Crohn’s disease – Harvard Health

Crohn’s disease is an inflammatory bowel disease that affects the digestive tract, usually the small and large intestines. This causes an array of digestive and other symptoms. Once the condition begins, it lasts a lifetime.

The inflammation most often injures the final section of the small intestine, called the ileum, and the beginning of the large intestine. However, the disease can affect any part of the digestive tract, from the mouth to the anus. It can also affect other parts of the body, such as the eyes and joints.

Exactly what triggers the inflammation that starts Crohn’s disease is still something of a medical mystery. A viral or bacterial infection may start the process by activating the immune system. Normally, the immune response fades away when the infection is over. In some people, though, the immune system stays active and creates inflammation in the intestines even after the infection goes away.

Symptoms of Crohn’s disease

Once Crohn’s disease begins, it can cause life-long symptoms that come and go. The most common symptoms include:

• abdominal pain, usually at or below the navel, that is typically worse after meals
• diarrhea that may contain blood
• weight loss
• weakness or fatigue
• sores around the anus
• drainage of pus or mucus from the anus
• pain during bowel movements
• painful mouth sores
• loss of appetite
• joint pain or soreness
• back pain
• eye inflammation that can cause pain or vision changes in one or both eyes
• fever
• red, tender bumps under the skin

In some people with Crohn’s disease, symptoms suddenly get worse. This is called a flare. Following a flare, symptoms may disappear for a while. This is called remission.

As the inside lining and deeper layers of the intestine wall become inflamed, they can thicken or wear away in spots. This creates ulcers, cracks, and fissures. Inflammation can allow an abscess (a pocket of pus) to develop.

A common complication of Crohn’s disease is called a fistula. A fistula is an abnormal connection between organs in the digestive tract, usually between one part of the intestine and another. Fistulas usually result from severe inflammation.

Diagnosing Crohn’s disease

There is no single, definitive test for Crohn’s disease. Instead, an individual’s symptoms and test results fit a pattern over time that is best explained by Crohn’s disease.

Some tests are often, but not always, abnormal in people with Crohn’s disease:

• blood tests can show a lot of white blood cells or other signs of inflammation, or anemia, a reduced number of red blood cells.
• autoantibody tests can help tell the difference between inflammation caused by Crohn’s disease from other inflammatory bowel diseases.
• stool tests, also called feces or bowel movement tests, can detect blood in the stool from irritated intestines and tell if an infection is causing the symptoms.

Imaging tests that may be done include:

• upper gastrointestinal series, an x-ray taken after an individual drinks a barium solution. This test can reveal places in the small intestine that are narrowed, and can also highlight ulcers and fistulas.
• flexible sigmoidoscopy or colonoscopy lets a doctor look at the insides of the large intestine.
• MR enterography uses an MR scan instead of x-rays to take pictures of the entire intestine.
• wireless capsule endoscopy involves swallowing a pill-sized object that contains a tiny video camera that takes pictures of the small intestine and wirelessly sends them to a nearby computer.

A biopsy involves removing a small sample of tissue from the lining of the intestine and examining it in a laboratory for signs of inflammation. This can help confirm Crohn’s disease and rule out other conditions.

Treating Crohn’s disease

Several self-help strategies can help ease symptoms or prevent flare-ups of Crohn’s disease. These include:

Modifying the diet. Not drinking carbonated beverages or eating high-fiber foods such as popcorn, vegetable skins, and nuts may improve symptoms. So might avoiding foods that cause gas, like beans, broccoli, and cauliflower. Drinking more liquids and eating smaller meals throughout the day, instead of three larger meals, helps some people with Crohn’s disease.

Avoiding some anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can worsen Crohn’s disease. If you need pain relief, ask your doctor about other options.

Not smoking. Smoking can make Crohn’s disease flare up. It also increases the risk of needing surgery.

Medications

Medications are effective at improving the symptoms of Crohn’s disease. Most of the drugs work by preventing inflammation in the intestines:

• aminosalicylates suppress inflammation in the intestine and joints. These anti-inflammatory drugs, which are chemically related to aspirin, are taken as pills or via enemas.
• antibiotics kill bacteria in irritated areas of the bowel and may also decrease inflammation.
• antidiarrheal medications may be helpful when diarrhea is present without infection.

Other more powerful anti-inflammatory drugs may be helpful. But they can also suppress the immune system, increasing the risk of infection. For this reason, they are not often used on a long-term basis.

