Crohn's disease, also known as regional enteritis, is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting, or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.
Crohn's disease is thought to be an autoimmune disease, in which the body's immune system attacks the gastrointestinal tract, causing inflammation; it is classified as a type of inflammatory bowel disease. There is evidence of a genetic link to Crohn's disease, putting individuals with siblings afflicted with the disease at higher risk. Males and females are equally affected. Smokers are two times more likely to develop Crohn's disease than nonsmokers. Crohn's disease affects between ( 400,000 and 600,000) people in North America. Crohn's disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age. There is no known pharmaceutical or surgical cure for Crohn's disease. Treatment options are restricted to controlling symptoms, maintaining remission, and preventing relapse.
The disease was named after American gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness. For this reason, the disease has also been called regional ileitis or regional enteritis. The condition, however, had previously been independently described in medical literature by others. The most notable case was in 1904 by Polish surgeon Antoni Lesniowski for whom the condition is alternatively named Lesniowski-Crohn's disease in Polish literature.
Crohn's disease is a chronic condition for which there is currently no cure. It is characterised by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy weight, and the mortality rate for the disease is relatively low. However, Crohn's disease is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer.
Causes, incidence, and risk factors
While the exact cause of Crohn's disease is unknown, the condition is linked to a problem with the body's immune system response.
Normally, the immune system helps protect the body, but with Crohn's disease the immune system can't tell the difference between normal body tissue and foreign substances. The result is an overactive immune response that leads to chronic inflammation. This is called an autoimmune disorder.
People with Crohn's disease have ongoing (chronic) inflammation of the gastrointestinal tract. Crohn's disease may occur in any area of the digestive tract. There can be healthy patches of tissue between diseased areas. The inflammation causes the intestinal wall to become thick.
There are different types of Crohn's disease, depending on the part of the gastrointestinal tract that is affected. Crohn's disease may involve the small intestine, the large intestine, the rectum, or the mouth.
A person's genes and environmental factors seem to play a role in the development of Crohn's disease. The body may be overreacting to normal bacteria in the intestines. he disease may occur at any age, but it usually occurs in people between ages 15 - 35. Risk factors include:
- Family history of Crohn's disease
- Jewish ancestry
Symptoms depend on what part of the gastrointestinal tract is affected. Symptoms range from mild to severe, and can come and go with periods of flare-ups.
The main symptoms of Crohn's disease are:
- Crampy abdominal (belly area) pain
- Loss of appetite
- Pain with passing stool (tenesmus)
- Persistent, watery diarrhea
- Unintentional weight loss
- Other symptoms may include:
- Eye inflammation
- Fistulas (usually around the rectal area, may cause draining of pus, mucus, or stools)
- Joint pain
- Liver inflammation
- Mouth ulcers
- Rectal bleeding and bloody stools
- Skin lumps or sores (ulcers)
- Swollen gums
DIET AND NUTRITION
- No specific diet has been shown to improve or worsen symptoms in Crohn's disease. Specific food problems may vary from person to person.
- You should eat a well-balanced, healthy diet. It is important for you to get enough calories, protein, and essential nutrients from a variety of food groups.
- Certain types of foods may worsen diarrhea and gas symptoms. The problem is more likely during periods when symptoms are present. Possible changes you can make to your diet include:
- Eat small amounts of food throughout the day.
- Drink lots of water (drink small amounts often throughout the day).
- Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
- Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
- If your body does not digest dairy foods well, limit dairy products. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
- Avoid foods that you know cause you gas, such as beans, spicy food, cabbage, broccoli, cauliflower, raw fruit juices and fruits -- especially citrus fruits.
- People who have a blockage of the intestines may need to avoid raw fruits and vegetables and other high-fiber foods.
- Ask your doctor about extra vitamins and minerals you may need:
- Iron supplements (if you are anemic)
- Calcium and vitamin D supplements to help keep your bones strong
- Vitamin B12 to prevent anemia
- You may feel worried, embarrassed, or even sad and depressed about having a bowel accident. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can cause digestive problems.
- Ask your doctor or nurse for tips on how to manage your stress.
- You can take medication to treat very bad diarrhea. Loperamide (Imodium) can be bought without a prescription. Always talk to your doctor or nurse before using these drugs.
- Other medicines to help with symptoms include:
- Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription. Ask your doctor about these products.
