Crohn's disease Classification and external resources
The three most common sites of intestinal involvement in Crohn's disease are ileal, ileocolic and colonic. In Anatomy of the Digestive system, the ileum is the final section of the Small intestine. [1]
ICD-10	K50.
ICD-9	555
OMIM	266600
DiseasesDB	3178
MedlinePlus	000249
eMedicine	med/477  ped/507 radio/197
MeSH	D003424

Crohn's disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books In Medicine, enteritis refers to Inflammation of the Small intestine. In Medicine, a chronic disease is a Disease that is long-lasting or recurrent In Medicine, inflammatory bowel disease ( IBD) is a group of inflammatory conditions of the large intestine and Small intestine Autoimmune diseases arise from an overactive Immune response of the body against substances and tissues normally present in the body Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn's disease vary among afflicted individuals. The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. The disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody, though this may not be visible to the naked eye), constipation, vomiting, weight loss or weight gain. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Weight gain is an increase in Body weight. This can be either an increase in Muscle mass, fat deposits or excess fluids such as Water. Crohn's disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye. A rash is a change of the Skin which affects its color appearance or Texture. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory ^[1]

The disease was independently described in 1904 by Polish surgeon Antoni Lesniowski and in 1932 by American gastroenterologist Burrill Bernard Crohn, for whom the disease was named. Antoni Leśniowski ( January 28, 1867 &ndash April 4, 1940) was a Polish Surgeon, credited with publishing what may have been the earliest Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied Burrill Bernard Crohn ( June 13, 1884 in New York – July 29, 1983 in Connecticut) was an American Gastroenterologist Crohn, along with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness. The terminal ileum is the most distal part of the Small intestine. ^[2] Crohn's disease affects between 400,000 and 600,000 people in North America. ^[3] Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given ^[4] Crohn's disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age. ^[1][5]

Although the cause of Crohn's disease is not known, it is believed to be an autoimmune disease that is genetically linked. Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is The highest relative risk occurs in siblings, affecting males and females equally. Smokers are three times more likely to get Crohn's disease.

Unlike the other major types of IBD, there is no known drug based or surgical cure for Crohn's disease. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental ^[6] Treatment options are restricted to controlling symptoms, putting and keeping the disease in remission and preventing relapse. Treatment of Crohn's disease involves first treating the acute symptoms of the disease then maintaining remission. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Remission is the state of absence of Disease activity in patients with known Chronic illness. A relapse (etymologically "who falls again" occurs when a person is affected again by a condition that affected them in the past

Classification

Distribution of gastrointestinal Crohn's disease. Based on data from American Gastroenterological Association. The American Gastroenterological Association is a Medical association of gastroenterologists.

Crohn's disease is generally classified as an autoimmune disease. Autoimmune diseases arise from an overactive Immune response of the body against substances and tissues normally present in the body As it almost invariably affects the gastrointestinal tract, most gastroenterologists categorize the presenting disease by the affected areas. Ileocolic Crohn's disease, which affects both the ileum (the last part of the small intestine that connects to the large intestine) and the large intestine, accounts for fifty percent of cases. In Anatomy of the Digestive system, the ileum is the final section of the Small intestine. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises The large intestine is the last part of the Digestive system: the final stage of the Alimentary canal in Vertebrate Animals Its function is to Crohn's ileitis, affecting the ileum only, accounts for thirty percent of cases, and Crohn's colitis, affecting the large intestine, accounts for the remaining twenty percent of cases, and may be particularly difficult to distinguish from ulcerative colitis. The disease can attack any part of the digestive tract, from mouth to anus. The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. However, individuals affected by the disease rarely fall outside these three classifications, being affected in other parts of the gastrointestinal tract such as the stomach and esophagus. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in ^[1] Crohn's disease may also be categorized by the behaviour of disease as it progresses. This was formalized in the Vienna classification of Crohn's disease. ^[7] There are three categories of disease presentation in Crohn's disease: stricturing, penetrating, and inflammatory. Stricturing disease causes narrowing of the bowel which may lead to bowel obstruction or changes in the caliber of the feces. Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus Penetrating disease creates abnormal passageways (fistulae) between the bowel and other structures such as the skin. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect Inflammatory disease (or non-stricturing, non-penetrating disease) causes inflammation without causing strictures or fistulae. ^[7][8]

Symptoms

Endoscopy image of colon showing serpiginous ulcer, a classic finding in Crohn's disease

Many people with Crohn's disease have symptoms for years prior to the diagnosis. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. Serpiginous, often referring to some chronic medical affliction signifies it as slowly progressive or "creeping" such as Ringworm. ^[9] The usual onset is between 15 and 30 years of age but can occur at any age. ^[10] Because of the patchy nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more vague than with ulcerative colitis. People with Crohn's disease will go through periods of flare-ups and remission.

