2. Introduction
• Crohn’s Disease is an idiopathic, chronic, transmural
inflammatory process of the bowel that can affect
any part of the gastro intestinal tract from the mouth
to theanus.
• Most casesinvolve the small bowel, particularly the
terminal ileum.
3. History
• 1806: First reported case of Crohn’s by Combe and
Sanders to the Royal College of Physicians in London,
England.
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1913: Surgical evidence of the disease reported in the
paper ‘Chronic Intestinal Enteritis’ written by Dr.
Kennedy.
Described in 1932 by Crohn, Ginsburg, and
Oppenheimer of Mount Sinai Hospital in New York.
4. Prevalence
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Higher number of cases of Crohn’s disease found in
western industrialized nations.
Males and females are equally affected.
Smokersare three times more likely to develop Crohn's
disease.
Crohn's disease affects between 400,000 and
600,000 people in NorthAmerica.
Prevalence estimates for Northern Europe have ranged
from 27–48 per 100,000.
Crohn's disease tends to present initially in the teens
and twenties.
Malathi and Shivabalan reported CDcasesin Southern
India.
5. Classification of CD
Onthe area of the gastrointestinal tract which it
affects:
• Ileocolic Crohn's disease:Affects both the ileum
and the large intestine(50%)
• Crohn's ileitis:Affects the ileum only(30%)
• Crohn's colitis: Affects the large intestine,
accounts for the remaining twenty percent of
cases.
6. Classification of CD
Onthe behavior of disease asit progresses:
• Stricturing disease causes narrowing of the bowel
which may lead to bowel obstruction or changes in the
caliber of thefeces.
Stricturing
7. Symptoms
• Onset of Crohn's disease is between 15-30
years of age.
• People with Crohn's disease will go through
periods of flare-ups andremission.
8. Gastrointestinal Symptoms
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Abdominal pain,diarrhoea, flatulence, bloating,perianal
discomfort .
People who have had surgery often end up withshort
bowel syndrome of the gastrointestinaltract.
Ileitis results in large volume watery feces &colitis result
in asmaller volume of feces of higherfrequency.
In severe cases,an individual may have more than 20
bowel movements per day and may need to awakenat
night to defecate.
Themouth may be affected by non-healingsores
(aphthous ulcers).
Difficulty in swallowing(dysphagia).
9. Systemic Symptoms
• Up to 30%of children with Crohn's disease have retardation
of growth.
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Among older individuals, Crohn's disease may manifest
as weight loss related to decreased foodintake
People with extensive small intestine disease also have
malabsorption of carbohydrates or lipids, which can further
exacerbate weight loss.
10. Extraintestinal Symptoms
• Crohn's disease also increases the risk of bloodclots;
painful swelling of the lower legs can be asign of
deep venous thrombosis.
• Difficult breathing may be aresult ofpulmonary
embolism.
• Autoimmune hemolytic anemia, acondition inwhich
the immune system attacks the red bloodcells.
11. Causes ofCrohn’s Disaese
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Genetics
The disease runs in families then 30 times more likely to
develop CD.
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Mutations in the NOD2 /CARD15 gene are associated with
Crohn's disease.
Over 30 genes that show genetics play a role in the disease,
either directly through causation or indirectly as with a
mediator variable.
• Anomalies in the XBP1 gene have recently been identified as
a factor, pointing towards a role for the unfolded protein
response pathway of the endoplasmatic reticulum in
inflammatory bowel diseases.
NOD2: nucleotide-binding oligomerization domain containing 2
CARD15:CathapseActivation RecruitmentDomain
12. Environmental Factors
• Smoking hasbeen shown to increase the risk of the return of active
disease,or "flares".
• Hormonal contraception in the USin the 1960s is linked with a
dramatic increase in the incidence rate of Crohn's disease.
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Immune System
Crohn's disease is thought to be an autoimmune disease, with
inflammation stimulated by an over-active Th1cytokineresponse.
• Recent gene to be implicated in Crohn's disease is ATG16L1, which
may induce autophagy and hinder the body's ability to attack
invasive bacteria.
13. Intestinal Complications of Crohn's Disease
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SoreorUlcer
Thecells in lining ofthe intestines are shed and replaced on a
regular basisin ahealthy body.
• When the lining of the intestine is irritated, cells may be shed
more frequently, causingulcers.