- Always talk to your doctor before using any laxative medicines.
- You may use acetaminophen (Tylenol) for mild pain.
- Drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) may make your symptoms worse.
- Your doctor may also give you a prescription for stronger pain medicines. Medicines that may be prescribed include:
- Aminosalicylates (5-ASAs) are medicines that help control mild to moderate symptoms. Some forms of the drug are taken by mouth; others must be given rectally.
- Corticosteroids (prednisone and methylprednisolone) are used to treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum.
- Medicines such as azathioprine or 6-mercaptopurine quiet the immune system's reaction.
- Antibiotics may be prescribed for abscesses or fistulas.
- Biologic therapy is used to treat patients with severe Crohn's disease that does not respond to any other types of medication. Medicines in this group include Infliximab (Remicade) and adalimumab (Humira), certolizumab (Cimzia), and natalizumab (Tysabri).
- If medicines do not work, a type of surgery called bowel resection may be needed to remove a damaged or diseased part of the intestine or to drain an abscess. However, removing the diseased portion of the intestine does not cure the condition.
- Patients who have Crohn's disease that does not respond to medications may need surgery, especially when there are complications such as:
- Bleeding (hemorrhage)
- Failure to grow (in children)
- Fistulas (abnormal connections between the intestines and another area of the body)
- Infections (abscesses)
- Narrowing (strictures) of the intestine
There is no cure for Crohn's disease. The condition is marked by periods of improvement followed by flare-ups of symptoms. It is very important to stay on medications long-term to try to keep the disease symptoms from returning. If you stop or change your medications for any reason, let your doctor know right away. You have a higher risk for small bowel and colon cancer if you have Crohn's disease.
- Bowel obstructions
- Complications of corticosteroid therapy, such as thinning of the bones
- Erythema nodosum
- Fistulas in the following areas:
- Impaired growth and sexual development in children
- Inflammation of the joints
- Lesions in the eye
- Nutritional deficiency (particularly vitamin B12 deficiency)
- Pyoderma gangrenosum
Crohn's disease is more common in northern countries, and shows a higher preponderance in northern areas of the same country. The incidence of Crohn's disease is thought to be similar in Europe but lower in Asia and Africa. It also has a higher incidence in Ashkenazi Jews and smokers.
Crohn's disease has a bimodal distribution in incidence as a function of age: the disease tends to strike people in their teens and twenties, people in their fifties through their seventies, and ages in between due to not being diagnosed with Crohn's and being diagnosed instead with irritable bowel syndrome (IBS). It is rarely diagnosed in early childhood. It usually strikes females who are pediatric patients more severely than males. However, only slightly more women than men have Crohn's disease. Parents, siblings or children of people with Crohn's disease are three to twenty times more likely to develop the disease. Twin studies show a concordance of greater than fifty five percent for Crohn's disease.
At the present time, there is no cure for Crohn's disease and remission may not be possible or prolonged if achieved. In cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes, and, in some cases, surgery. Adequately controlled, Crohn's disease may not significantly restrict daily living. Treatment for Crohn's disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.Lifestyle changes
Certain lifestyle changes can reduce symptoms, including dietary adjustments Elemental diet, proper hydration, and smoking cessation. Smoking may increase Crohn's disease; stopping is recommended. Eating small meals frequently instead of big meals may also help with a low appetite. To manage symptoms have a balanced diet with proper portion control. Fatigue can be helped with regular exercise, a healthy diet, and enough sleep. A food diary may help with identifying foods that trigger symptoms. Some patients should follow a low dietary fiber diet to control symptoms especially if fibrous foods cause symptoms. Patients should avoid milk or dairy products as they have been shown in recent research (2007) to contribute to or even cause Crohn's disease.
Crohn's cannot be cured by surgery, though it is used when partial or a full blockage of the intestine occurs. Surgery may also be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs. After the first surgery, Crohn's usually shows up at the site of the resection, however it can appear in other locations. After a resection, scar tissue builds up, which can cause strictures, which form when the intestines become too small to allow excrement to pass through easily, which can lead to a blockage. After the first resection, another resection may be necessary within five years
For patients with an obstruction due t. o a stricture, two options for treatment are strictureplasty and resection of that portion of bowel.
