Crohns disease is a kind of lifestyle disease. Crohns disease is also known as regional enterities. It is a type of inflammatory bowel disease. Crohns disease is different with ulcerative colitis which is another common type of inflammatory bowel disease.The differences between the two illness is the area that affected in the gastrointestinal tract (GI tract). Crohn’s disease affects the end of small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the end of the rectum.

Diagram 1 – Regions that are affected by

ulcerative colitis and Crohn’s disease

There are 700,000 Americans may affected Crohn’s disease. Crohn’s disease is a disease which can be associated with genetic inheritance which runs in some families. If there is anyone of your relatives have this disease, your family members will have a significantly increased in chance of getting Crohn’s disease.The risk of developing this disease will increase when your parents have inflammatory bowel disease. Related members of the family of the affected individuals will be at higher risk. The percentage of getting Crohn’s for males and females are 50% respectively. The ratio of getting this disease for smokers and non- smokers is two to one. This disease can occur at any age but it is more prevalent among teenagers and young adults. The range of the age is between 15 and 35.

The exact cause of Crohn’s disease is unknown. Crohn’s disease is more common in developed countries. It is an autoimmune disorder which is a condition that occurs when the body’s immune system mistakenly attacks and destroys healthy body tissue. In short, the body over-reacts to normal bacteria in the intestines. Immunological and bacterial factors in genetically susceptible individuals are the causes of the disease. The interaction between environmental is one of the cause of the Crohn’s disease. Crohn’s disease has traditionally been described as an autoimmune disease, but recent investigators have described it as an immune deficiency state.

Diagram1- Distribution of Crohn’s Disease in the intestinal tract

Crohn’s disease can be categorized by the specific tract region affected. 50 % of the Illeocolic Crohn’s will occur in both the ileum and the large intestine. 30% of the Crohn’s ileitis will occur on illeum only, while the Crohn’s colitis, that manifest the large intestine, accounts for the remaining 20%.

Diagram 2 – Affected region by Crohn’s disease

Crohns’ disease can be categorized by the behaviour of disease as it progresses. There are three categories of diseasee presentation in Crohn’s disease they are stricturing, penetrating and inflammatory. Stricturing disease causes narrowing of the bowel that may lead to bowel obstruction or changes in the calliber of the faeces. Penetrating disease creates abnormal passageways between bowel and other structures, such as the skin. Inflammation disease causes inflammation without causing strictures or fistule.

Crohn’s disease is a kind of chronic disease. It is a chronic inflammatory disorder, in which the body’s immune system attacks the gastrointestinal tract possibly directed at microbial antigens. The patient will suffer throughout the period that the disease flares up and causes a lot of symptoms. During this period, the patient may not be aware of the symptoms at all. Crohn’s disease affects any part of the gastrointestinal (GI) tract.

Diagram : Gastrointestinal Tract in which Crohn’s Disease affects Gastrointestinal Tract in which Crohn’s Disease affects

The primarily symptom of Crohn’s disease are pain in abdomen that often accompanied by diarrhoea which may or may be bloody especially for those who have had surgery. The nature of the diarrhea in the disease depends on the part of the small intestine or colon involved. Ileitis typically results in large-volume and watery faeces while the colitis may result in a smaller volume of faeces but with high frequency. The faecal consistency can be range from solid state to watery. There are several cases which the patients have more than 20 bowel movements per day at any time. We can see the bleeding n the faeces in Crohn’s colitis.Bloody bowel movements are continuous and it can be in bright or dark red in colour. Flatulence and bloating will cause more the intestinal discomfort.

Fever, vomiting, join pain, weight loss, skin problems and bleeding from the rectum may ocurred also and cause a person malnutrition. It may also cause the complications outside the gastrointestinal tract such as skin rashes, arthritis, anemia, fistula, inflammation of the eye, tiredness, and lack of concentration. Constipation may occur also. Children who have this disease may have growth problems.

