Crohn’s Disease BY: Brent Movson, Allison Cobb, Alma Hernandez

Epidemiology!

Crohn’s is commonly found in North America and Eastern Europe Crohn’s Prevalence rate ranges from 26 to cases per 100,000 persons. The Incidence rates range from 3.1 to 14.6 cases per 100,000 persons per year.

Epid

Epidemiology Found in Eastern European Countries People who are more prone to Disease: Ashkenazi Jews Smokers Hereditary genetics

Ashkenazi Jews People of Jewish decent are more likely to get disease Two-to-eight times more common in Ashkenazi Jews Doctor’s don’t know why it infects Jewish people

Smoking Smoking has been shown not only to increase the risk for Crohn’s disease but also WORSEN the course of the disease Smokers may be less responsive to certain treatments and are more likely to develop a recurrence of Crohn’s disease after surgery Jacque Cosnes from Rothschild Hospital

Genetics Siblings are more susceptible to have it If one sibling has CD, than it is 30% more likely the other sibling has it as well People with family history of CD are at a 10 times greater risk of contracting it

Etiology There is no mode of transmission Crohn’s is an autoimmune disorder caused by genetic factors It is acquired heretically The gene NOD2 determines the way bacteria is handled in the body and when this gene is damaged or mutated Crohn’s happens

Etiology Cont. Individuals with Crohn’s have a defect in this gene called fibrostenosing, which means they form very narrow and blocked bowel complications very quickly and require surgery to remove damaged parts of the intestines and other organs affected by Crohn’s There have been studies done to determine whether diet and smoking cigarettes cause or have a relation to Crohn’s like previously thought but a poor diet and cigarette addiction only make Crohn’s symptoms worse, they do not cause it.

Pathology Crohn’s is an autoimmune disease that usually presents first signs of symptoms between the ages of 15 and 35 Usually they manifest in the small intestine, the ileum to be exact, but it infects the entire GI tract among many other organs the patients immune system attacks healthy tissues along the lining of the intestine which causes severe swelling of the intestines and ulcerations the most common form of Crohn’s attacks the Ileum and colon

Symptoms Abdominal pain. The pain often is described as cramping and intermittent, and tender. Abdominal pain may turn to a dull, constant ache as the condition progresses. Diarrhea. Some people may have diarrhea 10 to 20 times a day. They may wake up at night and need to go to the bathroom. Crohn's disease may cause blood in stools, but not always.

Symptoms Cont. Loss of appetite. Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that the patient have a complication involving infection, such as an abscess. Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss. Too few red blood cells (anemia). Some people with Crohn's disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.

People with Crohn’s may also experience… Sores in the mouth. Nutritional deficiencies, such as lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food. Bowel obstructions Because there is some immune system involvement, you also may have symptoms outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.

Symptoms Cont. Signs of disease in or around the anus. These may include: Abnormal tunnels or openings called fistulas that sometimes form between organs. These develop because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall. Fistulas may form between parts of the intestine or between the intestine and another organ such as the bladder, vagina, or skin. A fistula may be the first sign of Crohn's disease. Pockets of infection (abscesses). Small tears in the anus (anal fissures). Skin tags that may resemble hemorrhoids. These are caused by inflamed skin.

Fun picture of the colon!!!

How to know if you have Crohn’s? Colonoscopy, Proctoscopy

Colonoscopy

Treatment THERE IS NO CURE FOR CROHN’S! Inflammation can be treated or reduced by using medications, surgery and/or special diets The goal of treatment is to reduce the symptoms, control the autoimmune response, and maintain the body’s ability to fight disease.

Medications Anti-inflammatory drugs (Asacol, Dipentum, Pentasa, 5-Aminosalicylic acid) Corticosteroids (Prednisone, Budesonide) Work by reducing inflammation. Serious side effects include osteoporosis and susceptibility to infection. Immunosuppressive Medications (6- Mercaptopurine, Azathioprine) Work by blocking the immune system reaction that contributes to inflammation. Side effects include: susceptibility to infection, nausea, diarrhea. Biological Therapies (Remicade, HUMIRA)- Injected directly into a vein or the skin. Work by blocking TNF substances. Antibiotics (Ampicillin, Sulfonamide). Used to treat bacterial overgrowth in the intestines that can result from fistulas.

Surgery Used as treatment to repair the presence of an intestinal fistula, abscess or ulcer. PROCTOCOLECTOMY- surgical removal of the rectum and all or part of the colon. ILEOSTOMY- surgical opening constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin. Intestinal waste is collected in an external pouch attached to the skin. INTESTINAL RESECTION- surgical procedure in which a part of the large or small intestine is removed. More than one surgery may be needed because disease frequently recurs in another area of the intestines.

Diet Diet alone cannot prevent Crohn’s Disease. However, when flare ups occur, symptoms can be made worse with milk, alcohol, hot spices or fiber. You can reduce abdominal discomfort and cramping during flare ups by: Eating smaller meals throughout the day. Reducing the amount of greasy or fried foods. Restricting the intake of high fiber foods. Limiting the consumption of milk and milk products. Intestinal inflammation tends to lead to dehydration and malabsorption. A visit with a dietitian is recommended to make sure there is an adequate supply of nutrients and fluids.

Relevance to Society Incidence of Crohn’s Disease appears to be rising. The theory that MAP is possibly the etiological agent is a concern because MAP is present in our food chain