement of a Power Port, several PICC Lines, and feeding tubes.  I became weak physically and discouraged mentally because nothing seemed to be working for me.  My disease was out of control and I felt there were no options left. 

Aside from the surgeries and procedures I was also diagnosed with other conditions that I still, at times, suffer from. Some of these conditions are either side effects of Ulcerative Colitis or Crohn's Disease or were caused by medications used to treat these diseases. These include:

Pancreatitis: An inflammation of the pancreas.  This causes severe abdominal pain and usually requires admission to the hospital until symptoms have subsided. 

Osteoporosis: A weakening of the structure of the bones.  This usually occurs among older women who have already gone through menopause.  I was first diagnosed with osteoporosis at the age of twenty-five. 

Arthritis: Swelling and pain in the joints.  This is also something that generally occurs among older people. 

Anemia:  I was diagnosed with anemia due to a deficiency of the vitamin B12.  Because I became anemic I was required to get monthly IM injections of the vitamin.

Peripheral Neuropathy:  This is a loss of sensation in certain areas of the body.  I began to experience this in my feet and hands after being on a medication that my doctors now believe I am allergic to.

Epilepsy:  I was diagnosed with epilepsy after having numerous, unexplainable seizures.  I believe that this was triggered by high doses of medications I was on at the time of my diagnosis. 

Infections:  I acquired countless infections included a staphylococcus infection in my blood that spread to my heart and nearly took my life. 

There were periods of remission where I would gain my strength back, when the depression would diminish, and I would feel confident about my future again.  But these periods were short lived and I would quickly become depressed again.  At times I felt like I had been robbed of my spirit.  At this point I knew that my entire life was going to be changed and that I wouldn’t be able to have the future that I’d dreamed of. 

I had no choice but to accept my disease.  With the help of my family and loved ones I was able to regain some state of mental balance and clarity.  I learned that whether I cried or laughed, at the end of the day I was still going to be sick.  I didn’t want to spend my days in self-pity or fill them with misery.  So I began taking things one day at a time and have learned to make the best of what I have. 

Ulcerative Colitis and Crohn's Disease affect all areas of your life including having interpersonal relationships and raising a family. Living with Inflammatory Bowel Disease can be difficult, embarrassing and even humiliating at times. The most essential aspect of having control over this disease is accepting it. By accepting it yourself you allow others to become more empathetic and accept it as well.

I’ve also found that it is important to surround yourself with people that are going to have a positive impact on your life. I have parents and siblings that are loving, caring, understanding and compassionate. Even with all of the hardships and challenging experiences I've endured I feel very lucky to have the family that I do. Without their support I'm not sure I would have made it through all of this without losing my sanity. I am where I am today because of their selflessness and unconditional love.

I have learned and am still learning to lead a life with minimal stress, to eat right and to exercise in the best way that I can. I've also involved myself in support groups for people with Inflammatory Bowel Disease. In doing this I know that I'm not alone. There are others out there who are also suffering because of these diseases. Only they truly understand what I'm going through and are able to offer the kind of support you can't find anywhere else. I have made a firm decision that no matter what happens or how bad it gets I will not let this disease dictate my life.

I hope that this blog not only becomes a place of learning but also a place where you can come to find support.  I will do my best to answer questions and make daily posts.  I look forward to all of your comments and questions and to getting to know you!