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Questions and Answers


Q
My step mother has Crohn's Disease.

I don't quite understand what it is. Could you explain? She just recently had another surgery since her last one 12 years ago. She has always been in and out of pain, and I'd like to better understand why.

A
Crohn's disease is one name for regional enteritis, a nonspecific, chronic inflammatory disease of the gastrointestinal tract. Its cause is unknown. It usually involves the small intestine, but may also involve both small and large intestine; sometimes only the colon is involved. It affects both males and females equally.

The commonest symptoms include abdominal pain, often in the lower right area, diarrhea and/or constipation. There may also be rectal bleeding, weight loss, and fever. Bleeding may be serious and persistent, leading to anemia. Affected children may suffer delayed development and stunted growth. Established chronic Crohn's is characterized by lifelong exacerbations.

Several drugs are helpful in controlling, but not curing the disease. The aim is to correct nutritional deficiencies, to control inflammation, and to relieve abdominal pain, diarrhea, and rectal bleeding. The drug sulfasalazine (Azulfidine) often lessens the inflammation and can be taken for as long as is needed. Patients who don't do well on this often do well on related drugs such as mesalamine (Pentasa}. More serious cases may require steroid drugs (usually prednisone in carefully controlled dosage), antibiotics for infection, or drugs that affect the bodies immune system (azathioprine or 6-mercaptopurine). I have just seen the preliminary results of a controlled trial of the anti-cancer/anti-arthritic drug, methotrexate, The results are promising - 'those given methotrexate therapy showed fewer disease-related symptoms and required less prednisone'.

The most common complication is blockage of the intestine. There may also be ulceration.

There may also be complications that affect other parts of the body - some respond to the same therapy but others must be treated seperately.

Surgery is indicated either to relieve chronic symptoms of active disease that does not respond to medical treatment, or to correct complications such as intestinal blockage, perforation, abscess,or bleeding. Most people with this disease continue to lead useful and productive lives. Between periods of disease activity, they may feel quite well and be free of symptoms. With proper medication (and good compliance) and perhaps some hospitalization, even periods of active disease can be made tolerable.

Trust this sheds some light.

Best wishes to you and your step mother.

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