Gastrointestinal symptoms

Abdominal pain may be the initial symptom of Crohn's disease. Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease The pain is commonly cramp-like and may be relieved by defecation. Cramps, sometimes called Charley horses are unpleasant often painful sensations caused by contraction or over shortening of Muscles Cramps can be caused by cold Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract It is often accompanied by diarrhea, which may or may not be bloody, though diarrhea is not uncommon especially in those who have had surgery. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea People who have had surgery or multiple surgeries often end up with short bowel syndrome of the gastrointestinal tract. Short bowel syndrome ( SBS, also short gut syndrome or simply short gut) is a Malabsorption disorder caused by the surgical removal The nature of the diarrhea in Crohn's disease depends on the part of the small intestine or colon that is involved. Ileitis typically results in large-volume watery feces. Colitis may result in a smaller volume of feces of higher frequency. Fecal consistency may range from solid to watery. In severe cases, an individual may have more than 20 bowel movements per day and may need to awaken at night to defecate. Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract ^{[1][5][11][12]} Visible bleeding in the feces is less common in Crohn's disease than in ulcerative colitis, but may be seen in the setting of Crohn's colitis. ^[1] Bloody bowel movements are typically intermittent, and may be bright or dark red in colour. In the setting of severe Crohn's colitis, bleeding may be copious. ^[5] Flatus and bloating may also add to the intestinal discomfort. Flatulence is the production of a mixture of gases in the digestive tract of Mammals that are byproducts of the digestion process ^[5]

Symptoms caused by intestinal stenosis are also common in Crohn's disease. A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel Abdominal pain is often most severe in areas of the bowel with stenoses. In the setting of severe stenosis, vomiting and nausea may indicate the beginnings of small bowel obstruction. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion ^[5] Crohn's disease may also be associated with primary sclerosing cholangitis, a type of inflammation of the bile ducts. Primary sclerosing cholangitis ( PSC) is a chronic liver disease caused by progressive Inflammation and scarring of the Bile ducts of the liver

Perianal discomfort may also be prominent in Crohn's disease. Itchiness or pain around the anus may be suggestive of inflammation, fistulization or abscess around the anal area^[1] or anal fissure. The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process An anal fissure is an unnatural crack or tear in the Anus skin Perianal skin tags are also common in Crohn's disease. An acrochordon (aka skin tag, pedunculated papilloma, or fibroepithelial polyp) is a small Benign Tumor that forms primarily in ^[13] Fecal incontinence may accompany peri-anal Crohn's disease. Fecal incontinence is the loss of regular control of the Bowels. At the opposite end of the gastrointestinal tract, the mouth may be affected by non-healing sores (aphthous ulcers). Rarely, the esophagus, and stomach may be involved in Crohn's disease. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following These can cause symptoms including difficulty swallowing (odynophagia), upper abdominal pain, and vomiting. Odynophagia is Painful Swallowing, in the mouth ( Oropharynx) or Esophagus. ^[14]

Systemic symptoms

Crohn's disease, like many other chronic, inflammatory diseases, can cause a variety of systemic symptoms. B symptoms refer to Systemic symptoms of Fever, Night sweats and Weight loss which can be associated with both Hodgkin's lymphoma ^[1] Among children, growth failure is common. Growth failure is a medical term for a pattern of a child's growth which is poorer than normal for age sex stage of maturation and genetic height expectation Many children are first diagnosed with Crohn's disease based on inability to maintain growth. Failure to thrive (FTT is a medical term which denotes poor weight gain and physical growth failure over an extended period of time in Infancy. ^[15] As Crohn's disease may manifest at the time of the growth spurt in puberty, up to 30% of children with Crohn's disease may have retardation of growth. ^[16] Fever may also be present, though fevers greater than 38. 5 ˚C (101. The Celsius Temperature scale was previously known as the centigrade scale. 3 ˚F) are uncommon unless there is a complication such as an abscess^[1] Among older individuals, Crohn's disease may manifest as weight loss. Fahrenheit is a temperature scale named after Daniel Gabriel Fahrenheit (1686–1736 a German Physicist who proposed it in 1724 An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process This is usually related to decreased food intake, since individuals with intestinal symptoms from Crohn's disease often feel better when they do not eat and might lose their appetite. ^[15] People with extensive small intestine disease may also have malabsorption of carbohydrates or lipids, which can further exacerbate weight loss. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. Carbohydrates (from ' Hydrates of Carbon ' or saccharides ( Greek σάκχαρον meaning " Sugar " are the most Lipids are broadly defined as any fat- Soluble ( lipophilic) naturally-occurring Molecule, such as fats oils waxes cholesterol sterols fat-soluble ^[17]

Extraintestinal symptoms

Erythema nodosum

In addition to systemic and gastrointestinal involvement, Crohn's disease can affect many other organ systems. ^[18] Inflammation of the interior portion of the eye, known as uveitis, can cause eye pain, especially when exposed to light (photophobia). Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Inflammation may also involve the white part of the eye (sclera), a condition called episcleritis. The sclera, called the white or white of the eye, is the opaque (usually white though certain animals such as horses and lizards can have black sclera fibrous Scleritis is a serious inflammatory Disease that affects the white outer coating of the Eye, known as the Sclera. Both episcleritis and uveitis can lead to loss of vision if untreated.

