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 Crohn's disease Filed under: Digestive Health

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PostSubject: Crohn's disease Filed under: Digestive Health   Crohn's disease Filed under: Digestive Health EmptySun Jan 23, 2011 6:36 pm

Crohn's disease
Filed under: Digestive Health
Crohn's disease is an inflammatory bowel disease (IBD). It causes
inflammation of the lining of your digestive tract, which can lead to
abdominal pain, severe diarrhea and even malnutrition.

The inflammation caused by Crohn's disease often spreads deep into the
layers of affected bowel tissue. Like ulcerative colitis, another common
IBD, Crohn's disease can be both painful and debilitating and sometimes
may lead to life-threatening complications.

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 long-term remission. With these therapies, many people with
Crohn's disease are able to function well.

©
Symptoms

Signs and symptoms of Crohn's disease can range from mild to severe and
may develop gradually or come on suddenly, without warning. You may also
have periods of time when you have no signs or symptoms (remission).
When the disease is active, signs and symptoms may 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. Diarrhea is the most common problem for
people with Crohn's.
* 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 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 include nausea and
vomiting.
* Blood in your stool. Food moving through your digestive tract may
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).
* Ulcers. Crohn's disease can cause small sores on the surface of
the intestine that eventually 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.

Other signs and symptoms
People with severe Crohn's disease may also experience:

* Fever
* Fatigue
* Arthritis
* Eye inflammation
* Skin disorders
* Inflammation of the liver or bile ducts
* Delayed growth or sexual development, in children

When to see a doctor
See your doctor if you have persistent changes in your bowel habits or
if you have any of the signs and symptoms of Crohn's disease, such as:

* Abdominal pain
* Blood in your stool
* Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications
* Unexplained fever lasting more than a day or two

©
Causes

The exact cause of Crohn's disease remains unknown. Previously, diet and
stress were suspect, but now doctors know that although these factors
may aggravate existing Crohn's disease, they don't cause it. Now,
researchers believe that a number of factors, such as heredity and a
malfunctioning immune system, play a role in the development of Crohn's
disease.

* Immune system. It's possible that a virus or bacterium may cause
Crohn's disease. When your immune system tries to fight off the invading
microorganism, the digestive tract becomes inflamed. Currently, many
investigators believe that some people with the disease develop it
because of an abnormal immune response to bacteria that normally live in
the intestine.
* Heredity. Mutations in a gene called NOD2 tend to occur frequently
in people with Crohn's disease and seem to be associated with a higher
likelihood of needing surgery for the disease. Scientists continue to
search for other genetic mutations that might play a role in Crohn's.

©
nRisk factors

Risk factors for Crohn's disease may include:

* Age. Crohn's disease can occur at any age, but you're likely to
develop the condition when you're young. Most people are diagnosed with
Crohn's between the ages of 20 and 30.
* Ethnicity. Although whites have the highest risk of the disease,
it can affect any ethnic group. If you're of Ashkenazi Jewish descent,
your risk is even higher.
* Family history. You're at higher risk if you have a close
relative, such as a parent, sibling or child, with the disease. As many
as 1 in 5 people with Crohn's disease has a family member with the
disease.
* Cigarette smoking. Cigarette smoking is the most important
controllable risk factor for developing Crohn's disease. Smoking also
leads to more severe disease and a greater risk of surgery. If you
smoke, stop. Discuss this with your doctor and get help. There are many
smoking-cessation programs available if you are unable to quit on your
own.
* Where you live. If you live in an urban area or in an
industrialized country, you're more likely to develop Crohn's disease.
Because Crohn's disease occurs more often among people living in cities
and industrial nations, it may be that environmental factors, including a
diet high in fat or refined foods, play a role in Crohn's disease.
People living in northern climates also seem to have a greater risk of
the disease.
* Isotretinoin (Accutane) use. Isotretinoin (Accutane) is a powerful
medication sometimes used to treat scarring cystic acne or acne that
doesn't respond to other treatments. Although cause and effect hasn't
been proved, studies have reported the development of inflammatory bowel
disease with isotretinoin use.
* Nonsteroidal anti-inflammatory drugs (NSAIDs). Although these
medications — ibuprofen (Advil, Motrin, others), naproxen (Aleve),
diclofenac (Cataflam, Voltaren), piroxicam (Feldene), and others —
haven't been shown to cause Crohn's disease, they can cause similar
signs and symptoms. Additionally, theses medications can make existing
Crohn's disease worse.