Symptoms

Crohn’s disease

Defecation

Often porridge- like, sometime steatorrhea

Tenesmus

Less common

Fever

Common

Fistulae

Common

Weight loss

Often

Table 1 – The common symptoms in Crohns’ disease

In Crohn disease the maximum damage to the intestine occurs beneath the mucosa, and lymphoid conglomerations, known as granulomata, are formed in the submucosa. In addition, Crohn disease attacks the perianal tissues more often than does ulcerative colitis. Crohn disease is diagnosed by a combination of methods, including blood and stool analysis and colonoscopy. Diagnosis may be confirmed by other methods, such as barium enema, which uses X-rays to examine the intestine following rectal insertion of a liquid barium contrast agent, and capsule endoscopy, which examines the intestines via a pill-sized video camera that is swallowed by the patient and transmits images to sensors attached to the patient’s body as it passes through the digestive tract.

The effect of the Crohn’s disease can be problematic during pregnancy. This is because some medications can cause undesirable outcome to the foetus or mother.Certain medication will reduce the production of sperms or may affect man’s ability to conceive. Preventive measures are taken through consultation with obstetrician and gastroenterologist.

Crohn’s disease can be diagnosed through stool tests, blood tests, biopsy, sigmoidoscopy (used to investigate the lower bowel), colonoscopy, endoscopy, Barium enema X-ray, Barium meal X-ray and CT scans. X-ray pictures of the abdomen then show the inside of the bowel more clearly. Barium appears white on X-rays. Although there are so many tests, none of them require a general anesthetic. They are generally carried out as out-patient procedures so the patient does not need to stay in hospital overnight.

Scientist

Crohn’s disease was first described by Burrill Bernard Crohn, Dr. Leon Ginzburg and Dr. Gordon Oppenheimer in 1932, but it was not clinically, histologically, or radiographically distinguished from ulcerative colitis until 1959.

Diagram – Dr. Burrill Bernard Crohn

Diagram – Dr Leon Ginzburg.

The history of the scientist

Burrill Bernard Crohn (June 13, 1884 – July 29, 1983) was an American gastroenterologist and was the first to describe the disease for which he is known, Crohn’s disease. His Institutions is Mount Sinai Hospital in New York. He studied at the College of Physicians & Surgeons, Columbia University in year 1908.

In 1932, Dr. Crohn and two colleagues, Dr. Leon Ginzburg and Dr. Gordon Oppenheimer, published an important paper describing the then-relatively unknown condition. Their seminal paper, “Terminal Ileitis: A new clinical entity,” documenting fourteen cases. The name of the disease was changed to “Regional ileitis” on publication.

At the time that he and his colleagues described the disease, Dr. Crohn had a private practice in New York City and usually admitted his patients for diagnosis and treatment to the Mount Sinai Hospital. At Mount Sinai he worked with the neurologist Bernard Sachs from 1858 to 1944. He also spent time working with Dr. Jesse Shapiro, another medical doctor was very involved with Crohn’s research. As Dr. Shapiro had been diagnosed with Crohn’s himself, he had a born devotion to cure the disease. At Mount Sinai Hospital, Dr. Crohn built a very large and successful practice for patients with granulomatous enterocolitis and eventually was made the first chief of the department of gastroenterology. He was highly respected throughout the remainder of his professional career and received numerous patients from all over the USA, as well as from abroad.

Crohn practiced medicine until he was 90, splitting time in his later years between the Upper East Side of Manhattan and at his country home in New Milford, Connecticut, where he met his second wife, Rose Elbogen Crohn, whom he married in 1947. The Burrill B. Crohn Research Foundation was established at Mount Sinai in 1983 with initial funding from Rose Crohn and later his daughter, Ruth Crohn Dickler.

The discovery

The first description of the Crohn’s disease was earlier made by the Italian physician Giovanni Battista Morgagni (1682-1771) in 1769, when he diagnosed a young man with a chronic, debilitating illness and diarrhea.

Successive cases were reported in 1898 by John Berg and by Polish surgeon Antoni Lesniowski in 1904. In 1913, Scottish physician T. Kennedy Dalziel, at the meeting of the British Medical Association, described nine cases in which the patients suffered from intestinal obstruction. On close examination of the inflamed bowel, the transmural inflammation that is characteristic of the disease was clearly evident. Abdominal cramps, fever, diarrhea and weight loss were observed in most patients, particularly young adults, in the 1920s and 1930s. In 1923, surgeons at the Mt Sinai Hospital in New York identified 12 patients with similar symptoms. In 1930, Dr Burrill Bernard Crohn pointed out similar findings in two patients whom he was treating.