Crohn's disease is associated with a type of rheumatologic disease known as seronegative spondyloarthropathy. Rheumatology is a sub-specialty in Internal medicine and Pediatrics, devoted to the Diagnosis and therapy of Rheumatic diseases. This group of diseases is characterized by inflammation of one or more joints (arthritis) or muscle insertions (enthesitis). A joint is the location at which two or more Bones make contact Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Enthesitis is an Inflammation of the Entheses, the location where a bone has an insertion to a tendon or a ligament The arthritis can affect larger joints such as the knee or shoulder or may exclusively involve the small joints of the hand and feet. The arthritis may also involve the spine, leading to ankylosing spondylitis if the entire spine is involved or simply sacroiliitis if only the lower spine is involved. Ankylosing spondylitis ( AS; previously known as Bechterew's disease, Bechterew syndrome, Marie Strümpell disease and a form of Spondyloarthritis In Medicine, sacroiliitis is an inflammation of the Sacroiliac joint. The symptoms of arthritis include painful, warm, swollen, stiff joints and loss of joint mobility or function. Arthralgia (from Greek arthro-, joint + -algos, pain literally means joint pain; it is a symptom of injury infection illnesses -- in particular

Crohn's disease may also involve the skin, blood, and endocrine system. The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental One type of skin manifestation, erythema nodosum, presents as red nodules usually appearing on the shins. Erythema nodosum (EN ( red nodules) is an Inflammation of the fat cells under the skin ( Panniculitis) Erythema nodosum is due to inflammation of the underlying subcutaneous tissue and is characterized by septal panniculitis. Panniculitis is a group of diseases whose hallmark is Inflammation of Subcutaneous Adipose tissue Another skin lesion, pyoderma gangrenosum, is typically a painful ulcerating nodule. Pyoderma gangrenosum is a disease that causes tissue to become necrotic, causing deep Ulcers that usually occur on the legs Crohn's disease also increases the risk of blood clots; painful swelling of the lower legs can be a sign of deep venous thrombosis, while difficulty breathing may be a result of pulmonary embolism. In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein Autoimmune hemolytic anemia, a condition in which the immune system attacks the red blood cells, is also more common in Crohn's disease and may cause fatigue, pallor, and other symptoms common in anemia. Autoimmune hemolytic anemia (AIHA is a type of Hemolytic anemia where the body's immune system attacks its own Red blood cells (RBCs leading to their destruction Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Clubbing, a deformity of the ends of the fingers, may also be a result of Crohn's disease. In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a Finally, Crohn's disease may cause osteoporosis, or thinning of the bones. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Individuals with osteoporosis are at increased risk of bone fractures. A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken ^[4]

Crohn's disease can also cause neurological complications (reportedly in up to 15% of patients). ^[19] The most common of these are seizures, stroke, myopathy, peripheral neuropathy, headache and depression. ^[19]

Crohn's patients often also have issues with Small bowel bacterial overgrowth syndrome, which has similar symptoms. Small bowel bacterial overgrowth syndrome ( SBBOS) or small intestinal bacterial overgrowth ( SIBO) also termed bacterial overgrowth; is ^[20]

Complications

Endoscopic image of colon cancer identified in the sigmoid colon (anatomy) on screening colonoscopy for Crohn's disease. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic

Crohn's disease can lead to several mechanical complications within the intestines, including obstruction, fistulae, and abscesses. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process Obstruction typically occurs from strictures or adhesions which narrow the lumen, blocking the passage of the intestinal contents. A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel Adhesions are fibrous bands that form between tissues and organs often as a result of injury during surgery Fistulae can develop between two loops of bowel, between the bowel and bladder, between the bowel and vagina, and between the bowel and skin. Abscesses are walled off collections of infection, which can occur in the abdomen or in the perianal area in Crohn's disease sufferers. An infection is the detrimental Colonization of a host Organism by a foreign Species. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis.