©
Complications

Crohn's disease may lead to one or more of the following complications:

* Bowel obstruction. Crohn's disease affects the entire thickness of
the intestinal wall. Over time, parts of the bowel can thicken and
narrow, which may block the flow of digestive contents through the
affected part of your intestine. Some cases require surgery to remove
the diseased portion of your bowel.
* Ulcers. Chronic inflammation can lead to open sores (ulcers)
anywhere in your digestive tract, including your mouth and anus, and in
the genital area (perineum) and anus.
* Fistulas. Sometimes ulcers can extend completely through the
intestinal wall, creating a fistula — an abnormal connection between
different parts of your intestine, between your intestine and skin, or
between your intestine and another organ, such as the bladder or vagina.
When internal fistulas develop, food may bypass areas of the bowel that
are necessary for absorption. An external fistula can cause continuous
drainage of bowel contents to your skin, and in some cases, a fistula
may become infected and form an abscess, a problem that can be
life-threatening if left untreated.
* Anal fissure. This is a crack, or cleft, in the anus or in the
skin around the anus where infections can occur. It's often associated
with painful bowel movements.
* Malnutrition. Diarrhea, abdominal pain and cramping may make it
difficult for you to eat or for your intestine to absorb enough
nutrients to keep you nourished. Additionally, anemia is common in
people with Crohn's disease.
* Other health problems. In addition to inflammation and ulcers in
the digestive tract, Crohn's disease can cause problems in other parts
of the body, such as arthritis, inflammation of the eyes or skin,
clubbing of the fingernails, kidney stones, gallstones and,
occasionally, inflammation of the bile ducts. People with long-standing
Crohn's disease also may develop osteoporosis, a condition that causes
weak, brittle bones.

IBD and colon cancer
Having Crohn's disease increases your risk of colon cancer. Despite this
increased risk, more than 90 percent of people with inflammatory bowel
disease never develop cancer.

Your risk is greatest if you've had inflammatory bowel disease for at
least eight years and if it has spread through your entire colon. The
longer you've had the disease and the larger the area affected, the
greater your risk of colon cancer. The risk of other cancers also is
increased, including cancer of the anus.

Medications and cancer risk
Immune system suppressors also are associated with a small risk of
cancer development. These include azathioprine, mercaptopurine,
methotrexate, infliximab and others. The risk may be due to the immune
system suppression that these medications cause. While these medications
do increase risk, they may be necessary for people with Crohn's disease
to improve quality of life and avoid surgery or hospitalization. Work
with your doctor to determine which medications are right for you.

©
Preparing for your appointment

Symptoms of Crohn's disease may first prompt a visit to your family
doctor or general practitioner. However, you may then be referred to a
doctor who specializes in treating digestive disorders
(gastroenterologist).

Because appointments can be brief, and there's often a lot of ground to
cover, it's a good idea to be well prepared for your appointment. Here's
some information to help you get ready for your appointment, and what
to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Ask a family member or friend to come with you to your
appointment, if possible. Sometimes it can be difficult to absorb all
the information provided during an appointment. Someone who accompanies
you may remember something that you missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
ahead of time will help you make the most of your visit. List your
questions from most important to least important in case time runs out.
For Crohn's disease, some basic questions to ask your doctor include:

* What's causing these symptoms?
* Are there other possible causes for my symptoms?
* What kinds of tests do I need? Do these tests require any special preparation?
* Is this condition temporary or long lasting?
* What treatments are available, and which do you recommend?
* Are there any medications that I should avoid?
* What types of side effects can I expect from treatment?
* Are there any alternatives to the primary approach that you're suggesting?
* I have other health conditions. How can I best manage them together?
* Do I need to follow any dietary restrictions?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
* Is there a risk to me or my child if I become pregnant?
* Is there a risk of complications to my partner's pregnancy if I have Crohn's disease and father a child?
* What is the risk to my child of developing Crohn's disease if I have it?
* What are the best sources of information to learn about Crohn's disease?
* Are there support groups for people with Crohn's and their families?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over points you want to spend more
time on. Your doctor may ask:

* When did you first begin experiencing symptoms?
* Have your symptoms been continuous or intermittent?
* How severe are your symptoms?
* Do your symptoms affect your ability to work or do other activities?
* Does anything seem to improve your symptoms?
* Is there anything that you've noticed that makes your symptoms worse?
* Do you smoke?
* Do you take nonsteroidal anti-inflammatory medications (ibuprofen, naproxen, diclofenac, others)?

