Crohn's Disease
by Yael Rosenberg, RN

   •  Description
   •  Symptoms
   •  Incidence and Carriers
   •  Treatment
   •  Testing
   •  Resources and More
   •  Support Group

Description
Crohn's disease is a serious inflammatory disease of the gastrointestinal (GI) tract. It predominates in the intestine (ileum) and the large intestine (colon), but may occur in any section of the GI tract.

Symptoms
Abdominal pain, often in the lower right area 
   •  Diarrhea 
   •  Rectal bleeding, which may be serious and persistent, leading to anemia 
   •  Weight loss 
   •  Fever may occur 
   •  A greater risk of developing colorectal cancer 
   •  Children with Crohn's may suffer delayed development and stunted growth

Incidence and Carriers
Although environmental factors clearly contribute, there is strong evidence from studies of twins and affected families that Inflammatory Bowel Disease (IBD), especially Crohn's disease, has a genetic basis. Research has shown evidence of a genetic predisposition to a chronic Inflammatory Bowel Disease (IDB) among Jewish individuals of Eastern European descent. 

Inflammatory Bowel Disease (IBD) is two-to-eight times more common in Ashkenazi Jews. Genetic factors inherited from the mother may play an important role in predisposing these individuals to Crohn's disease. Crohn's disease occurs in all ethnic groups and races. However, its incidence is highest in Caucasians and Jewish people of Eastern European (Ashkenazi Jews.) The Crohn's & Colitis Foundation of America estimates that over 2 million Americans suffer from some form of inflammatory disease.  There is an equal incidence of IBD in males and females. 

Crohn’s Disease is more common in the pediatric practice than Ulcerative colitis. It peaks in the second or third decade of life. Cases of Crohn's in infants and young children occur less frequently. Approximately 25% of all new cases in the population are less than 20 years of age. There is an increased prevalence of Crohn's disease among first-degree relatives; however, no specific habitability pattern has been recognized.

Treatment
   •  There is no cure for IBD, thus the focus is on controlling the inflammation.
   •  Medication – inflammation is controlled through powerful drugs such as corticosteroids.
   •  Surgery – to remove inflamed or damaged portions of the intestines
Nutrition Supplementation - The doctor may recommend nutritional supplements, especially for children
   •  whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.

Testing
Researchers continue to look for more effective treatments. Examples of investigational treatments include
   •  Anti-TNF - Research has shown that cells affected by Crohn's disease contain a cytokine, a protein produced by the immune system, called Tumor Necrosis Factor (TNF). TNF may be responsible for the inflammation of Crohn's disease. Anti-TNF is a substance that finds TNF in the bloodstream, binds to it, and removes it before it can reach the intestines and cause inflammation. In studies, anti-TNF seems particularly helpful in closing fistulas.
   •   Interleukin 10 - Interleukin 10 (IL-10) is a cytokine that suppresses inflammation. Researchers are now studying the effectiveness of synthetic IL-10 in treating Crohn's disease.
   •   Antibiotics - Antibiotics are now used to treat the bacterial infections that often accompany Crohn's disease, but some research suggests that they might also be useful as a primary treatment for active Crohn's disease.
   •   Budesonide - Researchers recently identified a new corticosteroid called budesonide that appears to be as effective as other corticosteroids but causes fewer side effects.
   •   Methotrexate and cyclosporine - These are immunosuppressive drugs that may be useful in treating Crohn's disease. One potential benefit of methotrexate and cyclosporine is that they appear to work faster than traditional immunosuppressive drugs.
   •   Zinc - Free radicals--molecules produced during fat metabolism, stress, and infection, among other things--may contribute to inflammation in Crohn's disease. Free radicals sometimes cause cell damage when they interact with other molecules in the body. The mineral zinc removes free radicals from the bloodstream. Studies are under way to determine whether zinc supplementation might reduce inflammation.

Participation in Research
If you would like to participate in research done on families who suffer from Crohn’s Disease, please contact the groups listed below:

The University of Chicago
Drs. Judy Cho, Steven Hanauer & Barbara Kirschner
Chicago, Illinois
Telephone: 773-702-2282

Johns Hopkins University and Hospital
Baltimore, Maryland
Drs. Steven Brant & Theodore M. Bayless
Toll Free: 888-279-4194
In addition to multiple affected families, Dr. Brant (Johns Hopkins) is particularly interested in Jewish families and in Jewish patients whose parents both are willing to participate.

University of Pittsburgh
Pittsburgh, Pennsylvania
Dr. Richard Duerr
Toll Free: 800-457-2015

North Shore University Hospital, New York
Drs. Jack Silver & Seymour Katz
Manhasset, New York
Telephone: 516-562-1113

Cedar-Sinai Hospital
Drs. Yang & Jerome Rotter
Los Angeles, California
Telephone310-855-6453

Resources and More
Crohn's & Colitis Foundation of America, Inc.
National Headquarters
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Telephone: 212-685-3440
Toll Free: 800-932-2423
Fax: 212-779-4098
Email:info@ccfa.org 

Pediatric Crohn's & Colitis Association, Inc.
P.O. Box 188
Newton, MA 02468
Telephone: (617) 489-5854
Website:http://pcca.hypermart.net 
Email:questions@pcca.hypermart.net 

United Ostomy Association, Inc.
19772 MacArthur Blvd., #200
Irvine, CA 92612-2405
Telephone: 949-660-8624
Toll Free: 800-826-0826
Fax: 949-660-9262
Website: http://www.uoa.org 
Email: uoa@deltanet.com 

The Israel Foundation for Crohn's Disease and Ulcerative Colitis
P.O. Box 5231
Herzlia
Israel
Fax: 09-9567628

Support Groups
Reach Out for Youth with Ileitis and Colitis, Inc.
15 Chemung Place
Jericho, NY 11753
Telephone: 516-822-8010