Crohn's disease also increases the risk of cancer in the area of inflammation. For example, individuals with Crohn's disease involving the small bowel are at higher risk for small intestinal cancer. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises In Oncology, small intestine cancer, also small bowel cancer and cancer of the small bowel, is a Cancer of the Small intestine. Similarly, people with Crohn's colitis have a relative risk of 5. In Statistics and mathematical Epidemiology, relative risk (RR is the risk of an event (or of developing a disease relative to exposure 6 for developing colon cancer. Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and ^[21] Screening for colon cancer with colonoscopy is recommended for anyone who has had Crohn's colitis for eight years, or more. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic ^[22]

Individuals with Crohn's disease are at risk of malnutrition for many reasons, including decreased food intake and malabsorption. Malnutrition is a general term for a medical condition caused by an improper or insufficient diet. Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. The risk increases following resection of the small bowel. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises Such individuals may require oral supplements to increase their caloric intake, or in severe cases, total parenteral nutrition (TPN). Total Parenteral nutrition (TPN is the practice of feeding a person Intravenously bypassing the usual process of Eating and Digestion. Most people with moderate or severe Crohn's disease are referred to a dietitian for assistance in nutrition. A dietitian (also 'dietician' though 'dietitian' is used consistently by professionals is an expert in Food and Nutrition. ^[23]

Crohn's disease can cause significant complications including bowel obstruction, abscesses, free perforation and hemorrhage. Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion Gastrointestinal perforation is a complete penetration of the wall of the stomach small intestine or large bowel resulting in intestinal contents flowing into the abdominal cavity Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from ^[24]

Crohn's disease can be problematic during pregnancy, and some medications can cause adverse outcomes for the fetus or mother. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and Consultation with an obstetrician and gastroenterologist about Crohn's disease and all medications allows preventative measures to be taken. In some cases, remission can occur during pregnancy. Certain medications can also impact sperm count or may otherwise adversely affect a man's ability to conceive. A semen analysis evaluates certain characteristics of a man's Semen and the sperm contained in the semen For soil improvement see Fertilization (soil. ^[25]

Cause

Schematic of NOD2 CARD15 gene, which is associated with certain disease patterns in Crohn's disease

The exact cause of Crohn's disease is unknown. However, genetic and environmental factors have been invoked in the pathogenesis of the disease. The term pathogenesis means step by step development of a disease due to a series of changes in the structure and /or function of a cell/tissue/organ being caused by a microbial, chemical or physical Research has indicated that Crohn's disease has a strong genetic link. ^[26] The disease runs in families and those with a sibling with the disease are 30 times more likely to develop it than the normal population. Ethnic background is also a risk factor. Until very recently, whites and European Jews accounted for the vast majority of the cases in the United States, and in most industrialized countries, this demographic is still true.

Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn's disease^[27] and with susceptibility to certain phenotypes of disease location and activity. In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism NOD2 ( n ucleotide-binding o ligomerization d omain containing 2) is a Protein, also known as the caspase recruitment domain History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance ^[28] In earlier studies, only two genes were linked to Crohn's, but scientists now believe there are over eight genes that show genetics play a crucial role in the disease.

A handful of cases of Crohn's disease cases were reported at the turn of the 20th century, but since then, the disease has continued to increase in prevalence dramatically. Some argue that this increase has been the result of a genetic shift in the population caused by conditions favoring individuals carrying the genes linked with the disease. These conditions could be a lower infant mortality rate or better health care in the nations that have the highest incidence of disease (industrialized nations).

Others argue that Crohn's disease is caused by a combination of environmental and genetic factors. Many environmental factors have also been hypothesized as causes or risk factors for Crohn's disease. Proven environmental risk factors include living in an industrialized country, smoking, and living in an urban area. Diets high in sweet, fatty or refined foods may also play a role. Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water Food processing is the set of methods and techniques used to transform raw Ingredients into Food or to transform food into other forms for consumption by A retrospective Japanese study found that those diagnosed with Crohn's disease had higher intakes of sugar, fat, fish and shellfish than controls prior to diagnosis. ^[29] A similar study in Israel also found higher intakes of fats (especially chemically modified fats) and sucrose, with lower intakes of fructose and fruits, water, potassium, magnesium and vitamin C in the diets of Crohn's disease sufferers before diagnosis,^[30] and cites three large European studies in which sugar intake was significantly increased in people with Crohn's disease compared with controls. Solubility of Pure SucroseTemperature(Cg Fructose (also levulose or laevulose) is a simple reducing Sugar ( Monosaccharide) found in many foods and is one of the three Potassium (pəˈtæsiəm is a Chemical element. It has the symbol K (kalium from qalīy Atomic number 19 and Atomic mass 39 Magnesium (mægˈniːziəm is a Chemical element with the symbol Mg, Atomic number 12 Atomic weight 24 Certain chemicals in the diet, known as microparticles, are also hypothesized as a risk factor for the disease, as well as a poor imbalance of omega-6 to healthy omega-3 fatty acids that emerging research shows helps to improve all types of inflammatory disease. The most common forms of microparticles include titanium dioxide, aluminosilicates, anatase, calcium phosphate, and soil residue. These substances are ubiquitous in processed food and most toothpastes and lip glosses. Soil residue is found on fresh fruits and vegetables unless carefully removed.

