This is an inflammatory disease involving the wall of the gut, anywhere from the mouth to the anus, but 80% involve the small bowel . It causes crampy abdominal pains, narrowing and obstruction of the bowel can occur, diarrhoea on and off, sometimes with blood. Sometimes fistulas (rupture into other tissues) can occur and the disease often causes poor absorption of foods especially fats.
In addition to the bowel symptoms, Crohn’s may affect other areas – fatigue and weight loss are very common, arthritis, anaemia, rashes and sometimes eye inflammation can occur.
The cause is not known, but is almost certainly an auto-immune disease where the body attacks itself, thinking it is a danger. Some however believe it may be the result of bacteria in the gut attacking the gut wall because of impaired immunity.
The disease is usually diagnosed by colonoscopy or CT scanning of the bowel. There are some diagnostic blood tests but they are still not fully evaluated.
What your doctor can do:
Drugs are the mainstay of treatment – The drugs used depend on the area involved and the severity of the illness:
- Mouth ulcers – topical Triamcinilone, fluocinonide gel covered by orabase 3 – 4 times a day till healed
- Ileum and colon – Sulphasalazine ( 5ASA drugs) is used in most cases and appears to hasten remission, but there is some controversy on its value. Antibiotics (metronidazole, ciprofloxacin) may change the gut bacteria and give benefit ( probiotics see below also seems logical, but are rerely recommended). Steroid drugs (prednisone 40-60mg per day) are very effective in reducing symptoms, and after 10-14 days taper off to 5mg then stopping. long term prednisone should be avoided.
- Once the disease has subsided, maintenance with 5ASA (Pentasa) should be continued.
- For resistant disease – more powerful disease modifying drugs are used including inflixomab, azathiaprine, methotrexate, cyclosporin and tacrolimus. These are owerful drugs and are only used when essential and must be monitored carefully by a skilled gastroenterologist.
Surgery – if there are obstructions or fistulae, often surgery is required to remove the affected areas.
What you can do
- Diet – it is important to watch what you eat and see if recurrences follow any particular foods, or if the symptoms become worse – if so then avoid them. Sometimes fruit and vegetables can aggravate symptoms as can rich fatty food or excess red meat. It may be better to have frequent small meals (graze) rather than large ones. Avoid lactose (milk products), and also see if eliminating gluten (wheat) helps.
- Smoking – patients who smoke have a higher risk of needing more operations than those who don’t. So stop smoking. The information about caffeine and alcohol is less certain, but most people recommend either stopping or limiting both.
- Stress often makes the symptoms worse, so meditation and relaxation therapies are often helpful. Unfortunately many of the symptoms of the disease can aggravate stressful feelings.
- Low dose naltrexone – may well help (click here for more details) – and after a discussion with your health provider, should be considered.
Supplements – Almost everyone with significant Crohn’s disease absorbs food poorly, and nutritional supplements are essential for good or optimal health. Much of the fatigue may be worsened by poor nutrition:
- Multivitamin mineral – take a regular quality multi-tablet to make sure the cells get the nutrients they require.
- Vitamin D – recent research has suggested this may play an important role on the genes controlling anti-microbial function. Take at least 5,000-8,000iu of vitamin D daily.
- Fish oils – these can have anti-inflammatory actions and may help with Crohn’s, but it is possible they may worsen symptoms in some people, so start gently and stop if symptoms worsen.
- Anti-inflammatory supplements such as grape seed extract and curcumin (tumeric) might help.
- Probiotics – many people believe that bad bacteria in the gut aggravate or even cause Crohn’s disease. Replacing them with good bacteria using quality probiotics seems a very logical
treatment and there is good data suggesting it helps.
- Fibre drinks that contain prebiotics (food for good bacteria) may help.
Research teams have suggested that such unlikely therapies as thalomide, cannabis and even infestation with hookworms can help Crohn’s symptoms, but I would not advocate any of these until more information comes to hand.
The Nutritional supplements I use and recommend to my patients
For Crohn’s patients – USANA – Cellsenials *, Biomega, Active Calcium plus, probiotics, Proflavanol C and vitamin D –
Curcumin (tumeric) – Curcugel in NZ obtain from www.johnappleton.co.nz