©
Tests and diagnosis

Your doctor will likely diagnose Crohn's disease only after ruling out
other possible causes for your signs and symptoms, including irritable
bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a
diagnosis of Crohn's disease, you may have one or more of the following
tests and procedures:

* Blood tests. Your doctor may suggest blood tests to check for
anemia — a condition in which there aren't enough red blood cells to
carry adequate oxygen to your tissues — or to check for signs of
infection. Two tests that look for the presence of certain antibodies
can sometimes help diagnose which type of inflammatory bowel disease you
have, but not everyone with Crohn's disease or ulcerative colitis has
these antibodies. While your doctor may order these tests, a positive
finding doesn't mean you have Crohn's disease and a negative finding
doesn't mean that you're free of the disease.
* Fecal occult blood test (FOBT). You may need to provide a stool
sample so that your doctor can test for blood in your stool.
* Colonoscopy. This test allows your doctor to view your entire
colon using a thin, flexible, lighted tube with an attached camera.
During the procedure, your doctor can also take small samples of tissue
(biopsy) for laboratory analysis, which may help confirm a diagnosis.
Some people have clusters of inflammatory cells called granulomas, which
help confirm the diagnosis of Crohn's disease because granulomas don't
occur with ulcerative colitis. In the majority of people with Crohn's,
granulomas aren't present and diagnosis is made through biopsy and the
location of the disease. Risks of colonoscopy include perforation of the
colon wall and bleeding.
* Flexible sigmoidoscopy. In this procedure, your doctor uses a
slender, flexible, lighted tube to examine the sigmoid, the last section
of your colon.
* Barium enema. This diagnostic test allows your doctor to evaluate
your large intestine with an X-ray. Before the test, your receive an
enema with a contrast dye containing barium. Sometimes, air also is
added. The barium dye coats the lining of the bowel, creating a
silhouette of your rectum, colon and a portion of your small intestine
that's visible on an X-ray.
* Small bowel imaging. This test looks at the part of the small
bowel that can't be seen by colonoscopy. After you drink a solution
containing barium, X-ray, CT or MRI images are taken of your small
intestine. The test can help locate areas of narrowing or inflammation
in the small bowel that are seen in Crohn's disease. The test can also
help your doctor determine which type of inflammatory bowel disease you
have.
* Computerized tomography (CT). Sometimes you may have a CT scan, a
special X-ray technique that provides more detail than a standard X-ray
does. This test looks at the entire bowel as well as at tissues outside
the bowel that can't be seen with other tests. Your doctor may order
this scan to better understand the location and extent of your disease
or to check for complications such as a partial blockages, abscesses or
fistulas. Although not invasive, a CT scan exposes you to more radiation
than a conventional X-ray does.
* Capsule endoscopy. If you have signs and symptoms that suggest
Crohn's disease but other diagnostic tests are negative, your doctor may
perform capsule endoscopy. For this test you swallow a capsule that has
a camera in it. The camera takes pictures, which are transmitted to a
computer that you wear on your belt. The images are then downloaded,
displayed on a monitor and checked for signs of Crohn's disease. Once
it's made the trip through your digestive system, the camera exits your
body painlessly in your stool. Capsule endoscopy is generally very safe,
but if you have a partial blockage in the bowel, there's a slight
chance the capsule may become lodged in your intestine.

©
Treatments and drugs

The goal of medical treatment is to reduce the inflammation that
triggers your signs and symptoms. In the best cases, this may lead not
only to symptom relief but also to long-term remission. Treatment for
Crohn's disease usually involves drug therapy or, in certain cases,
surgery.

Doctors use several categories of drugs that control inflammation in
different ways. But drugs that work well for some people may not work
for others, so it may take time to find a medication that helps you. In
addition, because some drugs have serious side effects, you'll need to
weigh the benefits and risks of any treatment.

Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

* Sulfasalazine (Azulfidine). Although this drug isn't always
effective for treating Crohn's disease, it may be of some help for
treating disease involving the colon. It has a number of side effects,
including nausea, vomiting, heartburn and headache. Don't take this
medication if you're allergic to sulfa medications.
* Mesalamine (Asacol, Rowasa). This medication tends to have fewer
side effects than sulfasalazine has, but may cause nausea, vomiting,
heartburn, diarrhea and headache. You take it in tablet form or use it
rectally in the form of an enema or suppository, depending on which part
of your colon is affected. This medication is generally ineffective for
disease involving the small intestine.
*

Corticosteroids. Corticosteroids can help reduce inflammation
anywhere in your body, but they have numerous side effects, including a
puffy face, excessive facial hair, night sweats, insomnia and
hyperactivity. More serious side effects include high blood pressure,
type 2 diabetes, osteoporosis, bone fractures, cataracts and an
increased susceptibility to infections. Long-term use of corticosteroids
in children can lead to stunted growth.

Also, these medications don't work for everyone with Crohn's
disease. Doctors generally use corticosteroids only if you have moderate
to severe inflammatory bowel disease that doesn't respond to other
treatments. A newer type of corticosteroid, budesonide (Entocort EC),
works faster than do traditional steroids and appears to produce fewer
side effects. Entocort EC is effective only in Crohn's disease that
involves the lower small intestine and the first part of the large
intestine .

Corticosteroids aren't for long-term use. But, they can be used
for short-term (three to four months) symptom improvement and to induce
remission. Corticosteroids also may be used with an immune system
suppressor — the corticosteroids can induce remission, while the immune
system suppressors can help maintain remission.

Occasionally your doctor may prescribe rectal steroids if you have
disease in your lower colon or rectum. These also are only for
short-term use.

Immune system suppressors
These drugs also reduce inflammation, but they target your immune system
rather than directly treating inflammation. By suppressing the immune
response, inflammation is also reduced. Immunosuppressant drugs include:

* Azathioprine (Imuran) and mercaptopurine (Purinethol). These are
the most widely used immunosuppressants for treatment of inflammatory
bowel disease. Although it can take two to four months for these
medications to begin to work, they help reduce signs and symptoms of IBD
in general and can heal fistulas from Crohn's disease in particular. If
you're taking either of these medications, you'll need to follow up
closely with your doctor and have your blood checked regularly to look
for side effects.
*

Infliximab (Remicade). This drug is for adults and children with
moderate to severe Crohn's disease who don't respond to or can't
tolerate other treatments. It works by neutralizing a protein produced
by your immune system known as tumor necrosis factor (TNF). Infliximab
finds TNF in your bloodstream and removes it before it causes
inflammation in your intestinal tract.

Some people with heart failure, people with multiple sclerosis,
and those with cancer or a history of cancer can't take infliximab or
the other members of this class (adalimumab and certolizumab pegol).
Talk to your doctor about the potential risks of taking infliximab.
Tuberculosis and other serious infections have been associated with the
use of these drugs. If you have an active infection, don't take these
medications. You should have a skin test for tuberculosis before taking
infliximab and a chest X-ray if you lived or traveled extensively in
areas where tuberculosis has been found. In addition, the Food and Drug
Administration has issued a warning that children and adolescents taking
infliximab and other TNF inhibitors have an increased risk of cancer.
*

Adalimumab (Humira). Adalimumab works similarly to infliximab by
blocking TNF for people with moderate to severe Crohn's disease. It's
prescribed for people who haven't been helped by infliximab or other
treatments. Adalimumab is given as an injection under the skin every
other week, which you may be able to administer yourself. Adalimumab may
reduce the signs and symptoms of Crohn's disease and may cause
remission.