Smoking has been shown to increase the risk of the return of active disease, or "flares". Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. ^[31] The introduction of hormonal contraception in the United States in the 1960s is linked with a dramatic increase in the incidence rate of Crohn's disease. Hormonal contraception refers to Birth control methods that act on the hormonal system Although a causal linkage has not been effectively shown, there remain fears that these drugs work on the digestive system in similar ways to smoking. ^[32]

Additionally, many in the scientific community believe that early childhood exposure to illness is necessary to the creation of a proper immune system for those with the genetic susceptibility for Crohn's Disease. Higher incidences of Crohn's Disease are associated with cleaner living conditions. Throughout the early and mid-20th century in the United States, the disease was strongly associated with upper-class populations, and today the disease does not yet exist in the many Third World countries, despite the fact that it occurs in all races. Third World is a name given to nations that are generally considered to be underdeveloped economically CD is also associated with first born and single children (because they would have less exposure to childhood illness from siblings) and in populations that have low incidences of gastric cancer. Gastric cancer is most often caused by the bacterium Helicobacter pylori that flourishes in cramped and unsanitary conditions. Stomach or gastric cancer can develop in any part of the Stomach and may spread throughout the stomach and to other organs particularly the Esophagus and Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. ^[33]

Abnormalities in the immune system have often been invoked as being causes of Crohn's disease. Immunity is a material term that describes a state of having sufficient biological defenses to avoid Infection, Disease, or other unwanted biological invasion It has been hypothesized that Crohn's disease involves augmentation of the T_h1 of cytokine response in inflammation. T helper cells (also known as effector T cells or Th cells) are a sub-group of Lymphocytes (a type of White blood cell or Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular ^[34] The most recent gene to be implicated in Crohn's disease is ATG16L1, which may reduce the effectiveness of autophagy, and hinder the body's ability to attack invasive bacteria. ^[35]

A variety of pathogenic bacteria were initially suspected of being causative agents of Crohn's disease. However, the current consensus is that a variety of microorganisms are simply taking advantage of their host's weakened mucosal layer and inability to clear bacteria from the intestinal walls, both symptoms of the disease. ^[36] Some studies have linked Mycobacterium avium subsp. paratuberculosis to Crohn's disease, in part because it causes a very similar disease, Johne's disease, in cattle. Mycobacterium avium subspecies paratuberculosis is an obligate Pathogenic bacteria in the Genus Mycobacteria. Johne's disease (pronounced "yo-knees" is a contagious chronic and sometimes fatal Infection that affects primarily the Small intestine of Ruminants ^[37] The mannose bearing antigens, mannins, from yeast may also elicit pathogenic anti saccharomyces cerevisiae antibodies. Mannose is a Sugar Monomer of the Hexose series of Carbohydrates Metabolism Mannose enters the carbohydrate Metabolism Anti- Saccharomyces cerevisiae antibodies ( ASCA) along with perinuclear antineutrophil cytoplasmic antibodies (pANCA are among the two most useful and often discriminating ^[38] Newer studies have linked specific strains of enteroadherent E. coli to the disease but failed to find evidence of contributions by other species. ^[39]

Several scientific studies have posited that Accutane is a probable cause of Crohn's Disease and Ulcerative colitis in some individuals. Isotretinoin ( INN) (aɪsoʊtrɨˈtɪnoʊɨn or /ˌaɪsoʊtrɨˈtɪnoʊɨn/ is a Medication used for the treatment of severe acne. Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD Three cases in the United States have gone to trial thus far, with all three resulting in multi-million dollar judgements against the makers of isotretinoin; there are an additional 425 cases pending. [1] [2] [3] [4] [5]