Crohn’s contribution to physiology

Some of Crohn’s initial research into the causes of the disease was centered on his personal conviction that it was caused by the same pathogen, a bacterium called Mycobacterium paratuberculosis (MAP), responsible for the similar condition that afflicts cattle, that is Johne’s disease. However, he was unable to isolate the pathogen-most likely because M. paratuberculosis sheds its cellular wall in humans and takes the form of a spheroplast, making it virtually undetectable under an optical microscope. This theory has resurfaced in recent years, and has been lent more credence with the arrival of more sophisticated methods to identify the MAP bacteria.

Research

Doctors and scientists are conducting Crohn’s disease research that known as clinical trials. Research studies are designed to answer important questions and to determine whether new approaches to treating Crohn’s disease are safe and effective. This research has already led to many advances, and researchers continue to search for more effective methods for dealing with Crohn’s disease.

Crohn’s Allogeneic Transplant Study’s investigation team of Seattle is undergoing the Phase II clinical trial to cure it. Transplanting of bone marrow is involved. The purpose of this phase is curing effectively patients who have this disease, Crohn’s disease.

The Phase II research, the doctors will give the best medical and surgical treatments to the patients with Crohn’s disease who is going to undergo the transplantation so that they are healthy enough. The transplant procedure starts with chemotherapy and a small dose of radiation so that the patient’s immune system is weak and can accept the bone marrow calls from other.

After receiving other person’s bone marrow cells, immune suppressive medicines are given to prevent the new cells from being rejected and to stop those cells from damaging the patient. The new immune system will start growing and the blood counts will rise after the new donor cells start working. There is a risk of infection during this time so antibiotics and anti- viral drugs are given to prevent the infection.

After the new donor cells are well-established, the immune suppressive medicines will be stopped. Doctors will examine parts of the intestine that were inflamed before the start of the transplant procedure; to make sure the Crohn’s Disease has disappeared after the transplant. Patients will be formally evaluated for Crohn’s activity at around 100 days after transplant, and yearly after that for 5 years.

The effect of Crohn’s disease in intestine

Crohn’s disease can cause several mechanical complications within the intestines, including obstruction, fistulae, and abscesses. Obstruction typically occurs from structures or adhesions that narrow the lumen, blocking the passage of the intestinal contents. Fistulae (an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect) can develop between two loops of bowel, between the bowel and bladder, between the bowel and vagina, and between the bowel and skin. Abscesses are collections of infections, which may occur in the abdomen or in the perianal area in Crohn’s disease sufferers. Ileovesical fistulae are the most common cause in Crohn’s disease. Crohn’s disease involves in the small bowel that will cause higher risk for small intestinal cancer. People with Crohn’s colitis will have a relative risk of 5.6 for developing colon cancer.

Diagram : Endoscopy image of colon showing serpiginous ulcer, a classic finding in Crohn’s disease

Pathophysiology

During a colonoscopy, biopsies of the colon are often taken to confirm the diagnosis. Certain characteristic features of the pathology seen point toward Crohn’s disease; it shows a transmural pattern of inflammation, meaning the inflammation may span the entire depth of the intestinal wall. Ulceration is an outcome seen in highly active disease. There is usually an abrupt transition between unaffected tissue and the ulcer – a characteristic sign known as skip lesions. Under a microscope, biopsies of the affected colon may show mucosal inflammation, characterized by focal infiltration of neutrophils, a type of inflammatory cell, into the epithelium. This typically occurs in the area overlying lymphoid aggregates. These neutrophils, along with mononuclear cells, may infiltrate the crypts, leading to inflammation (crypititis) or abscess (crypt abscess). Granulomas, aggregates of macrophage derivatives known as giant cells, are found in 50% of cases and are most specific for Crohn’s disease. The granulomas of Crohn’s disease do not show “caseation”, a cheese-like appearance on microscopic examination characteristic of granulomas associated with infections, such as tuberculosis. Biopsies may also show chronic mucosal damage, as evidenced by blunting of the intestinal villi, atypical branching of the crypts, and a change in the tissue type (metaplasia). One example of such metaplasia, Paneth cell metaplasia, involves development of Paneth cells (typically found in the small intestine) in other parts of the gastrointestinal system.

