The Crohnsicle

I just stumbled upon some articles that stated Todd Helton (the amazing Colorado Rockies first baseman) was diagnosed with “acute terminal ileitis” back in May of 06. I saw it on several blogs, but this was on the mlb site. It stated “The ailment, acute terminal ileitis, is an infection at the end of the small intestine. Doctors hope it is a one-time condition that won’t flare up again, but if it does recur, doctors would look into a possible connection with Crohn’s disease, among other complications.”

I have not found anything more current yet, but thought this was a bit interesting since he is playing in the world series right now.

update:

Well, it seems it is not really Crohn’s Disease from what I am reading, but acute terminal ileitis as noted above. I have not found any other mention of it except for an article earlier this year explaining how he bulked back up during the off season. Feel free to view the article on mlb.com here.

-Ben

Okay, so far we have covered what it is and that are the signs and symptoms. If you did not catch that entry you can check it out here. Now we will cover Causes along with Screening and Diagnosis.

Causes
The cause of Crohn’s disease is unknown. Several theories exist about what causes Crohn’s disease, but none have been proven. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn’s disease. To date, however, there has been no convincing evidence that the disease is caused by infection. Crohn’s disease is not contagious. Although diet may affect the symptoms in patients with Crohn’s disease, it is unlikely that diet is responsible for the disease.

The human immune system is made from cells and different proteins that protect people from infection. The most popular theory is that the body’s immune system reacts abnormally in people with Crohn’s disease, mistaking bacteria, foods, and other substances for being foreign. The immune system’s response is to attack these “invaders.” During this process, white blood cells accumulate in the lining of the intestines, producing chronic inflammation, which leads to ulcerations and bowel injury.

Activation of the immune system in the intestines appears to be important in IBD. The immune system is composed of immune cells and the proteins that these immune cells produce. Normally, these cells and proteins defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is an important mechanism of defense used by the immune system.)

Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with IBD, however, the immune system is abnormally and chronically activated in the absence of any known invader. The continued abnormal activation of the immune system results in chronic inflammation and ulceration. The susceptibility to abnormal activation of the immune system is genetically inherited. Thus, first degree relatives (brothers, sisters, children, and parents) of patients with IBD are more likely to develop these diseases. Recently a gene called NOD2 has been identified as being associated with Crohn’s disease. This gene is important in determining how the body responds to some bacterial products. Individuals with mutations in this gene are more susceptible to developing Crohn’s disease.

Scientists do not know if the abnormality in the functioning of the immune system in people with Crohn’s disease is a cause, or a result, of the disease. Research shows that the inflammation seen in the GI tract of people with Crohn’s disease involves several factors: the genes the patient has inherited, the immune system itself, and the environment. Foreign substances, also referred to as antigens, are found in the environment. One possible cause for inflammation may be the body’s reaction to these antigens, or that the antigens themselves are the cause for the inflammation. Some scientists think that a protein produced by the immune system, called anti-tumor necrosis factor (TNF), may be a possible cause for the inflammation associated with Crohn’s disease.

Diagnosis
The diagnosis of Crohn’s disease is based on a combination of exams: endoscopic, X-rays and histologic blood and tissue tests. Upon diagnosis, patients may need additional tests to monitor the disease and diagnose possible complications or side effects of medications.

Laboratory Tests
CBC (complete blood count) tests detect high white blood cell counts, which could indicate intestinal inflammation or infection and low blood counts (anemia) which might reveal intestinal bleeding. The presence of C-reactive protein can also indicate intestinal inflammation. Tests also monitor for side effects of certain medications. Liver function tests help screen for liver and bile duct abnormalities. Stool studies determine whether patients have treatable bacterial infections. Antibody tests can help clarify the situation for “indeterminate colitis” patients without a definite diagnosis.

Endoscopy – Several types of endoscopes are used to determine if the patient has ulcerative colitis or Crohn’s disease and how much bowel is affected. All use a thin, flexible tube with a lighted camera inside the tip, which allows doctors to look at the lining of the gastrointestinal (GI) tract. The image is magnified and appears on a television screen. Each procedure is named according to the section of GI tract examined:

• Sigmoidoscopy — Examines the lining of the lower third of the large intestine (the sigmoid colon).
• Colonoscopy — Examines the lining of the entire large intestine (colon), and sometimes can peek into the very end of the small intestine (or ileum).
• ERCP (Endoscopic retrograde cholangiopancreatography) — Examines the bile ducts in the liver and the pancreatic duct.
• Endoscopic ultrasound — Uses an ultrasound probe attached to an endoscope to obtain deep images of the gut below the surface. Used to diagnose perianal fistulas in patients with Crohn’s disease.
• Capsule endoscopy — Patients swallow a vitamin-sized capsule with a camera inside to produce images of sections of the small intestine that are beyond the reach of an EGD.

Radiology Tests – These radiologic tests provide information that endoscopy alone cannot:

• Plain X-rays
• Plain X-rays without contrast detect blockage in the large intestine.
• X-rays with Contrast – Contrast X-rays are used with endoscopy in monitoring and treating Crohn’s. These X-rays track special liquid contrast, usually barium, as it passes through the intestine, highlighting specific conditions.
• CT Scan -A CT scan takes simultaneous X-rays from different angles to reconstruct images of the internal organs.
• White Blood Cell Scan -Inflammation of the GI tract is characteristic of Crohn’s disease. Leukocyte scintigraphy (tagged white blood cell scan) detects white blood cell accumulation in inflamed tissue.