However, adalimumab, like infliximab, carries a small risk of
infections, including tuberculosis and serious fungal infections. Your
doctor will administer a skin test for tuberculosis before you begin
adalimumab treatment. The most common side effects of adalimumab are
skin irritation and pain at the injection site, nausea, runny nose and
upper respiratory infection.
* Certolizumab pegol (Cimzia). Approved by the Food and Drug
Administration (FDA) for the treatment of Crohn's disease, certolizumab
pegol works by inhibiting TNF. Certolizumab pegol is prescribed for
people with moderate to severe Crohn's who haven't been helped by other
treatments. You initially receive certolizumab pegol as one injection
every two weeks. After a few injections, if your doctor determines it's
working for you, you receive one injection a month. Common side effects
include headache, upper respiratory infections, abdominal pain, nausea
and reactions at the injection site. Like other medications that inhibit
TNF, because this drug affects your immune system, you're also at risk
of becoming seriously ill with certain infections, such as tuberculosis.
* Methotrexate (Rheumatrex). This drug, which is used to treat
cancer, psoriasis and rheumatoid arthritis, is sometimes used for people
with Crohn's disease who don't respond well to other medications. It
starts working in about eight weeks or more. Short-term side effects
include nausea, fatigue and diarrhea, and rarely, it can cause
potentially life-threatening pneumonia. Long-term use can lead to
scarring of the liver and sometimes to cancer. Avoid becoming pregnant
while taking methotrexate. If you're taking this medication, follow up
closely with your doctor and have your blood checked regularly to look
for side effects.
* Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug,
often used to help heal Crohn's-related fistulas, is normally reserved
for people who don't respond well to other medications. Although
effective, cyclosporine has the potential for serious side effects, such
as kidney and liver damage, high blood pressure, seizures, fatal
infections and an increased risk of lymphoma.
* Natalizumab (Tysabri). This drug works by inhibiting certain
immune cell molecules — integrins — from binding to other cells in your
intestinal lining. Blocking these molecules is thought to reduce chronic
inflammation that occurs when they bind to your intestinal cells.
Natalizumab is approved for people with moderate to severe Crohn's
disease with evidence of inflammation and who aren't responding well to
other conventional Crohn's disease therapies. Because the drug is
associated with a rare, but serious, risk of multifocal
leukoencephalopathy — a brain infection that usually leads to death or
severe disability — you must be enrolled in a special restricted
distribution program to use it. This program is called the Crohn's
Disease-Tysabri Outreach Unified Commitment to Health (CD-TOUCH)
Prescribing Program.

New medications are in development and in clinical trial. If your
Crohn's disease isn't well controlled with current medications, ask your
doctor if there are clinical trials available to you.

Antibiotics
Antibiotics can heal fistulas and abscesses in people with Crohn's
disease. Researchers also believe antibiotics help reduce harmful
intestinal bacteria and suppress the intestine's immune system, which
can trigger symptoms. Frequently prescribed antibiotics include:

* Metronidazole (Flagyl). Once the most commonly used antibiotic for
Crohn's disease, metronidazole can sometimes cause serious side
effects, including numbness and tingling in your hands and feet and,
occasionally, muscle pain or weakness. If these effects occur, stop the
medication and call your doctor. Other side effects include nausea, a
metallic taste in your mouth, headache and loss of appetite. You should
avoid alcohol while taking this medication.
* Ciprofloxacin (Cipro). This drug, which improves symptoms in some
people with Crohn's disease, is now generally preferred to
metronidazole. Ciprofloxacin may cause nausea, vomiting, headache and,
rarely, tendon problems.

Other medications
In addition to controlling inflammation, some medications may help
relieve your signs and symptoms. Depending on the severity of your
Crohn's disease, your doctor may recommend one or more of the following:

* Anti-diarrheals. A fiber supplement, such as psyllium powder
(Metamucil) or methylcellulose (Citrucel), can help relieve mild to
moderate diarrhea by adding bulk to your stool. For more severe
diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheals
with caution and only after consulting your doctor, because they
increase the risk of toxic megacolon, a life-threatening inflammation of
your colon.
* Laxatives. In some cases, swelling may cause your intestines to
narrow, leading to constipation. Talk to your doctor before taking any
laxatives, because even those sold over-the-counter may be too harsh for
your system.
* Pain relievers. For mild pain, your doctor may recommend
acetaminophen (Tylenol, others). Avoid nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or
naproxen (Aleve). These are likely to make your symptoms worse.
* Iron supplements. If you have chronic intestinal bleeding, you may
develop iron deficiency anemia. Taking iron supplements may help
restore your iron levels to normal and reduce this type of anemia once
your bleeding has stopped or diminished.
* Nutrition. Your doctor may recommend a special diet given via a
feeding tube (enteral nutrition) or nutrients injected into a vein
(parenteral nutrition) to treat your Crohn's disease. This can improve
your overall nutrition and allow the bowel to rest. Bowel rest can
reduce inflammation in the short term. However, once regular feeding is
restarted, your signs and symptoms may return. Your doctor may use
nutrition therapy short term and combine it with other medications, such
as immune system suppressors. Enteral and parenteral nutrition are
typically used to get people healthier for surgery or when other
medications fail to control symptoms.
* Vitamin B-12 shots. Vitamin B-12 helps prevent anemia, promotes
normal growth and development, and is essential for proper nerve
function. It's absorbed in the terminal ileum, a part of the small
intestine often affected by Crohn's disease. If inflammation of your
terminal ileum is interfering with your ability to absorb this vitamin,
you may need monthly B-12 shots for life. You'll also need lifelong B-12
injections if your terminal ileum has been removed during surgery.
* Calcium and vitamin D supplements. Most people with Crohn's
disease need to take a calcium supplement with added vitamin D. This is
because Crohn's disease and steroids used to treat it can increase your
risk of osteoporosis. Ask your doctor if a calcium supplement is right
for you.

Surgery
If diet and lifestyle changes, drug therapy or other treatments don't
relieve your signs and symptoms, your doctor may recommend surgery to
remove a damaged portion of your digestive tract or to close fistulas or
remove scar tissue.

In Crohn's disease, surgery can provide years of remission at best. At
the least, it may provide a temporary improvement in your signs and
symptoms. During surgery, your surgeon removes a damaged portion of your
digestive tract and then reconnects the healthy sections. In addition,
surgery may also be used to close fistulas and drain abscesses. A common
procedure for Crohn's is strictureplasty, a procedure that widens a
segment of the intestine that has become too narrow.

Even so, the benefits of surgery for Crohn's are only temporary. The
disease often recurs, frequently near the reconnected tissue or
elsewhere in the digestive tract. Nearly 3 of 4 people with Crohn's
disease eventually need some type of surgery. Of those, as many as half
will need a second procedure, or more. The best approach is to follow
surgery with medication to minimize the risk of recurrence.

©
Lifestyle and home remedies

Sometimes you may feel helpless when facing Crohn's disease. But changes
in your diet and lifestyle may help control your symptoms and lengthen
the time between flare-ups.

Diet
There's no firm evidence that what you eat actually causes inflammatory
bowel disease. But certain foods and beverages can aggravate your signs
and symptoms, especially during a flare-up in your condition. If you
think there are foods that make your condition worse, try keeping a food
diary to keep track of what you're eating as well as how you feel. If
you discover certain foods are causing your symptoms to flare, it's a
good idea to try eliminating those foods. Here are some suggestions that
may help:

* Limit dairy products. Like many people with inflammatory bowel
disease, you may find that problems, such as diarrhea, abdominal pain
and gas, improve when you limit or eliminate dairy products. You may be
lactose intolerant — that is, your body can't digest the milk sugar
(lactose) in dairy foods. If so, limiting dairy or using an enzyme
product, such as Lactaid, will help break down lactose.
* Try low-fat foods. If you have Crohn's disease of the small
intestine, you may not be able to digest or absorb fat normally.
Instead, fat passes through your intestine, making your diarrhea worse.
Foods that may be especially troublesome include butter, margarine,
cream sauces and fried foods.
* Experiment with fiber. For most people, high-fiber foods, such as
fresh fruits and vegetables and whole grains, are the foundation of a
healthy diet. But if you have inflammatory bowel disease, fiber may make
diarrhea, pain and gas worse. If raw fruits and vegetables bother you,
try steaming, baking or stewing them. You may also find that you can
tolerate some fruits and vegetables, but not others. In general, you may
have more problems with foods in the cabbage family, such as broccoli
and cauliflower, and nuts, seeds, corn and popcorn. Consult your doctor
prior to starting a high-fiber diet.
* Avoid problem foods. Eliminate any other foods that seem to make
your signs and symptoms worse. These may include "gassy" foods such as
beans, cabbage and broccoli, raw fruit juices and fruits — especially
citrus fruits, spicy food, popcorn, alcohol, and foods and drinks that
contain caffeine, such as chocolate and soda.
* Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
* Drink plenty of liquids. Try to drink plenty of fluids daily.
Water is best. Alcohol and beverages that contain caffeine stimulate
your intestines and can make diarrhea worse, while carbonated drinks
frequently produce gas.