Another complication following surgery for Crohn's disease in which the terminal ileum has been removed is the development of excessive watery diarrhea. This is due to an inability of the ileum to reabsorb bile acids after resection of the terminal ileum.
More than half of people with Crohn's disease have tried complementary or alternative therapy. These include diets, probiotics, fish oil and other herbal and nutritional supplements. The benefit of these medications is uncertain.
Acupuncture is used to treat inflammatory bowel disease in China, and is being used more frequently in Western society. However, there is little evidence that acupuncture has benefits beyond the placebo effect.
Homeopathy is frequently used in Germany as a treatment for Crohn's disease, though no clinical trials exist that demonstrate effectiveness.
Crohn's disease is one type of inflammatory bowel disease (IBD). It typically manifests in the gastrointestinal tract and can be categorized by the specific tract region affected. A disease of both the ileum (the last part of the small intestine, which connects to the large intestine), and the large intestine, Ileocolic Crohn's accounts for fifty percent of cases. Crohn's ileitis, manifest in the ileum only, accounts for thirty percent of cases, while Crohn's colitis, of the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis. Gastroduodenal Crohn's disease causes inflammation in the stomach and first part of the small intestine, called the duodenum. Jejunoileitis causes spotty patches of inflammation in the top half of the small intestine, called the jejunum . The disease can attack any part of the digestive tract, from mouth to anus. However, individuals affected by the disease rarely fall outside these three classifications, with presentations in other areas.
Crohn's disease may also be categorized by the behavior of disease as it progresses. These categorizations formalized in the Vienna classification of the disease. There are three categories of disease presentation in Crohn's disease: stricturing, penetrating, and inflammatory. Stricturing disease causes narrowing of the bowel that may lead to bowel obstruction or changes in the caliber of the feces. Penetrating disease creates abnormal passageways (fistulae) between the bowel and other structures, such as the skin. Inflammatory disease (or nonstricturing, nonpenetrating disease) causes inflammation without causing strictures or fistulae.
Endoscopy image of colon showing serpiginous ulcer, a classic finding in Crohn's disease
Many people with Crohn's disease have symptoms for years prior to the diagnosis. The usual onset is between fifteen and thirty ears of age, but can occur at any age. Because of the 'patchy' nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more subtle than those of ulcerative colitis. People with Crohn's disease experience chronic recurring periods of flare-ups and remission.
Abdominal pain may be the initial symptom of Crohn's disease. It is often accompanied by diarrhea, especially in those who have had surgery. The diarrhea may or may not be bloody. People who have had surgery or multiple surgeries often end up with short bowel syndrome of the gastrointestinal tract. The nature of the diarrhea in Crohn's disease depends on the part of the small intestine or colon involved. Ileitis typically results in large-volume, watery feces. Colitis may result in a smaller volume of feces of higher frequency. Fecal consistency may range from solid to watery. In severe cases, an individual may have more than twenty bowel movements per day and may need to awaken at night to defecate. Visible bleeding in the feces is less common in Crohn's disease than in ulcerative colitis, but may be seen in the setting of Crohn's colitis. Bloody bowel movements are typically intermittent, and may be bright or dark red in color. In the setting of severe Crohn's colitis, bleeding may be copious. Flatulence and bloating may also add to the intestinal discomfort.
Symptoms caused by intestinal stenosis are also common in Crohn's disease. Abdominal pain is often most severe in areas of the bowel with stenoses. In the setting of severe stenosis, vomiting and nausea may indicate the beginnings of small bowel obstruction. Although the association is greater in the context of ulcerative colitis, Crohn's disease may also be associated with primary sclerosing cholangitis, a type of inflammation of the bile ducts.
Crohn's disease, like many other chronic, inflammatory diseases, can cause a variety of systemic symptoms. Among children, growth failure is common. Many children are first diagnosed with Crohn's disease based on inability to maintain growth. As it may manifest at the time of the growth spurt in puberty, up to thirty percent of children with Crohn's disease may have retardation of growth. Fever may also be present, though fevers greater than (101.3 °F) are uncommon unless there is a complication such as an abscess. Among older individuals, Crohn's disease may manifest as weight loss, usually related to decreased food intake, since individuals with intestinal symptoms from Crohn's disease often feel better when they do not eat and might lose their appetite. People with extensive small intestine disease may also have malabsorption of carbohydrates or lipids, which can further exacerbate weight loss.
