I know that some of the articles this week pointed out the general symptoms that persons with Crohn's disease or ulcerative colitis have such as abdominal pain, vomiting, diarrhea, and hematochezia. I wanted to know more of the details on the symptoms people with Crohn's disease possess and the severity of them.
People with Crohn's disease will have diarrhea but the kind of diarrhea they will experience depends on the location that is involved, whether it be in the small intestines or colon will cause them to have large-volume watery feces or small volume but of high frequency. Many people have more than 20 bowel movements a day. There is less visible bleeding in Crohn's disease than ulcerative colitis. They may also experience primary sclerosing cholangitis which is where the bile ducts are inflamed as well, and this can lead to liver failure. Other symptoms that may be involved in Crohn's disease are aphthous ulcers affecting the mouth and will cause difficulty in swallowing.
Crohn's disease is a chronic inflammatory disease that can cause growth failure in children as well as retardation of growth. In addition, due to all the unpleasant symptoms many people experience weight loss because they either lose their appetite or do not eat. Also if their small intestine disease is severe, weight loss can be caused my malabsorption of lipids or carbohydrates.
This disease has been known to affect other organ systems such as the eye, joints, blood, endocrine system, and skin. People with Crohn's disease may experience inflammation of the eye that cause eye pain and if not treated loss of vision. Many people with Crohn's disease have inflammation of the joints and some have reported arthritis in the spine. The skin can develop skin lesions such as red nodules and pyoderma gangrenosum. There is an increased risk of obtaining blood clots as well as developing a condition where the immune system ends up attacking the red blood cells called autoimmune hemolytic anemia. Other potential symptoms are difficulty breathing, deformity of the ends of fingers, and osteoporosis.
Additionally, Crohn's disease has been reported to have an affect on the nervous system which some of the symptoms include: stroke, depression, headache, seizures, and myopathy. Furthermore, there is a large increase risk of getting cancer in the inflamed areas of the small intestines and/or colon.
After learning about all of the complications and symptoms someone with Crohn's disease has a tremendous risk of obtaining, I was amazed by all the different parts of the body that can be effected by one disease. The vast amount of different systemic and extraintestinal symptoms that Crohn's disease can cause a person to have is overwhelming. I do not feel that the articles this week went into as much depth in discussing the symptoms as they should have.
Sources:
http://www.ccfa.org/info/about/crohns
http://www.aolhealth.com/conditions/crohns-disease-major-1/symptoms
17 October 2008
15 October 2008
Treatments for IBD
One of the things I felt none of our articles really touched upon are the many different treatments for IBD. Since Crohn's Disease and Ulcerative Colitis manifest in different ways, there are also different treatments for each disease.
For Crohn's disease, treatments include medications such as mesalamine, corticosteroids, antibiotics and immunsuppresive drugs. Mesalamine and corticosteroids are primarily used to control the inflammation, relieving the symptoms of Crohn's disease. Antibiotics are used most often after surgery, such as an ileum resection, in order to prevent flare ups caused by introduced bacteria. Immunosuppresives are used to block the inflammation, however they have side effects including nausea, vomiting, liver problems and may cause inflammation in the pancreas, which can cause additional problems. A more recent drug therapy is the use of infliximab. Infliximab is an antibody which blocks TNF (tumor necrosis factor) which is one of the primary causes of inflammation in Crohn's disease. Finally, surgery can also be used to treat Crohn's disease when pharmaceuticals fail to control the symptoms, however this only relieves symptoms for a short time.
In Ulcerative Colitis, immunosuppresants and anti-inflammatory drugs are also used, for the same reasons as previously stated for Crohn's disease. The drug Infliximab is also approved for treatment in UC for its ability to block TNF. Often times infliximabs side effects out weigh its benefits for UC patients, as it may cause increased risk for cancer as well as susceptibility to disease such as tuberculosis. Since UC is limited to the colon, many patients undergo laproscopic surgery to remove the troublesome areas. Unlike in Crohn's disease, removal of the colon completely cures the disease.
References:
Mayo Clinic Diseases & Treatments, 2008
13 October 2008
Smoking and IBD
The effects of smoking on IBD are especially interesting because of the dual effects it has on the two manifestations of IBD, ulcerative colitis and Crohn's disease. In ulcerative colitis, smoking actually alleviates the symptoms in patients. However, in Crohn's disease smoking makes the symptoms worse.