Diagram : Section of colectomy showing transmural inflammation

Prevention

Crohn’s disease cannot be prevented, because the cause is unknown. But you can take steps to reduce the severity of the disease. First, take medicines regularly can reduce sudden attacks and keep the disease in remission.Second, do not smoke. Smoking will increase the disease. Third, never use antibiotics unlesss the doctor prescribed for you. Eating small meals can help with a low appetite too. Getting a healthy diet, regular exercise and enough of sleep also can help to reduce the symptoms. By controlling the symptoms, we should follow the low dietary fiber diet especially the fibrous foods that cause symptoms.

Treatment

There is no cure for the Crohn’s disease because Crohn’s disease is unpredictable but there may have treatment options that can make sufferers to minimise the effects of the condition on their lives. If the remission is achieved, the relapse can be prevented and the symptoms can be controlled. A person needs to receive the treatment when the symptoms are active. Crohn’s disease cannot cure by surgery. There are three main goals for the treatment of Crohn’s disease. There are the achieving remission that relieve symptoms, maintaining remission that prevent symptom flare- ups and improving the quality of life.

The main treatment for Crohn’s disease is to take medicine so that can stop the inflammation that occurred in the intestine. Medicine can prevent the flare- ups and keep you in remission. These treatments are ongoing treatment that the doctor will want to see the patient about every half year. If your condition will flare- ups, you may have lab tests every 2- 3 months. People who have serious complications may require a stronger medicine

The doctor will give the patients the traditional first-line at the beginning of the treatment. If the patients are getting worse, the doctor will change or add the medicines. Antidiarrheal medicine which will slows or stops the painful spams in intestines that cause symptoms can be respond for the mild symptoms. Aminosalicylates, antibiotics, cortisoteroids, Biologics and the medicine that suppress the immune system are the types of medicine that the doctor will give to the mild to moderate symptoms. Lastly, the severe symptoms may be treated with corticosteroids given through a vein. The first step is to control the disease. After the symptoms are gone, the doctor will change the medicine that listed above so that the symptoms are in remission.

Conclusion

Crohn’s disease is a type of inflammatory bowel disease (IBD) which will affected ours gastrointestinal (GI) tract. Patients who have this disease can’t able to notice at all. Crohn’s disease is a disease which can be associated with genetic inheritance which runs in some families. Teenagers and young adults whose age is between 15 – 35 will be easilly to get this disease. There are three types of Crohn’s disease that is Crohn’s colitis, Crohn’s ileitis and Crohn’s Illeocolic which will affected different region of the gastrointestinal (GI) tract.

Crohn’s disease is an autoimmune disorder. Crohn’s disease is a chronic disease which the body’s immune system attacks the gastrointestinal tract possibly directed at microbial antigens. The patient will suffer throughout the period that the disease flares up and causes a lot of symptoms. The primarily symptom of Crohn’s disease are pain in abdomen that often accompanied by diarrhoea. Constipation, fever, vomiting, join pain, weight loss, skin problems and bleeding from the rectum may ocurred also and cause a person malnutrition. Crohn’s disease may cause the patient to get colon cancer too.

Burrill Bernard Crohn and two of his colleagues, Dr. Leon Ginzburg and Dr. Gordon Oppenheimer described this disease in New York City and usually admitted his patients for diagnosis and treatment to the Mount Sinai Hospital in 1932. Dr. Burrill Bernard Crohn practiced medicine until he was 90.

Crohn’s disease cannot be prevented, because the cause is unknown and it is a genetic association disease so we have to change our bad lifestyle. We can change certain lifestyle like dietary adjustments, elemental diet, proper hydration, and smoking cessation will reduce the symptoms. Getting enough sleep is important too.

Doctors and scientists are conducting Crohn’s disease research that known as clinical trials. Crohn’s Allogeneic Transplant Study’s investigation team of Seattle is still undergoing the Phase II clinical trial to cure it by the bone marrow transplantation.

There is still no cure for Crohn’s disease because Crohn’s disease is unpredictable. The doctor’s goal is to control inflammation, correct nutritional problems, and relieve symptoms. Doctors will give the patients medicine so that can stop the inflammation that occurred in the intestine. Medicine can prevent the flare- ups and keep you in remission. Sometimes, surgery is needed too.

Crohn’s disease may cause us die if we didn’t get the accurate treatment. For those who have this disease have to change those bad lifestyle. There have treatment options that can make sufferers to minimise the effects of the condition on their lives.