Stay tuned for yet more info soon…
* Complications
* Treatments
* Diet and taking care of your self
* Alternative Medicine
* Resources

Okay, it is time for the multi-part Crohn’s Disease informational blog entries to start. In an effort to obtain the latest information I will be researching (and updating my own knowledge) as I go… so this may take a little time. Please be patient. In the mean time some good resources to check our are:
http://www.webmd.com/ibd-crohns-disease/crohns-disease/what-is-crohns-disease
http://www.mayoclinic.org/crohns/
http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm

In these entries I intend to cover the following topics related to Crohn’s Disease:

• What is Crohn’s Disease
• Signs and symptoms
• Causes
• Screening and Diagnosis
• Complications
• Treatments
• Diet and taking care of your self
• Alternative Medicine
• Resources

If there are any areas you think I may be missing or I may need to add please feel free to let me know.

Thanks!
Ben

What is Crohn’s Disease?
Crohn’s Disease is a type of inflamatory bowel disease (IBD) which involves the digestive tract, from the esophagus to the small bowel. It causes pain, fever, and diarrhea. It can also affect the joints and the eyes, leading to blindness. When it attacks the colon and bowel, it thickens the walls with inflamed tissue, which if left unchecked, can lead to intestinal blockages, which are life threatening. The mechanism for it is the same for all of the autoimmune disorders – the body turns on itself.

In a normal system, if a person experiences a wound or an illness, the T cells and white cells react as antigens which attack the diseased or damaged area, then shut themselves off. In autoimmune disorders, there is a failure to turn off this immune response, resulting in damage that continues, unless through medications it is modified. Most of the drugs used are geared toward damping the response down to healthier levels. Imuran, cyclosporin, Plaquenil, azothioprine and prednisone are often used. All of them have unpleasant side effects, much like those experienced in chemotherapy.

While there’s no known medical cure for Crohn’s disease, therapies can greatly reduce the signs and symptoms of Crohn’s disease and even bring about a long-term remission. With these therapies, many people afflicted with Crohn’s disease are able to function normally in their everyday lives. 

Signs and Symptoms
The signs and symptoms of Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. They include:

Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. In mild cases, stools may simply be looser or more frequent than usual. But people with severe disease may have dozens of bowel movements a day, affecting both sleep and ordinary activities.

Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of intestinal tract contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and occur with nausea and vomiting.

Blood in your stool. Food moving through your digestive tract can cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood). In severe disease, bleeding is often serious and ongoing.

Ulcers. Crohn’s disease begins as small, scattered sores on the surface of the intestine. Eventually these sores may become large ulcers that penetrate deep into – and sometimes through – the intestinal walls. You may also have ulcers in your mouth similar to canker sores.

Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.

Fistula or abscess. Inflammation from Crohn’s disease may tunnel through the wall of the bowel into adjacent organs, such as the bladder or vagina, creating an abnormal connection called a fistula. This can also lead to an abscess, a swollen, pus-filled sore. The fistula may also tunnel out through your skin. A common place for this type of fistula is in the area around the anus. When this occurs, it’s called perianal fistula.

Other signs and symptoms. People with severe Crohn’s disease may experience fever and fatigue as well as problems that occur outside the digestive tract, including arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts. Children with Crohn’s disease may have delayed growth or sexual development.

The course of Crohn’s disease varies greatly. You may have long periods without signs and symptoms, or you may have recurrent episodes of abdominal pain, diarrhea, and sometimes fever or bleeding.

Stay tuned for more info…
 

I have recently begun reading another blog (http://livingwithcrohnsdisease.blogspot.com) which also covers the topic of Crohn’s Disease (it helped to inspire me to begin this blog) Anyhow, aside from this being a very well written and informative blog entry, it also has a very concise (not too technical) description of Crohn’s Disease. I also have to admit it is very sad, yet uplifting as well… I recommend reading it. The particular entry I am referring to is titled “Lupis and Crohn’s Disease”

I have taken the liberty of extracting an excerpt of the description of Crohn’s and placed it below, but would also recommend that you read the blog entry… it is worth it.

“Crohn’s Disease involves the digestive tract, from the esophagus to the small bowel. It causes pain, fever, and diarrhea. It can also affect the joints and the eyes, leading to blindness. When it attacks the colon and bowel, it thickens the walls with inflamed tissue, which if left unchecked, can lead to intestinal blockages, which are life threatening. The mechanism for it is the same for all of the autoimmune disorders-the body turns on itself.

In a normal system, if a person experiences a wound or an illness, the T cells and white cells react as antigens which attack the diseased or damaged area, then shut themselves off. In autoimmune disorders, there is a failure to turn off this immune response, resulting in damage that continues, unless through medications it is modified. Most of the drugs used are geared toward damping the response down to healthier levels. Imuran, cyclosporin, Plaquenil, azothioprine and prednisone are often used. All of them have unpleasant side effects, much like those experienced in chemotherapy.”

Thanks to “Ames” for the enlightening blog entry.

And thanks to “Hello Lady” for pointing it out to me.