Not only does smoking effect the course of the disease, it also effects the initial risk of suffering from the disease. Smokers are less likely to get ulcerative colitis, but interestingly former smokers have an increased risk of getting ulcerative colitis when compared to people who never smoked. Smokers were also less likely to have severe symptoms, and require surgery. On the other hand people who suffered from Crohn's disease and smoked were more likely to have a progressive form of the disease. I thought it was interesting that some Crohn's disease patients who quit smoking developed lesions that are typically seen in ulcerative colitis.
The conflicting effects made me wonder if it would be better to keep smoking if you had ulcerative colitis. It seems to be a good treatment, but you also have to consider the risks of smoking itself. Smoking can cause lung cancer, increases the risk of cardiovascular disease, and increases inflammation throughout the body. I thought maybe there was a way of isolating the beneficial effects of cigarettes without being exposed to the detrimental effects at the same time.
While reading the articles I assumed that the beneficial effects were due to the nicotine in the cigarettes and I wanted to know if using a nicotine patch was just as effective as cigarettes. I did some searching, and I found out there have been a few studies that used the transdermal nicotine patches to treat mild to moderate ulcerative colitis. The treatment was fairly successful, and when used with the conventional therapies it is even more successful.
So overall, it would be a good idea that anyone with IBD should quit smoking. Although it seems like smoking is a good way to treat ulcerative colitis, in the end it isn't worth the other risks smoking carries with it. Especially when nicotine patches are almost as effective as smoking itself.
12 October 2008
Inflammatory Bowel Disease: Crohn's and Colitis
Hi all:
I hope for this post to provide some introductory information about Inflammatory Bowel Disease (of which the two major diagnosed disease states are Crohn's Disease and Ulcerative Colitis) and to touch on some potential discussion topics for the next couple weeks. IBD is of particular interest to me because my younger brother was diagnosed with Crohn's Disease six years ago, so I've seen the dramatic difference between a Crohn's flare up and remission.
IBD is commonly described as an autoimmune disorder, since it is speculated that the inflammation cascades and resulting symptoms are the result of an immune system response to the constituent bacterial flora in the human body. This bacterial makeup is important in proper nutrition and absorption, but in the IBD disease states the bacteria are recognized as foreign and treated as pathogens. Since the body cannot afford to lose this bacteria, the inflammation state is persistent. This leads to the clinical expressions of Crohn's and Colitis.
Crohn's and ulcerative colitis differ diagnostically, as they are manifested in different locations and with different tissues affected. Crohn's can affect any portion of the GI tract (from mouth to anus), and is an inflammatory response associated with multiple layers of the intestinal wall. Colitis is an inflammatory response isolated to the mucosa, and is contained to the colon and rectum.
Symptomatically, Crohn's Disease can vary widely (since the inflammation can occur at any point along the GI tract), but since most cases arise in the ileum, some common symptoms can be considered 'red flags' for diagnosis, such as sudden unexplained weight loss, diarrhea, abdominal pain, and bleeding. As Crohn's Disease involves a number of inflammatory mediators, it is also common to have arthritis, skin problems, persistent fever and anemia. Crohn's Disease frequently leads to nutritional absorption problems, so a whole series of complications are common, including osteopenia (precursor osteoperosis), stunted growth, early age low bone density, postural problems, and a decreased appetite.
Symptoms of ulcerative colitis tend to be more consistent, including sharp abdominal pain, weight loss, bloody or mucousy discharge and diarrhea. Many of the same secondary symptoms associated with malabsorption and systemic inflammation seen in Crohn's are seen in Colitis, which can make diagnosis and therapy difficult.
Both diseases are commonly diagnosed by endoscopy, as there are characteristic patterns of ulcer formation and inflammation for each disease state. But again, since the symptoms can be fairly common and indicative of more common problems, it sometimes can take awhile for an accurate diagnosis of Crohn's or Colitis. This makes the current genetic work particularly important.
In class I hope to discuss the current proposed models of inflammatory cascades that are expressed in IBD, the current genetic research aimed at locating a possible single IBD gene, the effects of smoking on the supression of Colitis/simultaneous increase in Crohn's activity (something that's REALLY interesting), and the relationship between intestinal bacteria and immune system development. Let me know if you have any other areas of interest that you'd like us to look into.
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