NetNews Usenet Archive 1992 #27/NN_1992_27.iso/spool/sci/med/21441

Text File | 1992-11-24 | 3.3 KB | 67 lines

Newsgroups: sci.med
Path: sparky!uunet!pipex!warwick!mrccrc!mdiffin
From: [e-mail] (Dr. M.C. Diffin)
Subject: Re: Any information on Crohn's disease?
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Date: Tue, 24 Nov 1992 01:19:10 GMT
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ch>Hi, I've recently been diagnosed with Crohn's disease, and I'd like to know
ch>more about it.
ch>
ch>More specifically, the effect of diet and the benefits of 5-ASA.
ch>
ch>I followed the diet in the book 'Food and the Gut Reaction' until I went to
ch>my first support group meeting, at which point the book was discredited to
ch>my satisfaction.

Crohn's disease is a chronic inflammatory disease of any part of the GI
tract (ileocaecal region favoured) which has a tendency to recurrence.
The bowel is thickened and narrowed; ulcers, fissures, fistulas or
abscesses may be seen, with inflammation through all layers of the
bowel.  Main presentation is diarrhoea, pain and anorexia with
(possibly) general malaise, lethargy and nausea and vomiting.  The
aetiology is obscure, although some of the systemic complications,
association with other autoimmune diseases, responsiveness to
immunosuppressives and the granulomatous lesions suggest an
immunological pathogenesis.  There is also some evidence for an
infectious agent, possibly a mycobacterium.

For acute attacks, corticosteroids are effective (30/60mg per day).
These suppress inflammation but are unsuitable for maintenance because
of contraindications.  Sulphasalazine has been used for some time,
although it is less effective when the small intestine is affected.
Sulphasalazine is sulphapyridine (only a carrier, although it has its own
side effects) azo-linked to 5-aminosalicylic acid (5-ASA) which is the
pharmacologically active moiety (may be cytoprotective or
immunosuppressive).  Dietary supplements are required with this drug
(esp. folate).  More recently olsalazine (two molecules of 5-ASA linked)
or mesalzine (5-ASA itself) have been used; these circumvent the
sulphapyridine side effects, but diarrhoea and salicylate
hypersensitivity may still be a problem.  Additionally, metronidazole
and co-trimoxazole may be effective, presumably because of their
antibacterial activity.

As for diet, an elemental diet or parenteral nutrition seems to induce
remission.  These put less stress on the bowel and also reduce antigen
load.  To my knowledge, most patients relapse at some time after they
start a normal diet, but one hardly wants to live on hospital fare forever.
I should imagine support groups will have more dietary information.

Another option is surgery, though this is not indicated unless medical
treatment fails or severe complications (like toxic dilatation) appear.
Many patients do have the surgery, but remission is almost inevitable.

The good news is that most such patients lead quite a normal life and do
not have a significantly higher mortality than the general population
(if memory serves, most of the mortality is a consequence of surgery)
--
___________________________________________________________________________
Michael Diffin
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