Crohn's treatment

Crohn's treatment may include drugs, nutrition supplements, surgery, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. At this time, treatment can help control the disease by lowering the number of times a person experiences a recurrence, but there is no cure. Treatment for Crohn’s disease depends on the location and severity of disease, complications, and the person’s response to previous medical treatments when treated for recurring symptoms.

Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.

Someone with Crohn’s disease may need medical care for a long time, with regular doctor visits to monitor the condition.

Drug Therapy

Anti-Inflammation Drugs. Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine-containing drugs include nausea, vomiting, heartburn, diarrhea, and headache.

Cortisone or Steroids. Cortisone drugs and steroids—called corticosteriods—provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered once symptoms have been controlled. These drugs can cause serious side effects, including greater susceptibility to infection.

Immune System Suppressors. Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteroids may eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.

Infliximab (Remicade). This drug is the first of a group of medications that blocks the body’s inflammation response. The U.S. Food and Drug Administration approved the drug for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically for Crohn’s disease is an anti-TNF substance. Additional research will need to be done in order to fully understand the range of treatments Remicade may offer to help people with Crohn’s disease.

Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

Anti-Diarrheal and Fluid Replacements. Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.

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 to be fed intravenously for a brief time through a small tube inserted into the vein of the arm. This procedure can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food. There are no known foods that cause Crohn’s disease. However, when people are suffering a flare in disease, foods such as bulky grains, hot spices, alcohol, and milk products may increase diarrhea and cramping.

Surgery

Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point in their lives. Surgery becomes necessary when medications can no longer control symptoms. Surgery is used either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine. Surgery to remove part of the intestine can help people with Crohn’s disease, but it is not a cure. Surgery does not eliminate the disease, and it is not uncommon for people with Crohn’s Disease to have more than one operation, as inflammation tends to return to the area next to where the diseased intestine was removed.

Some people who have Crohn’s disease in the large intestine need to have their entire colon removed in an operation called a colectomy. A small opening is made in the front of the abdominal wall, and the tip of the ileum, which is located at the end of the small intestine, is brought to the skin’s surface. This opening, called a stoma, is where waste exits the body. The stoma is about the size of a quarter and is usually located in the right lower part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. The majority of colectomy patients go on to live normal, active lives.

Sometimes only the diseased section of intestine is removed and no stoma is needed. In this operation, the intestine is cut above and below the diseased area and reconnected.

Because Crohn’s disease often recurs after surgery, people considering it should carefully weigh its benefits and risks compared with other treatments. Surgery may not be appropriate for everyone. People faced with this decision should get as much information as possible from doctors, nurses who work with colon surgery patients (enterostomal therapists), and other patients. Patient advocacy organizations can suggest support groups and other information resources.

People with Crohn’s disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn’s disease are able to hold jobs, raise families, and function successfully at home and in society.

Colonoscopy

What is colonoscopy?

Physicians recommend screening for colon cancer after the age of 50. Even healthy individuals with no history of colon cancer, colon polyps, other bowel problems or bleeding should have a colonoscopy.

Colonoscopy is a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

How to Prepare for a Colonoscopy?

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include:

fat-free bouillon or broth
strained fruit juice
water
plain coffee
plain tea
sports drinks, such as Gatorade
gelatin

A laxative or an enema may be required the night before colonoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water. An enema is performed by flushing water, or sometimes a mild soap solution, into the anus using a special wash bottle.

Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including:

aspirin
arthritis medications
blood thinners
diabetes medications
vitamins that contain iron

Driving is not permitted for 12 hours after colonoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home.

What causes GERD or Acid Reflux?

The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.