A colonoscopy is the best test for making the diagnosis of Crohn's disease, as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement. On occasion, the colonoscope can travel past the terminal ileum, but it varies from patient to patient. During the procedure, the gastroenterologist can also perform a biopsy, taking small samples of tissue for laboratory analysis, which may help confirm a diagnosis. As thirty percent of Crohn's disease involves only the ileum, cannulation of the terminal ileum is required in making the diagnosis. Finding a patchy distribution of disease, with involvement of the colon or ileum, but not the rectum, is suggestive of Crohn's disease, as are other endoscopic stigmata. The utility of capsule endoscopy for this, however, is still uncertain. A "cobblestone"-like appearance is seen in approximately forty percent of cases of Crohn's disease upon colonoscopy, representing areas of ulceration separated by narrow areas of healthy tissue.
A small bowel follow-through may suggest the diagnosis of Crohn's disease and is useful when the disease involves only the small intestine. Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine. CT and MRI scans are useful for evaluating the small bowel. . They are also useful for looking for intra-abdominal complications of Crohn's disease, such as abscesses, small bowel obstructions, or fistulae. Magnetic resonance imaging (MRI) is another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available.
Multiphase white blood cell scans have been shown to be effective in detecting the locations of active Crohn's disease, particularly in hard to diagnose patients suffering with the early stages or a mild form of the disease with negative endoscopic and radiologic findings. The procedure, a type of nuclear medicine, uses white blood cells removed from the patient; they are tagged with a radioisotope, and then injected intravenously into the patient, and later scanned at several intervals to detect any abnormal white blood cell accumulation, such as pooling in the intestinal tract.
A complete blood count may reveal anemia, which may be caused by blood loss, by vitamin B12 deficiency or, possibly, autoimmune hemolysis. The latter may be seen with ileitis because vitamin B12 is absorbed in the ileumi.
Comparison with ulcerative colitis
The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
Cannabinoids Alleviate Crohn’s Symptoms
Historically, marijuana has been used to treat diarrhea and has been advocated for the treatment of a variety of other gastrointestinal problems, including Crohn's disease. More recent pharmacological studies have clearly established that cannabinoids inhibit gastrointestinal motility and secretion by acting on CB1 receptors located on the terminals of both intrinsic and extrinsic submucosal neurons. When administered to mice with chemically induced enteritis,cannabinoids also reduce inflammation and fluid accumulationin in the gut. In these latter studies, high levels of anandamide and 2-arachidonoylglycerol as well as increased expression of CB1 receptors have been detected in the inflamed intestines.
The novelty in the findings of Massa et al is the active protective role of the endocannabinoid system, as indicated by the altered inflammatory response of mice lacking CB1 receptors or FAAH. Furthermore, CB1 activation reversed the electrophysiological signs of smooth muscle irritability and, at the same time, blunted the increase in tissue myeloperoxidase activity, a measure of leukocyte infiltration. These observations suggest that endocannabinoids protect the gut not only by decreasing bowel motility but also by inhibiting the inflammatory process itself.
In 2008, a team of researchers in Switzerland isolated a little-known compound in cannabis called beta-caryophyllene from oily resin in Cannabis sativa L. buds. The scientists induced an immune attack in laboratory mice, then fed the cannabis compound to the rodents. After the mice ate the extract, their inflammation went down. The team then demonstrated that beta-caryophyllene works by turning on CB2 cannabinoid receptors, known to reduce swelling, pain and inflammation. The compound is structurally different from anti-inflammatory medications now on the market, and it provides a novel approach for those who suffer from Crohn’s and other immune diseases. Unlike THC, a cannabis compound with similar anti-inflammatory properties, beta-caryophyllene does not affect CB1 receptors in the brain, and thus has no psychoactive effect whatsoever.
“Crohn’s disease, characterized by intestinal inflammation, is another example of a Th1-mediated disease. Anecdotal reports of beneficial marijuana use for this disease gain support by examining modern pharmaceutical approaches. Down-regulation of Th1 effectors has produced dramatic results in the treatment of this disease. New immuno-therapeutic strategies that treat Crohn’s disease with antitumor necrosis factor (TNF-alpha) antibodies, have induced complete remissions and few side effects. THC has been shown to inhibit THF-alpha. Thus, the same therapeutic targets of the newest pharmaceuticals are acted upon by one of nature’s oldest medicines.”
