Crohn's disease treatments advancing, leading to remission

Special to The Herald-LeaderMarch 9, 2013 

LEE P.THOMAS 859-229-1937

Crohn's disease is a form of inflammatory bowel disease that may involve the small or large intestine, rectum or mouth. Crohn's most commonly affects the end of the small bowel and the beginning of the colon. People with Crohn's disease have chronic inflammation that causes the intestinal wall to become thick.

According to a recent National Health and Nutrition Examination Survey, there are approximately 1.8 million cases of Crohn's disease nationwide. It may occur at any age, but commonly occurs in people between ages 15-35.

The exact cause of Crohn's remains unknown. However, it is an autoimmune disorder that occurs when the body mistakenly attacks healthy body tissue. We do know that genetics and family history, environmental factors, smoking and the body's tendency to overreact to normal bacteria in the intestines all seem to play a role in Crohn's disease.

Crohn's patients in Kentucky have more severe disease than in other parts of the country. This is thought to be related to our higher percentage of patients who smoke and higher rate of obesity.

Symptoms of Crohn's can range from mild to severe. Typical symptoms include: diarrhea, abdominal pain and cramping, blood in stool, ulcers, reduced appetite and weight loss.

Some patients also experience periods without symptoms, when the disease is in remission. With proper medical care we achieve remission with many of our patients. That's the good news.

Treatment for Crohn's often involves drugs, nutritional supplements, surgery or a combination thereof. Treatment choices depend upon the severity of the disease and where it is located. The first step in treatment usually involves taking steps to reduce the inflammation, typically using steroids for just a short time. More recent developments in the treatment of Crohn's have mostly eliminated long-term steroid use. In addition, newer steroids have been developed that affect only local areas in the intestine and do not circulate throughout the body, which may help reduce widespread side effects.

Now we are able to use immunosuppressive drugs or biologics to control the disease. Most patients are able to feel well with few side effects.

Recent research has also shown that probiotics can be a useful tool in promoting and sustaining remission from Crohn's. Probiotics help the digestive system to function better by balancing digestive flora, the microorganisms that live in the digestive tract, which have many benefits including calming the digestive system.

Another tool for the treatment of Crohn's is diet. While a poor diet isn't believed to cause Crohn's disease, it can aggravate the symptoms in some cases. A low FODMAP diet, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, all sugars that are found in many foods, has been shown to provide some relief to patients with Crohn's. Eating a low FODMAP diet can reduce symptoms including pain, gas, bloating and more.

A common misconception about Crohn's is that female patients will experience infertility. Symptoms of Crohn's can hinder fertility; however the fertility rates for women with Crohn's are not much different from women without the disease. Women are able to stay on most of the Crohn's medicines throughout their pregnancy. This allows them to stay healthy through delivery and have a healthy baby. We do recommend that new mothers breastfeed as this may lower the chance that the child will develop Crohn's.

The most important thing to remember if you or someone you love has been diagnosed with Crohn's is that we can work with you to manage the disease and in most people, get it into remission.

Dr. Kathleen Martin is with Saint Joseph Gastroenterology Associates

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