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Crohn's Disease

Living With Crohn's Disease

Last modified: 
21/03/2012 - 13:36

Contributing Author: Guy Slowik FRCS

Most people living with Crohn's disease find that periods of remission (when they are free from symptoms) are longer and more frequent than periods of acute illness. This has never been truer than it is today, when doctors have large and growing arsenal of treatment options to prescribe.

The severity of Crohn's disease can be measured objectively with indexes that chart symptoms, including:

  • The number of bowel movements per day
  • Appetite level
  • Fever
  • Number of days in a month when an individual must modify his or her work, home, or social schedule because of diarrhea, fatigue, fever, and other symptoms

Severity can also be measured subjectively, through a doctor's assessment of an individual's general state of being (such as whether he or she is angry, depressed, in pain, or embarrassed by needing to use the toilet frequently in social or business situations).

There is considerable variation in how people with Crohn's disease experience their illness. An individual whose radiological examinations reveal an extent of disease that would seem to be debilitating may lead a relatively normal life, while a person with few objective signs of disease may find his or her symptoms totally debilitating, both physically and mentally.

Remission And Relapse

Although Crohn's disease is a chronic (long-term) inflammatory bowel disease, it is not a constant disease. That is, Crohn's disease is characterized by acute flare-ups of symptoms followed by remissions that last for varying periods of time. Each individual's pattern of symptoms is different, and conscientious doctors treat patients according to their reported symptoms rather than the results of laboratory tests or radiological exams.

Diarrhea, pain, and fever-along with fatigue, chills, and possibly vomiting-come and go, sometimes in waves and sometimes in sharp bursts. Flare-ups can occur out of the blue, following a viral illness such as a head cold, or during times of extreme personal, business, or social stress.

Nutritional Issues And Proper Diet

Compromised nutrition, even malnutrition, is a constant threat to an individual with Crohn's disease. This is because the disease creates a vicious cycle:

  • Fever and diarrhea cause a loss of appetite.
  • Fever, by raising the body's metabolic rate, adds to the need for caloric energy.
  • Diarrhea can lead to dehydration and temporary lactose intolerance (the inability to digest milk sugars).
  • Lactose intolerance causes milk sugars to ferment in the colon, leading to cramps and more diarrhea.
  • Lactose intolerance can also indirectly lead to calcium deficiency, which in turn can lead to the loss of bone density called osteoporosis. This side effect can be especially prevalent among those being treated with corticosteroids such as prednisone.

Nutritional treatment for Crohn's disease has two main goals.

  • The first is to increase the intake of calories, especially in the form of proteins, along with vitamins, minerals, and trace elements, to prevent nutritional deficiency.
  • The second is to create an eating pattern that minimizes stress on the diseased digestive tract. This often means eating smaller, more frequent meals. Many nutrition counselors suggest that people with Crohn's disease consume six half-sized meals each day, spacing them equally and consuming the last at least three hours before bedtime.

Most doctors tell people with Crohn's disease that their diet should be "normal, as tolerated." There is no conclusive evidence that particular foods cause flare-ups. During a flare-up, however, doctors often suggest that individuals reduce their intake of dietary fiber, such as whole grains, raw fruits and vegetables.

Colon Cancer Risk

Statistically, individuals with Crohn's disease have a slightly increased risk of developing colorectal cancer, although not as much of an increased risk as those with ulcerative colitis. Scientists are still searching for the link between inflammatory bowel disease and colon cancer.

For individuals with Crohn's disease, the risk of developing colorectal cancer increases over time, as is true for the general population. For this reason, regular screenings-either a colonoscopy with biopsy or a barium enema-should begin about 12 years after initial diagnosis if the disease is confined to the small intestine, and eight years after diagnosis if there is disease in the colon.

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.