* Consider multivitamins. Because Crohn's disease can interfere with
your ability to absorb nutrients and because your diet may be limited,
multivitamin and mineral supplements are often helpful. Check with your
doctor before taking any vitamins or supplements.
* Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress
Although stress doesn't cause Crohn's disease, it can make your signs
and symptoms much worse and may trigger flare-ups. Stressful events can
range from minor annoyances to a move, job loss or the death of a loved
one.

When you're stressed, your normal digestive process changes. Your
stomach empties more slowly and secretes more acid. Stress can also
speed or slow the passage of intestinal contents. It may also cause
changes in intestinal tissue itself.

Although it's not always possible to avoid stress, you can learn ways to help manage it. Some of these include:

* Exercise. Even mild exercise can help reduce stress, relieve
depression and normalize bowel function. Talk to your doctor about an
exercise plan that's right for you.
* Biofeedback. This stress-reduction technique may help you reduce
muscle tension and slow your heart rate with the help of a feedback
machine. You're then taught how to produce these changes without
feedback from the machine. The goal is to help you enter a relaxed state
so that you can cope more easily with stress. Biofeedback is usually
taught in hospitals and medical centers.
* Regular relaxation and breathing exercises. One way to cope with
stress is to regularly relax. You can take classes in yoga and
meditation or use books, CDs or DVDs at home.

©
Alternative medicine

Many people with either Crohn's disease or ulcerative colitis have used
some form of complementary or alternative therapy. Some commonly used
therapies include:

* Herbal and nutritional supplements
* Probiotics
* Fish oil
* Acupuncture

Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care.

The majority of alternative therapies aren't regulated by the FDA.
Manufacturers can claim that their therapies are safe and effective but
don't need to prove it. In some cases that means you'll end up paying
for products that don't work. For example, studies done on fish oil and
on probiotics for the treatment of Crohn's haven't found benefit. What's
more, even natural herbs and supplements can have side effects and
cause dangerous interactions. Make sure your doctor is aware if you
decide to try any herbal supplement.

Some people may find acupuncture or hypnosis helpful for the management
of Crohn's, but neither therapy has been well studied for this use.

Unlike probiotics — which are beneficial live bacteria that you consume —
prebiotics are natural compounds found in plants, such as artichokes,
that help fuel beneficial intestinal bacteria. An initial study on
prebiotics had promising results. More studies are under way.

©
Coping and support

Crohn's disease doesn't just affect you physically — it takes an
emotional toll as well. If signs and symptoms are severe, your life may
revolve around a constant need to run to the toilet. In some cases, you
may barely be able to leave the house. When you do, you might worry
about an accident, and this anxiety only makes your symptoms worse.

Even if your symptoms are mild, gas and abdominal pain can make it
difficult to be out in public. You may also feel hampered by dietary
restrictions or embarrassed by the nature of your disease. All of these
factors — isolation, embarrassment and anxiety — can severely alter your
life. Sometimes they may lead to depression.

Educate yourself, and connect
One of the best ways to feel more in control is to find out as much as
possible about Crohn's disease. Organizations such as the Crohn's and
Colitis Foundation of America (CCFA) have chapters set up across the
country to provide information and access to support groups. Your
doctor, nurse or dietitian can locate the chapter nearest you, or you
can contact the organization directly at 888-MY-GUTPAIN (888-694-8872).

Although support groups aren't for everyone, they can provide valuable
information about your condition as well as emotional support. Group
members frequently know about the latest medical treatments or
integrative therapies. You may also find it reassuring to be among
people who understand what you're going through.

Some people find it helpful to consult a psychologist or psychiatrist
who's familiar with inflammatory bowel disease and the emotional
difficulties it can cause. Although living with Crohn's disease can be
discouraging, research is ongoing and the outlook is brighter than it
was a few years ago.

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