The newest drugs approved for treatment of Crohn’s disease are tumor necrosis factor (TNF) inhibitors. These medications block the effect of TNF. TNF is a substance made by immune system cells that causes inflammation. TNF inhibitors have potentially very serious side effects. They are generally prescribed for moderate to severe Crohn’s disease that is not responding to other therapies. Infliximab (Remicade) and adalimumab (Humira) are TNF inhibitors.

Bowel rest

When symptoms of Crohn’s disease become severe, bowel rest gives the intestines a chance to heal. This means the only food is clear liquids. Sometimes bowel rest means not taking anything by mouth. In that case, nutrition is given through a vein.

Surgery

Surgery to remove a section of the bowel is another possible treatment. In general, surgery is recommended only if a person has:

• a bowel obstruction
• a non-healing fistula
• severe side effects from medications
• symptoms that cannot be controlled with medications

Checking for colorectal cancer

Crohn’s disease increases the risk of developing colon cancer, so it’s important to be checked for this type of cancer with a colonoscopy every one to two years.

Journal of Pediatric Gastroenterology and Nutrition

Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999

Solzi, G; Di Lorenzo, C; Flores, A; Hyman, P

Author Information

Division of Pediatric Gastroenterology, Children’s Hospital of Pittsburgh, Pennsylvania; ^Newton Wellesley Hospital, Newton, Massachusetts; *Children’s Hospital of Orange Country, California.

Journal of Pediatric Gastroenterology & Nutrition 29(4):p 514, October 1999.

• Free

Abstract 101

Background: Many clinicians believe that continuous drip feedings are “less natural” or “a step backward” from bolus tube feedings. One concern is that feedings might interrupt the Migrating Motor Complex (MMC), the “digestive housekeeper” and marker for neuromuscular integrity of the bowel.

Aims: We used 24 hr small bowel manometry to evaluate if phase 3 of the MMC persists during continuous feeding or during short fasting periods between bolus feeding.

Methods: We studied 6 children (age 4.1 +/- 3.3 yr., range 10 mo. to 12 yr., 2 male) with gastrostomies (n=2) or jejunostomies (n=4) for tube feeding. We placed a solid state manometry catheter with 3-5 channels 3-4 cm apart through the ostomy into the small bowel alongside a feeding tube under fluoroscopic guidance. After a 4 hr fasting recording we fed the patients using a Zevex infusion pump over 2 different cycles. One 10 hr cycle consisted of 3 hr feeding, 2 hr fasting, repeated twice. The other cycle was 10 hr continuous feeding. The sequence of cycles was randomized. Volume and calories during the two cycles were identical. We recorded intraluminal pressures into a portable device. We measured the number of MMC/hr during each cycle.

Results: In every child MMCs continued during feeding. There was no difference in the number of MMCs during the two cycles (0.6/hr +/- 0.3 during intermittent feeding vs. 0.7/hr +/- 0.5 during continuous feeding, p=0.7). There was no difference in symptoms during the two types of feedings.

ovid.com/mrws/1.0″>Conclusions: Tube feedings into the small bowel do not interrupt MMCs. Phase 3 of the MMC is preserved during both continuous and bolus tube feeding.

Section Description

POSTER SESSION II

Nutrition/Nutrition Support

© 1999 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

“Day off” for the stomach – Amurskaya Pravda, news of Blagoveshchensk and Amur Region

After the holidays, you need to arrange a fasting day for the body

01/13/2011, 05:49 Food

Give yourself a post-holiday gift – spend a fasting day. After heavy drinking and overeating, the organs of the gastrointestinal tract need rest.

In “besieged Leningrad”

A fasting day is most often a mini-mono-diet, eating in small quantities. Your favorite product is taken, divided into 5-6 parts and consumed every 3 hours during the day. Plus – you need to drink plenty of water, 1.5-2 liters. You can make decoctions: corn silk, fennel, mint. Or drink green tea. You should not get carried away with coffee: it is a drink that tones, excites, stimulates, it does not positively affect the pancreas and stomach.

Fasting days, due to their short duration, do not cause disturbances in providing the body with basic or indispensable nutrients. They give your pancreas a rest, a stomach that worked overtime during the holidays. And also contribute to weight loss – 200 grams, or even more. But the effect will be only if such “days off” become regular.

“It is better to sit on a fasting day once a week, not more often,” recommends Alina Bozhko, a dietitian at the Annunciation clinic “Doctor Qi”. – You can define one permanent day when it is more convenient for you – sitting at home or at work. It is advisable to arrange fasting days after overeating. For example, on Friday you had a christening-name day, which means that on Saturday you take a break from plentiful food.