“Curative leaf - Compound in marijuana reduces inflammation without the psychological effects” Amy Maxmen, Science News, June 23rd, 2008
The endogenous cannabinoid system in the gut of patients with inflammatory bowel disease
A Di Sabatino, N Battista, P Biancheri, C Rapino, L Rovedatti, G Astarita, A Vanoli, E Dainese, M Guerci, D Piomelli, S L F Pender, T T MacDonald, M Maccarrone and G R Corazza
Activation of cannabinoid receptors (CBs) by endocannabinoids impacts on a number of gastrointestinal functions. Recent data indicate that CB1 agonists improve 2,4-dinitrobenzene sulfonic acid-induced colitis in mice, thus suggesting a role for the endocannabinoid agonist anandamide (AEA) in protecting the gut against inflammation. We here examined the gut endocannabinoid system in inflammatory bowel disease (IBD) patients, and investigated the ex vivo and in vitro effects of the non-hydrolysable AEA analog methanandamide (MAEA) on the mucosal proinflammatory response. The content of AEA, but not of 2-arachidonoyl-glycerol and N-palmitoylethanolamine, was significantly lower in inflamed than uninflamed IBD mucosa, and this was paralleled by lower activity of the AEA-synthesizing enzyme N-acyl-phosphatidylethanolamine-specific phospholipase D and higher activity of the AEA-degrading enzyme fatty acid amide hydrolase. MAEA significantly downregulated interferon-γ and tumor necrosis factor-α secretion by both organ culture biopsies and lamina propria mononuclear cells. Although these results are promising, further studies are needed to determine the role of cannabinoid pathways in gut inflammation.
In 2005 New Scientist published a joint study by Bristol University and the University of Bath on the apparent healing power of cannabis on IBD. Reports that cannabis eased IBD symptoms indicated the possible existence of cannabinoid receptors in the intestinal lining, which respond to molecules in the plant-derived chemicals. CB1 cannabinoid receptors – which are known to be present in the brain – exist in the endothelial cells which line the gut, it is thought that they are involved in repairing the lining of the gut when damaged. The team deliberately damaged the cells to cause inflammation of the gut lining and then added synthetically produced cannabinoids; the result was that gut started to heal: the broken cells were repaired and brought back closer together to mend the tears. It is believed that in a healthy gut, natural endogenous cannabinoids are released from endothelial cells when they are injured, which then bind to the CB1 receptors. The process appears to set off a wound-healing reaction, and when people use cannabis, the cannabinoids bind to these receptors in the same way. Previous studies have shown that CB1 receptors located on the nerve cells in the gut respond to cannabinoids by slowing gut motility, therefore reducing the painful muscle contractions associated with diarrhea. The team also discovered another cannabinoid receptor, CB2, in the guts of IBD sufferers, which was not present in healthy guts. These receptors, which also respond to chemicals in cannabis, appear to be associated with apoptosis – programmed cell death – and may have a role in suppressing the overactive immune system and reducing inflammation by mopping up excess cells.
Cannabis and GI Disorders / Crohn’s Disease
Research suggests that cannabis is effective in treating the symptoms of these GI disorders in part because it interacts with the endogenous cannabinoid receptors in the digestive tract, which can result in calming spasms, assuaging pain, and improving motility. Cannabis has also been shown to have anti-inflammatory properties and recent research has noids playing crucial neuromodulatory roles in controlling the operation of the gastrointestinal system, with synthetic and natural cannabinoids acting powerfully to control gastrointestinal motility and inflammation.
Recommendation: Indica hybrid. Use whole plant extracts. Tinctures, teas, suppositories, vaporizer, cannabutter, edibles (maybe).
Best Strains for Crohn's disease: Blueberry, Auntie Em, Blackberry, God Bud, Williams Wonder, Afghani Bullrider, OG, AK47, Northern Lights, Kandy Kush, Bubba Kush, Black Domina, Blue Fruit, Chemo, Cripple Creek, Dynamite, G13, Super Silver Haze, Ultimate Indica, Purple Kush, Santa Maria, Platinum Bubba.
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Mayo Clinic: Crohn's Disease
National Digestive Diseases Information Clearinghouse
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