Pathophysiology

Section of colectomy showing transmural inflammation

At the time of colonoscopy, biopsies of the colon are often taken in order to confirm the diagnosis. Colectomy consists of the surgical Resection of any extent of the large intestine ( colon) Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues There are certain characteristic features of the pathology seen that point toward Crohn's disease. Pathology (from Greek grc πάθος pathos, "fate harm" and grc -λογία -logia) is the study and Crohn's disease shows a transmural pattern of inflammation, meaning that the inflammation may span the entire depth of the intestinal wall. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens ^[1] Grossly, ulceration is an outcome seen in highly active disease. Ulcers are healing wounds that develop on the skin mucous membranes or eye There is usually an abrupt transition between unaffected tissue and the ulcer. Under a microscope, biopsies of the affected colon may show mucosal inflammation. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in This inflammation is characterized by focal infiltration of neutrophils, a type of inflammatory cell, into the epithelium. Neutrophil granulocytes, generally referred to as neutrophils, are the most abundant type of White blood cells in humans and form an essential part of the In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body This typically occurs in the area overlying lymphoid aggregates. The lymphatic system in Vertebrates is a network of conduits that carry a clear fluid called Lymph. These neutrophils, along with mononuclear cells, may infiltrate into the crypts leading to inflammation (crypititis) or abscess (crypt abscess). A lymphocyte is a type of White blood cell in the Vertebrate Immune system. The crypts of Lieberkühn (or intestinal glands) are Glands found in the Epithelial lining of the Small intestine and colon. Granulomas, aggregates of macrophage derivatives known as giant cells, are found in 50% of cases and are most specific for Crohn's disease. In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted Macrophages ( Greek: "big eaters" from makros "large" + phagein "eat" ( Mø) are cells within the tissues that The granulomas of Crohn's disease do not show "caseation", a cheese-like appearance on microscopic examination that is characteristic of granulomas associated with infections such as tuberculosis. Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Biopsies may also show chronic mucosal damage as evidenced by blunting of the intestinal villi, atypical branching of the crypts, and change in the tissue type (metaplasia). Villus ( Latin: "shaggy hair" plural villi) can refer to Intestinal villus. Metaplasia ( Greek: "change in form" is the reversible replacement of one differentiated Cell type with another mature differentiated cell type One example of such metaplasia, Paneth cell metaplasia, involves development of Paneth cells (typically found in the small intestine) in other parts of the gastrointestinal system. ^[40]

Diagnosis

Endoscopic image of Crohn's colitis showing deep ulceration

CT scan showing Crohn's disease in the fundus of the stomach

Crohn's disease can mimic ulcerative colitis on endoscopy. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic Computed tomography (CT is a Medical imaging method employing Tomography. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD This endoscopic image is of Crohn's colitis showing diffuse loss of mucosal architecture, friability of mucosa in sigmoid colon and exudate on wall, all of which can be found with ulcerative colitis. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in Friability means the ability to reduce a Solid substance into smaller pieces with little effort

The diagnosis of Crohn's disease can sometimes be challenging,^[9] and a number of tests are often required to assist the physician in making the diagnosis. ^[5] Even with a full battery of tests it may not be possible to diagnose Crohn's with complete certainty; a colonoscopy is approximately 70% effective in diagnosing the disease with further being less effective. Disease in the small bowel is particularly difficult to diagnose as a traditional colonoscopy only allows access to the colon and lower portions of the small intestines; introduction of the Capsule endoscopy^[41] aids in endoscopic diagnosis. Capsule Endoscopy is a term used to describe a miniature capsule used to record images through the Digestive tract for use in Medicine.

Endoscopy

A colonoscopy is the best test for making the diagnosis of Crohn's disease as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement. Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic The terminal ileum is the most distal part of the Small intestine. Occasionally, the colonoscope can travel past the terminal ileum but it varies from patient to patient. During the procedure, the gastroenterologist can also perform a biopsy, taking small samples of tissue for laboratory analysis which may help confirm a diagnosis. Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues As 30% of Crohn's disease involves only the ileum,^[1] cannulation of the terminal ileum is required in making the diagnosis. A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal Finding a patchy distribution of disease, with involvement of the colon or ileum but not the rectum, is suggestive of Crohn's disease, as are other endoscopic stigmata. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals ^[42]The utility of capsule endoscopy for this, however, is still uncertain. ^[43]

Radiologic tests

A small bowel follow-through may suggest the diagnosis of Crohn's disease and is useful when the disease involves only the small intestine. A barium follow-through procedure is a type of Medical imaging technique Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum As a result, a barium follow-through x-ray, wherein barium sulfate suspension is ingested and fluoroscopic images of the bowel are taken over time, is useful for looking for inflammation and narrowing of the small bowel. A barium follow-through procedure is a type of Medical imaging technique Barium sulfate is a white crystalline solid with the chemical formula BaSO4 Fluoroscopy is an imaging technique commonly used by Physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope ^[42][44] Barium enemas, in which barium is inserted into the rectum and fluoroscopy used to image the bowel, are rarely used in the work-up of Crohn's disease due to the advent of colonoscopy. They remain useful for identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through, or in the detection of colonic fistulae. ^[45]

CT and MRI scans are useful for evaluating the small bowel with enteroclysis protocols. Computed tomography (CT is a Medical imaging method employing Tomography. Enteroclysis is a Fluoroscopic X-ray of the Small intestine. Radiocontrast is infused through a tube inserted through the nose to the Duodenum ^[46]They are additionally useful for looking for intra-abdominal complications of Crohn's disease such as abscesses, small bowel obstruction, or fistulae. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process ^[47] Magnetic resonance imaging (MRI) are another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available^[48]