Why not be zealous and unload 2-3 times a week or arrange a mono-diet 4-5 days in a row? The fact is that the body does not like a tough attitude towards itself, it is not vindictive, but it remembers and then demands from you everything that it did not receive. People who are on strict diets and rapidly lose weight by three kg in a week, then gain five kg in five days. The cells remember that they were in “besieged Leningrad”, and when a person even slightly begins to expand the menu, all the calories are deposited in the sides.

Fruit-vegetables

One of the most popular options for “time off” is an apple day. It is especially recommended for obesity, gout, diseases of the liver, kidneys, heart, hypertension. But it is contraindicated in exacerbation of gastritis, pancreatitis, colitis – it can cause pain. In this case, apples can be baked in the oven and eat pectin puree, without peel.

– If a person does not like apples, there is no need to torture yourself with an apple day, – Alina Nikolaevna notes. – Choose the product that you will eat with pleasure. Otherwise, this day will seem like flour. Take oranges, tangerines, melon, watermelon, pears. You can make a fruit platter – one and a half kilograms of different fruits, except for bananas and grapes.

A vegetable day is also useful. “Monotonous” – only on cucumbers or zucchini or in the form of salads. Cut tomatoes, cucumbers, cabbage, zucchini, pumpkin, any greens, add a drop of vegetable oil, sprinkle with lemon juice and divide into 5-6 doses.

Porridge-meat-milk

People sit for weeks on buckwheat or eat unsalted rice – they say fasting days on porridge are very effective.

– And I removed them from practice, – says nutritionist Alina Bozhko. – I noticed that the effect is worse. Fruits and vegetables improve peristalsis – and we just need to quickly remove everything from the body. And rice, for example, leads to constipation, slows down metabolic processes. Buckwheat can be recommended as an unloading product, but not more than once a month.

Meat days are very fond of men. You can use not only lean meats, but also fish as a protein fasting day. Boil 500 g of the product and divide into 6 doses. However, there are contraindications: it is not recommended for people with kidney disease, as they need to strictly control the protein.

Fans of dairy products can sit on kefir, fermented baked milk, milk – up to 2 liters, cottage cheese – 300-400 g plus a liter of kefir during the day. Just make sure that the fat content of the selected product is small – ideally 1.5%.

Tea-water

Sitting on tea or water is difficult. Such fasting days are called hungry.

– But if you overate the day before, you can give your body a rest and drink only liquids all day – up to 3 liters. The main thing is not to break into dinner, the doctor advises. – You can cook fruit compote without sugar or brew herbs. Fans can “sit” on milkweed: this is green tea diluted with milk.

The chocolate myth

Among those who are losing weight with experience, fasting day on dark chocolate is popular. Like, not only will it help health, but you will also get 200 grams of pleasure without leaving the cash register.

– I classify the chocolate diet as glamorous. If on a vegetable fasting day you get microelements, vitamins, fiber, a large amount of nutrients, then only cocoa and sugar will enter the body with chocolate. If we eat salads, vegetables, meat, fish, cottage cheese, then the blood sugar level is approximately the same even throughout the day. This fact provokes the breakdown of fats. And after each serving of chocolate, “leaps” of sugar occur. Then he falls, after the next tile – rises … Such waves are bad for the body. If a person abuses sweets at all, then the development of type 2 diabetes is quite possible, the doctor explains.

Unloading regulations

We choose the most suitable product for you and use it throughout the day in small portions every 2 hours (5-6 times a day). In addition, we drink a lot of liquid – about 2 liters.

Fasting days are best spent constantly – once a week. You can alternate products.

If during the fasting day you experience a terrible hunger (most often this happens on fruits, kefir, vegetables), you can take some protein food: eat a piece of boiled meat, Adyghe cheese, a soft-boiled egg. No need to suffer from hunger.

The average calorie content of the menu for the day is from 1000 to 1300 kcal. However, comorbidities and physical activity must be taken into account. If we give a miner 1000 calories a day, he will die in the mine, and the surgeon will fall from dizziness during the operation.

OPINION

Alina Bozhko, dietitian of the Annunciation clinic “Doctor Qi”

We don’t need glamor!

No need to rush to glamorous diets. These actresses can urgently lose weight by 12 kg in a week – because the director told them to urgently lose weight, otherwise they won’t see a new role. This is their job, their income. And for ordinary people, it is desirable to reduce weight systematically, slowly. Only then will it be stable. The body does not like to sharply lose weight and get fat. After such “harmonicas” it’s hard. From experience, I note: people who have experienced a bunch of diets, it is very difficult to bounce back. Adipose tissue is very smart: it remembers all its suffering and resists.

