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Saturday, February 23, 2008

Crohn's Disease

Crohn’s disease is a chronic inflammation of the digestive tract, usually in the lower portion of the small intestine and/or the large intestine (the colon and rectum), but any part of the digestive system can be involved. Inflammation begins at the surface of the tissue and, over time, penetrates into the deep tissue layers of the affected area.

The first symptoms of Crohn’s disease usually begin between ages 16 and 40. The disease occurs with the same frequency in men and women and is more common in people who live in northern climates. Once it develops, Crohn’s disease can recur at any time over a lifetime. Some people experience long periods without symptoms (remission), but there is no way to predict if or when remission will occur or how long it will last.

Symptoms of Crohn’s disease vary greatly from person to person, depending on what section of the digestive tract is affected. The most common symptoms include abdominal pain, cramping and diarrhea. Other symptoms are fever, weight loss, rectal bleeding, abscesses, fissures, bloating, a lump in the lower right abdomen and joint pain.

Crohn’s disease disrupts bowel function and can lead to some serious complications:

  • Tissue lining the bowel can swell, thicken or scar and block bowel movement.
  • Ulcers -- open sores -- can develop deep in the tissue and cause infection, severe pain and diarrhea.
  • The bowel may become unable to absorb nutrients from digested food, leading to nutrition problems.
  • Abnormal passageways (fistulas) may develop from one part of the bowel to another or from the bowel to a nearby structure such as the vagina or bladder.

Other potential complications include arthritis, kidney stones, gallstones, inflammation of the eyes and mouth, skin rashes and skin ulcers. Crohn’s disease is believed to be caused by a disorder of the immune system, the body’s natural defense against infection, and these problems probably are caused by the immune system triggering the inflammatory response in other parts of the body. When Crohn’s disease occurs in children, it can cause delayed development and growth.

There is no cure for Crohn’s disease, but medical treatment can be very effective in managing early Crohn’s disease and relieving symptoms.

Specialists at The Cleveland Clinic use a combination of the latest drug therapy, diet, and exercise to control inflammation, treat symptoms and correct nutrition problems. The main classes of medications used in Crohn’s disease are anti-inflammatory drugs to reduce inflammation, antibiotics to treat infections or abscesses if they develop and immune system suppressors. Inflammation is part of the body’s natural immune response to a virus, bacteria or – when the immune system goes haywire -- its own tissue. Suppressing the immune response with drugs reduces inflammation.

For patients with advanced Crohn’s disease or those who do not respond to medical treatment, a gastroenterologist and colorectal surgeon experienced in managing Crohn’s disease are best equipped to help patients decide the next step in treatment.

As many as 75 percent of people with Crohn’s disease eventually have surgery. Surgery can repair complications such as abscesses, perforations and blockages and control bleeding. When performed by an experienced colorectal surgeon, surgery for Crohn’s disease is safe and does not cause further complications.

Cleveland Clinic colorectal surgeons offer the latest surgical treatments for Crohn’s disease, with an emphasis on a conservative approach. The most common is a resection, which involves removing the diseased portion(s) of the intestine and reconnecting the two healthy ends. They also perform strictureplasty, which means surgically widening sections of the intestine that have become narrowed due to scarring.

These surgical treatments can provide long-term symptom relief and reduce or eliminate the need for medication. Whenever possible, Cleveland Clinic surgeons use small incision (laparoscopic) surgical techniques with Crohn’s disease patients to shorten the hospital stay, reduce postoperative pain and speed recovery.

Even at the hands of the most experienced surgeon, surgery is not a cure for Crohn’s disease. In many patients, the inflammation returns in another section of the bowel, and they eventually need another operation. But, other patients never require another operation and can manage their disease with medication alone for the rest of their lives.

Many patients come to The Cleveland Clinic with complex problems related to Crohn’s disease that require complex procedures. Cleveland Clinic surgeons are experienced in treating these difficult cases. Even patients who have had previous resections for Crohn’s disease can be treated successfully to minimize symptoms and improve their quality of life.

Cleveland Clinic colorectal surgeons also are experienced in a variety of techniques that preserve fecal continence in patients with Crohn’s disease of the anus or rectum. The leading techniques for this type of surgery were pioneered here.

Via: http://cms.clevelandclinic.org

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