Blood tests

A complete blood count may reveal anemia, which may be caused either by blood loss or vitamin B₁₂ deficiency. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Cyanocobalamin is an especially common Vitamer of the B-12 vitamin family. The latter may be seen with ileitis because vitamin B₁₂ is absorbed in the ileum. In Anatomy of the Digestive system, the ileum is the final section of the Small intestine. ^[49] Erythrocyte sedimentation rate, or ESR, and C-reactive protein measurements can also be useful to gauge the degree of inflammation. The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells C-reactive protein ( CRP) is a Plasma protein, an Acute phase protein produced by the Liver and by Adipocytes. ^[50] It is also true in patient with ilectomy done in response to the complication. Another cause of anaemia is anaemia of chronic disease, characterized by its microcytic and hypochromic anaemia. There can be various reasons for anaemia, including medication used in treatment of inflammatory bowel disease like azathioprine which can lead to cytopenia and sulfasalazine which can also result in folate malabsorption, etc. Testing for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammatory diseases of the intestine^[51] and to differentiate Crohn's disease from ulcerative colitis. Saccharomyces cerevisiae is a Species of Budding Yeast. It is perhaps the most useful Yeast owing to its use since ancient times Anti-neutrophil cytoplasmic antibodies ( ANCAs) are a group of mainly IgG Antibodies against Antigens in the Cytoplasm of ^[52]

Comparison with ulcerative colitis

The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis. ^[11][1][5]

Treatment

Main articles: Treatment of Crohn's disease and Biological therapy for inflammatory bowel disease

Currently there is no cure for Crohn's disease and remission may not be possible or prolonged if achieved;^[56] in cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes and in some cases, surgery. The terminal ileum is the most distal part of the Small intestine. The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. Primary sclerosing cholangitis ( PSC) is a chronic liver disease caused by progressive Inflammation and scarring of the Bile ducts of the liver Ulcers are healing wounds that develop on the skin mucous membranes or eye In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular T helper cells (also known as effector T cells or Th cells) are a sub-group of Lymphocytes (a type of White blood cell or In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Treatment of Crohn's disease involves first treating the acute symptoms of the disease then maintaining remission. Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease Remission is the state of absence of Disease activity in patients with known Chronic illness. A relapse (etymologically "who falls again" occurs when a person is affected again by a condition that affected them in the past A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Adequately controlled, Crohn's disease may not significantly restrict daily living. ^[57] Treatment for Crohn's disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission. In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course Remission is the state of absence of Disease activity in patients with known Chronic illness.

Medication

Acute treatment uses medications to treat any infection (normally antibiotics) and to reduce inflammation (normally aminosalicylate anti-inflammatory drugs and corticosteroids). In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. When symptoms are in remission, treatment enters maintenance with a goal of avoiding the recurrence of symptoms. Prolonged use of corticosteroids has significant side-effects; as a result they are generally not used for long-term treatment. In Medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as Chemotherapy or Surgery. Alternatives include aminosalicylates alone, though only a minority are able to maintain the treatment, and many require immunosuppressive drugs. ^[54]

Medications used to treat the symptoms of Crohn's disease include 5-aminosalicylic acid (5-ASA) formulations , prednisone, immunomodulators such as azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab^[11] and natalizumab. Mesalazine ( INN, BAN) also known as Mesalamine ( USAN) or 5-aminosalicylic acid (5-ASA is an Anti-inflammatory Prednisone is a synthetic Corticosteroid drug that is usually taken orally but can be delivered by Intramuscular injection and can be used for a great number Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory Mercaptopurine (also called 6-Mercaptopurine 6-MP or its brand name Purinethol) is an Immunosuppressive drug used to treat Leukemia. Infliximab (brand name Remicade) is a drug used to treat Autoimmune disorders. Adalimumab (brand name HUMIRA) is the third TNF inhibitor, after Infliximab and Etanercept, to be approved in the United States. Natalizumab is a humanized Monoclonal antibody against the Cellular adhesion molecule α4-integrin. ^[58][59]

Lifestyle changes

Certain lifestyle changes can reduce symptoms, including dietary adjustments, proper hydration and smoking cessation. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. Smoking cessation is the effort to stop smoking Tobacco products ^[57]

Surgery

Crohn's cannot be cured by surgery, though it is used when partial or a full blockage of the intestine occurs. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Surgery may also be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs within a reasonable time. After the first surgery, Crohn's usually shows up at the site of the resection though it can appear in other locations. After a resection, scar tissue builds up which causes strictures. A stricture is when the intestines becomes too small to allow excrement to pass through easily which can lead to a blockage. After the first resection, another resection may be necessary within five years. ^[60] For patients with an obstruction due to a stricture, two options for treatment are strictureplasty and resection of that portion of bowel. There is no statistical significance between strictureplasty alone versus strictureplasty and resection in cases of duodenal involvement. In Statistics, a result is called statistically significant if it is unlikely to have occurred by Chance. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum In these cases, re-operation rates were 31% and 27%, respectively, indicating that strictureplasty is a safe and effective treatment for selected patients with duodenal involvement. ^[61]

Short bowel syndrome (SBS, also short gut syndrome or simply short gut) can be caused by the surgical removal of the small intestines. Short bowel syndrome ( SBS, also short gut syndrome or simply short gut) is a Malabsorption disorder caused by the surgical removal It usually develops if a person has had half or more of their small intestines removed. ^[62] Diarrhea is the main symptom of short bowel syndrome though other symptoms may include cramping, bloating and heartburn. Short bowel syndrome is treated with changes in diet, intravenous feeding, vitamin and mineral supplements and treatment with medications.