• Thesores and ulcers are most common in ileum, colonor
rectum.
• Ulcers can be serious if they go through theintestines and
damage an artery.
• Thiscan lead to life-threateningbleeding.
14. Intestinal Complications of Crohn's
Disease
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Cancer
Crohn's disease may increase risk of developingcancer.
• If the inflammation is mainly in small intestine, risk of cancer
of the small intestine isincreased.
• Therisk of cancer gets higher asgreat as32 times the normal
rate if thewhole colon is involved.
15. Systemic Complications ofCrohn's
Disease
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Joint Problems
Up to 25 percent of people with Crohn's disease will have
joint complications.
• Thismay include intermittent joint tenderness orarthritis
include ankylosing spondylitis.
Ankylosingspondylitis
16. Skin Problems
• Erythema nodosum presents as red nodules on the shins is
due to inflammation of the underlying subcutaneous tissue
and is characterized by septal panniculitis.
• Skin complications occur in about 15 percent of people with
Crohn's disease.
Erythema nodosum on the back and leg of a person with Crohn's Disease
17. Systemic Complications ofCrohn's Disease
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Eye Problems
Eyecomplications occur in about 5 percent ofpeople with
Crohn's disease.These include:
Iritis (inflammation of the colored part of the eyes)
Uveitis (inflammation of the middle layer of the eye)
Episcleritis (inflammation of the white part of the eyes)
Episcleritis Uveitis
18. Diagnosis
• Crohn's disease does not diagnose with completecertainty.
• Acolonoscopy is 70%effective in diagnosing the disease via
direct visualization of the colon and the terminalileum.
• Capsule endoscopy help in endoscopicdiagnosis.
• 30%of Crohn's disease involves only the ileum, cannulationof
the terminal ileum is required in making the diagnosis.
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Radiologic Tests
A barium X-ray where barium sulfate suspension is ingested
and fluoroscopic images of the bowel are taken to check
inflammation and narrowing of thesmall bowel.
• Identifying anatomical abnormalities when strictures of the
colon are too small for a colonoscope to pass through, or in
the detection of colonic fistulae.
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Blood Tests
Acomplete blood count may reveal anemia caused either by
blood loss or vitaminB12deficiency.
• Erythrocyte sedimentation rate(ESR) and C-reactive protein
measurements can also be useful to check the degree of
inflammation.
• Testing for anti-Saccharomyces cerevisiae antibodies (ASCA)
and anti-neutrophil cytoplasmic antibodies (ANCA) has been
evaluated to identify inflammation of the intestine.
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Treatment
Remission may be prolonged in Crohn’sdisease.
• Symptoms controlled with medication, lifestyle changes and
surgery.
• Adequately controlled Crohn's disease may not significantly
restrict daily living.
• Treatment for Crohn's disease is only when symptoms are
active and involve first treating the acute problem, then
maintaining remission.
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Medication
Antibiotics useto reduce inflammation .
• Prolonged useof corticosteroids hassignificant side.
• Alternatives include aminosalicylates alone, though only a
minority are able to maintain the treatment, and many
require immunosuppressive drugs.
23. Medicine Used in Treatment of
Crohn's Disease
• 5-aminosalicylic acid (5-ASA)
• Prednisone and methylprednisolone
• Immunomodulators such as azathioprine, mercaptopurine,
methotrexate, infliximab, adalimumab.
• Hydrocortisone should be used in severe attacks ofCrohn's
disease.
24. Lifestyle Changes
• Dietary adjustments, proper hydration and
smoking cessation reduce symptoms.
• Consume balanced diet with proper portion
control & eat small meals frequently instead
of bigmeals.
• Doregular exercise and take enough sleep.
• Identifying foods that triggersymptoms.
25. Diet for Crohn's Disease
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Drink lots of fluid to keep body hydrated and prevent
constipation.
Takemultivitamin-mineral supplement to replacelost
nutrients .
Eatahigh fiber diet when CD is under control.
During aflare up, limit high fiber foods and follow alow fiber
diet.
Avoid lactose-containing foods if one haslactoseintolerance
or uselactase enzymes and lactase pretreated foods.
Try small frequent meals.
Eating ahigh protein diet with lean meats, fish andeggs,may
help relieve symptoms of Crohn’s.
