How would you feel, at 18 years of age, if suddenly you were diagnosed with Crohn’s Disease (CD)?
It would be devastating news. Unlike other well-known diseases, you would probably know nothing about this illness, and even its name sounds ominous. But you would not be alone. Crohn’s Disease is not a household word and, in spite of its importance, receives little in research dollars.
Crohn’s Disease affects 600,000 people in North America. Normally, it strikes those between 20 to 35 years of age, with another peak in the 50s, but no age is immune to this disorder. And smokers are three times more likely to develop this disease.
It shows no sex bias as it affects both equally. In about 20% of cases a blood relative has some form of this inflammatory bowel disease. Those of Jewish heritage have an increased risk but African Americans are less likely to develop it.
Patients suffer from recurrent episodes of abdominal pain, bloody diarrhea, fever and weight loss. Geographically it can affect any part of the gastrointestinal tract from mouth to the anus.
But most commonly it involves the lower part of the small bowel, called the ileum.
There are several theories about what causes Crohn’s Disease.
Some researchers believe CD is an autoimmune disease in which the body’s defenses become confused and begin attacking its own cells. But whatever the reason, the bowel’s wall becomes repeatedly inflamed, often with no rhyme nor reason as to when these attacks occur.
Initially, it may be difficult to know whether the patient suffers from Crohn’s Disease or ulcerative colitis which primarily affects the large bowel. But blood tests, X-ray and colonoscopy examinations will eventually determine the diagnosis.
The most common complication is blockage of the intestine. Repeated episodes of inflammation cause swelling, scar tissue and narrowing of the bowel. In some cases the inflammatory response may be so intense that perforation of the intestine occurs and tunnels develop between the bowel, vagina, bladder or skin. Fissures or small tears may occur at the anal area.
So a diagnosis of Crohn’s Disease, whether at 18 years of age or older, causes a major readjustment in one’s life. As one young female patient said to me ,“If I’m out on a date I’m often thinking where is the bathroom if I need one, and how do I tell him I have this problem?”
Others say repeated attacks place a strain on their relationships. The uncertainty of recurrences make it hard to plan ahead.
Patients with Crohn’s Disease must get to know their disease and start a food diary to ascertain what foods cause trouble. But, at the same time, be careful not to develop a food phobia as food does not cause CD, nor does it cure it. And above all else, they must not let this disease overwhelm their entire life.
Some patients discover that if they consume lesser amounts of food there’s a decreased chance of bowel problems.
But this can be dangerous as it can lead over time to malnutrition and that’s the last thing a patient with Crohn’s Disease needs. For instance, intestinal bleeding can lead to iron deficiency anemia.
It’s also important to make sure that patients with CD have sufficient amounts of Vitamin B12.
Since Vitamin B12 is absorbed at the end of the small bowel where CD often strikes, this vitamin may be lacking.
And since many patients with CD cannot tolerate lactose, it’s important they receive adequate amounts of calcium and Vitamin D.
Treatment depends on the severity of the disease. Cortisone and drugs to suppress the immune system may limit the inflammatory response. But sometimes multiple surgeries are needed to remove inflamed portions of intestine.
Recently the Gifford-Jones Living Will was made available to readers, but it was not possible to fill the demand.
However, a reprint is now available and it can again be obtained by sending $10 along with a self-addressed stamped envelope to Dr. Gifford-Jones, 65 Harbour Square, Suite 1110, Toronto, Ontario M5J 2L4.