Other factors that may contribute to GERD include

-obesity
-pregnancy
-smoking

Acid reflux diet

Common foods that can worsen reflux symptoms include

-citrus fruits
-chocolate
-drinks with caffeine or alcohol
-fatty and fried foods
-garlic and onions
-mint flavorings
-spicy foods
-tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

Burn Fat

Fat burners

When your body moves (or any cell in your body does any type of ”work”) it needs energy. The amount of energy needed is measured as a unit of heat—or a calorie. The fuel to produce this energy comes from several sources, mostly fat and carbs (glucose), and occasionally amino acids (protein). How and when fat is ‘”burned” (or metabolized to provide energy for the body) and how that affects body fat levels and weight is a very complex area of physiology research. There have been hundreds, maybe thousands, of studies exploring the utilization of fat for energy under a variety of different conditions. There is still much to be understood, but this is how we know it works so far:

Whether you are watching TV or running around a track, the fuel your body uses to give you the calories your cells need for energy comes from burning mostly fat and carbs. Your body nearly always burns a mix of both fat calories and carb calories. So normally, for every calorie burned, the fuels are around a 50/50 split of both fat and carbs.

How hard you are moving during exercise is one major determinant of which fuel your body will use. Carbs provide a faster energy source. So whenever you need to do something fast or produce force, carbs are the better fuel. Fats are favored during long, low-intensity activities. It’s not that you stop using one or the other fuel, it’s that the ratio of both shifts depending on your activity. In more scientific terms, you alternate between aerobic (more fat-burning) and anaerobic (more carb-burning) metabolism.

Losing Weight by Burning Calories

When it comes to weight loss, it really doesn’t matter whether you are more or less fat burning. It doesn’t matter what your calories are made of, but it does matter how many calories you burn—and the more the better. So when you are sitting—and burning more fat--you are burning only about one calorie per minute. Clearly, even though you’re in a greater fat-burning state, no one ever lost weight by sitting! (How many calories you burn depends on many factors, including how heavy you are—the more you weigh, the more you burn.)

You do burn less fat when you work anaerobically, but it doesn’t matter because you are burning more total calories. You will always burn more calories the longer or harder you exercise, no matter what your intensity is. So doing cardio for only 15 minutes makes no sense unless you are short on time. Burning BOTH fat calories and carb calories can result in fat loss or pounds off the scale.

Wall Street Journal Gives BIG Thumbs Up to Good Bacteria

Consuming healthy bacteria, or probiotics, can improve your body's overall balance of good versus bad micro-organisms, boosting your general health. But be careful -- not all of the probiotic-containing products found on store shelves provide the health benefits they claim.

Some regular foods contain healthy bacteria naturally, such as yogurt and naturally fermented pickles. But pasteurization has eliminated many of the probiotics that should be found in modern foods. The recent boom in probiotic products reflects an effort to re-introduce bacteria that promote good health.

When choosing a probiotic, look for products that list a specific strain of bacteria on their label, such as Lactobacillus rhamnosus GG -- the final two letters identify the strain. A product that simply uses the first two names may include a similar, but not identical, bacterium that doesn't have the same scientific testing behind it. It’s best when the actual product -- not just the bacterium -- has been tested in humans. Don’t be afraid to do a bit of research, especially when a simple Web search can yield a lot of information.

Some additional tips: Look for the word "live" on the package, since organisms killed by processing won't be helpful. The expiration date may be particularly important, because even if a product still tastes good the bacteria may no longer be alive. For maximum benefit, try to consume a variety of different bacteria, as each may contribute something slightly different.

Sources: Wall Street Journal January 13, 2009

What is GERD or Acid Reflux

Gastroesophageal acid reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.

What are the symptoms of GERD?

The main symptom of GERD acid reflux in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

For more information about acid reflux www.acid-reflux.com/index.html

What are the symptoms of ulcerative colitis?

The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea.
Patients also may experience


anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)


About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.

What causes ulcerative colitis?

Many theories exist about what causes ulcerative colitis. People with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or a result of the disease. The body’s immune system is believed to react abnormally to the bacteria in the digestive tract.

Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms

Crohn’s Disease

What is Crohn’s disease?

Crohn’s disease is an ongoing disorder that causes inflammation of the digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn’s disease is an inflammatory bowel disease, the general name for diseases that cause swelling in the intestines. Because the symptoms of Crohn’s disease are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis, it can be difficult to diagnose. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine. In Crohn’s disease, all layers of the intestine may be involved, and normal healthy bowel can be found between sections of diseased bowel.

Crohn’s disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but it is more often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohn’s disease, and African Americans are at decreased risk for developing Crohn’s disease.

Crohn’s disease may also be called ileitis or enteritis.