Age category of materials: 18+

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Treatment of the gastrointestinal tract (GIT) in the sanatorium “Solnechny” in Kislovodsk

Treatment of the gastrointestinal tract in Kislovodsk

Sanatorium “Solnechny” is located in the picturesque city of Kislovodsk – a balneological health resort of international importance. Every year, thousands of people with various diseases of the gastrointestinal tract come to us for treatment and rehabilitation. Thanks to an integrated approach to the treatment of the gastrointestinal tract in the Kislovodsk sanatorium, our specialists manage to help many patients achieve sustainable remission and improve the quality of life.

Many diseases of the gastrointestinal tract, as well as their relapses, are associated with an incorrect lifestyle – non-compliance with the diet, alcohol abuse, overwork and constant stress, which have long become part of the life of a modern person. Thanks to spa treatment, mineral water intake and the use of various therapy methods, it is possible to form a healthy regimen for each patient, eliminate pain, and restore the normal functioning of the digestive organs.

Indications for treatment in a sanatorium

Our specialists have developed a comprehensive program of treatment and prevention for patients with gastrointestinal diseases, which has allowed us to become one of the most popular sanatoriums in Kislovodsk, including the gastrointestinal profile. Therapy in our sanatorium is indicated in the following cases:

• a planned examination of the gastrointestinal tract and treatment with a sanatorium component is required;

• prevention of gastrointestinal diseases with a frequently relapsing course is necessary;

• rehabilitation is indicated for patients after elective surgery, when it is recommended to take mineral water and other spa procedures during the recovery period.

What diseases of the gastrointestinal tract do we treat?

Methods of treatment of the gastrointestinal tract in the sanatorium “Solnechny”

The resort has its own pump room with different types of mineral water, which have proven effectiveness in the treatment of various diseases of the gastrointestinal tract. Patients are consulted by qualified gastroenterologists, advanced medical equipment is used for diagnosis and treatment. Consider the most effective methods of treatment of the gastrointestinal tract in the conditions of our sanatorium.

Monitor bowel cleansing or colon hydrotherapy

The essence of the monitor bowel cleansing procedure is to cleanse the gastrointestinal tract from toxins, parasites and pathogenic microbes. The procedure is painless and effective.

How colon hydrotherapy is performed:

• a special tip is inserted into the lower colon through the rectum;

• through it, a large volume of liquid is supplied to the gastrointestinal tract – up to 20 liters;

• pain is avoided during this procedure due to automatic regulation of the speed and intensity of the jet using a computer program;

• in the process of cleansing in a closed circuit, the waste products of the body leave the intestines.

The Monitor Colon Cleanse uses ordinary purified water enriched with oxygen as the main solution. If indicated, the doctor may recommend replacing the water with an infusion of herbs, a solution of antibiotics or other drugs.

Indications for monitor bowel cleansing:

• gastrointestinal diseases accompanied by constipation;

• unfavorable allergic background;

• biliary dyskinesia;

• severe intoxication of the body, slagging and food poisoning;

• certain skin diseases;

• worm infestation.

The duration of the procedure does not exceed 45 minutes, if necessary, the session can be repeated, but with an interval of three to four days. To track the effectiveness of the cleansing, the patient is prescribed a number of additional laboratory tests.

Narzan mineral water

Kislovodsk mineral water improves the functioning of internal organs, normalizes (increases) acidity, secretion of bile and gastric juice, activates peristalsis, relieves spasms and reduces pain. For diseases of the gastrointestinal tract, mineral water is taken internally according to the scheme prescribed by the doctor, as well as a number of procedures for the external use of water, for example, mineral baths and internal irrigation.

Narzan mineral water is indicated for atrophic gastritis and other diseases with low acidity, Narzan is also used in the sanatorium treatment of pancreatitis in Kislovodsk. With low acidity, Narzan mineral water is drunk warm 15 minutes before a meal. We emphasize that the scheme and drinking regimen are selected by the doctor after collecting an anamnesis and conducting diagnostic studies.

Balanced nutrition, massage and balneological procedures

• Additionally, patients of the Solnechny sanatorium in Kislovodsk with profile treatment of the gastrointestinal tract are selected an individual diet – a nutrition scheme taking into account the specifics of the disease of the gastrointestinal tract.