Ileitis, Enteritis, or Regional Enteritis, Crohn\'s Disease

¶ … ileitis, enteritis, or regional enteritis, Crohn's disease is a relapsing, inflammatory bowel disease that affects the ileum (lower part of the small intestine), which becomes inflamed and swells deep into its lining ("Crohn's Disease," 2006; Nachimuthi, 2005; Baumgart & Sandborn, 2007). It can affect the entire gastrointestinal tract -- from the mouth to the anus -- but is typically found in the lower part of the intestine ("Crohn's Disease," 2006; Baumgart & Sandborn, 2007).

Crohn's is most commonly characterized by symptomology such as diarrhea and abdominal pain in the lower right area ("Crohn's Disease," 2006). Symptoms can range from mild to severe, occurring gradually or suddenly (MayoClinic.com, 2009). Patients can become malnourished, dehydrated, and experience weight loss as the result of low or no water absorption by their intestine ("Insights into Crohn's Disease," 2006; Nachimuthi, 2005). Other possible symptoms include rectal bleeding, weight loss, arthritis, skin affectations, and fever ("Crohn's Disease," 2006).

Crohn's can cause serious complications, the most common of which is blockage ("Crohn's Disease," 2006). Also possible are ulcers, which, via fistulas (ulcers tunneling into surrounding regions), can affect the bladder, vagina, or skin ("Crohn's Disease," 2006). Fistulas can often become infected ("Crohn's Disease," 2006). Other complications include fissures (small, painful cracks in the anus) protein, calorie, and vitamin deficiencies, arthritis, skin problems, kidney stones, gallstones, and inflammation of the eyes or mouth ("Crohn's Disease," 2006; Nachimuthi, 2005). Children with Crohn's may have delayed development or stunted growth (Nachimuthi, 2005). Rare cases of bowel perforation and bowel cancer have been documented ("Insights into Crohn's Disease," 2006).

There are no definitive methods for diagnosing Crone's, as there are no definitive diagnostic tests (Baumgart & Sandborn, 2007). As such, doctors tend to rely on the basis of history and physical examination in combination with endoscopic, radiological, laboratory, and histological findings (Baumgart & Sandborn, 2007). Blood tests can also be used; factors taken into consideration are blood cell counts, electrolytes, protein, C-reactive protein, and erythrocyte sedimentation rate (Nachimuthi, 2005). Stool samples are checked for blood and parasites (Nachimuthi, 2005). Also indicative are abdominal tenderness, painful mass, obstruction, greater than 10% weight loss, fever, abdominal pain, intermittent nausea, vomiting, cahexia, or evidence of an abscess (Baumgart & Sandborn, 2007).

There are a number of theories about the causes of Crohn's disease. None have been proven ("Crohn's Disease," 2006). The most popular theory is that the body's immune system mistakenly treats bacteria and other substances as foreign and responds by producing white blood cells ("Crohn's Disease," 2006). An accumulation of white blood cells in the lining of the intestine can produce inflammation, which results in ulceration and bowel problems such as those experienced by Crohn's patients ("Crohn's Disease," 2006). Another theory is based on the often simultaneous occurrence of the disease and mutations in the NOD2 gene (MayoClinic.com, 2009). It has been found that surgery is more often necessary for these patients with mutations in this gene (MayoClinic.com, 2009). A popular alternative to the theories listed above combines them, as well as other risk factors, claiming that genetics, environment, diet, blood vessel abnormalities, and psychosocial factors cause Crohn's disease (Nachimuthi, 2005).

As there is no known cure of Crohn's, all available treatments are response-driven -- rather than preventative or curative -- with the main goal of lowering the frequency of recurrence ("Crohn's Disease," 2006). While optimum first-line therapies are best recommended by location, initial treatments are in the form of anti-inflammatories to control inflammation of the ileum (Baumgart & Sandborn, 2007; "Crohn's Disease," 2006,). The most commonly used anti-inflammatory is Sulfasalzine ("Crohn's Disease," 2006). Additional treatments include corticosteroids, immune system suppressors (reducing inflammation), Infliximab (deactivating inflammation response), antibiotics to treat fissures and fistulas, and anti-diarrheal and fluid replacements ("Crohn's Disease," 2006). Baumgart & Sandborn recommend the use of ciproflaxin 1000 mg per day or metronidazole as an initial treatment for fistulas (2007). Doctors sometimes recommend nutritional supplements ("Crohn's Disease," 2006). Moreover, while surgery is not curative, a significant number (two-thirds to three-quarters) of Crohn's patients will require it when medication is no longer sufficient ("Crohn's Disease," 2006). Surgery is also recommended upon detection of fibrotic structures that cause partial or complete bowel blockage, fistulas complicated by abdominal abscess, enterovisical fistulas, and enterocutaneous fistulas (Baumgart & Sandborn 2007). The most common surgery administered to Crohn's patients is removing the diseased part of the intestine, which in turn requires an ostomy, in which the normal bowel is attached to the stoma (Nachimuthi, 2005). Unfortunately, there are a number of negative side affects to the most common surgeries; recurrence will often occur at the place where the diseased bowel was cut, short bowel syndrome can affect those who had part of their small intestine removed, and patients who have had large portions of their intestines removed often must rely on intravenous nutrition for the rest of their lives (Nachimuthi, 2005).