Prospective treatments

Researchers at University College London have questioned the wisdom of suppressing the immune system in Crohn's, as the problem may be an under-active rather than an over-active immune system: their study found that Crohn's patients showed an abnormally low response to an introduced infection, marked by a poor flow of blood to the wound, and the response improved when the patients were given sildenafil. University College London ( UCL) is a multi-faculty university institution based in the United Kingdom and a constituent college of the University of London Sildenafil citrate, sold as Viagra, Revatio and under various other trade names is a drug used to treat Erectile dysfunction (male impotence ^[63]

Recent studies using helminthic therapy or hookworms to treat Crohn's Disease and other (non-viral) auto-immune diseases seem to yield promising results. Helminthic therapy is the treatment of Autoimmune diseases and Immune disorders by means of deliberate infestation with a Helminth or with the ova of a helminth The hookworm is a parasitic Nematode worm that lives in the Small intestine of its host which may be a Mammal such as a Dog, ^[64]

A single, small, uncontrolled trial of patients with mild Crohn's on stable medications suggested improvement with low dose naltrexone therapy. Low dose naltrexone (LDN, where Naltrexone is used in doses approximately one-tenth those used for drug/alcohol rehabilitation purposes is being used as an " off-label ^[65]

Prognosis

Crohn's disease is a chronic condition for which there is currently no cure. In Medicine, a chronic disease is a Disease that is long-lasting or recurrent It is characterised by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is low. Crohn's disease is associated with an increased risk of small bowel and colorectal carcinoma. ^[66]

Epidemiology

The incidence of Crohn's disease has been ascertained from population studies in Norway and the United States and is similar at 6 to 7. Norway ( Norwegian: Norge ( Bokmål) or Noreg ( Nynorsk) officially the Kingdom of Norway, is a Constitutional The United States of America —commonly referred to as the 1:100,000. ^[67][68] Crohn's disease is more common in northern countries, and shows a higher preponderance in northern areas of the same country. ^[69] The incidence of Crohn's disease is thought to be similar in Europe but lower in Asia and Africa. ^[67] It also has a higher incidence in Ashkenazi Jews. Ashkenazi Jews, also known as Ashkenazic Jews or Ashkenazim ( Hebrew: אַשְׁכֲּנָזִים, ˌaʃkəˈnazim sing ^[11]

Crohn's disease has a bimodal distribution in incidence as a function of age: the disease tends to strike people in their teens and 20s, and people in their 50s through to their 70s, and ages in between due to not being diagnosed with Crohn's and being diagnosed instead with irritable bowel syndrome IBS. Incidence is a measure of the risk of developing some new condition within a specified period of time ^[1][5] It is rarely diagnosed in early childhood. It usually strikes females more than males. [6] Parents, siblings or children of people with Crohn's disease are 3 to 20 times more likely to develop the disease. ^[70] Twin studies show a concordance of greater than 55% for Crohn's disease. ^[71]

History

Inflammatory bowel diseases were described by Giovanni Battista Morgagni (1682-1771), by Polish surgeon Antoni Leśniowski in 1904 (leading to the use of the eponym "Leśniowski-Crohn disease" in Poland) and by Scottish physician T. Giovanni Battista Morgagni ( February 25, 1682 – December 6, 1771) Italian anatomist, was born on at Forlì Poland (Polska officially the Republic of Poland Scotland ( Gaelic: Alba) is a Country in northwest Europethat occupies the northern third of the island of Great Britain. Kennedy Dalziel in 1913. ^[72]

Burrill Bernard Crohn, an American gastroenterologist at New York City's Mount Sinai Hospital, described fourteen cases in 1932, and submitted them to the American Medical Association under the rubric of "Terminal ileitis: A new clinical entity". Burrill Bernard Crohn ( June 13, 1884 in New York – July 29, 1983 in Connecticut) was an American Gastroenterologist The City of New York This page is about a hospital in New York For other uses please see disambiguation pages for Mount Sinai or Mount Sinai Hospital. The American Medical Association (AMA founded in 1847 and incorporated 1897 is the largest association of Physicians and Medical students in the United States Later that year, he, along with colleagues Leon Ginzburg and Gordon Oppenheimer published the case series as "Regional ileitis: a pathologic and clinical entity". ^[2]

See also

• Crohn's and Colitis Foundation of America
• List of Crohn's disease organizations worldwide
• Urinary incontinence
• Incontinence

References