Potential Sequelae of Crohn's Disease

Osteoporosis

Osteoporosis is perhaps the most significant sequela to Crohns disease and several aspects may contribute to its development. Nutrient deficiencies of vitamins D and K result in low BMD.^170,171 Corticosteroid therapy contributes to osteoporosis in Crohns patients.¹³⁹ Hypogonadism in men, resulting from Crohn's Disease-related stunted growth has also been shown to decrease bone density.²⁶¹

Numerous studies confirm that Crohns disease^262,263 and some of the commonly used conventional therapies²⁶⁴ can result in low BMD, increased fracture risk, and osteoporosis. A study of 95 patients (31 treated predominantly with corticosteroids, 33 treated with dietary manipulation, and 31 not treated with diet and with a history of low life-time steroid exposure) demonstrated those in the steroid-treatment group had significantly lower BMD than those in either of the other two groups, indicating steroids were the cause of the osteoporosis.²⁶⁵

A recent study of subjects from the UK's General Practice Research Database examined the incidence of hip fractures among IBD patients compared to controls. IBD cases (n=16,550) were evaluated, and after adjustment for confounding variables, it was determined the relative risk for hip fracture in Crohn's Disease patients was 1.68 (compared to 1.41 for Ulcerative Colitis patients). These results indicate hip fracture risk in Crohn's Disease patients is increased by approximately 70 percent. However, statistics also indicate less than half of hip fractures in Crohn's Disease patients are not the result of steroid therapy,²⁶⁶ but may be attributable to other factors, such as altered intestinal absorption resulting in nutrient and vitamin deficiencies,^170,171 or overproduction of TNF-alpha-mediated bone loss.²⁶⁷

Cancer and Crohns disease

Epidemiological studies evaluating the risk of colorectal cancer in Crohn’s patients have yielded contradictory results. A 2004 populationbased study of 374 Danish Crohn's Disease patients reported no increased risk of colorectal cancer, but a more than 60-fold increase in small bowel cancer.²⁶⁸ Conversely, another 2004 publication reported a relative risk of 5.6 for colorectal cancer in Crohns colitis (a subcategory of Crohn’s).²⁶⁹ Because some conventional drug therapies for Crohn's Disease, including sulfasalazine, have carcinogenic potential, prudence dictates regular cancer screening of Crohns patients when they are being treated with these drugs.²⁷⁰

Infertility caused by Crohns disease

Several studies investigated the effect of Crohns disease on fertility in both men and women. A study examining the medical records of 103 women noted a substantial degree of infertility and a slight increase in spontaneous abortion compared to the general population. Exact numbers and statistics for the general population were not reported.²⁷¹ Other research indicates Crohns Disease patients who have had intestinal surgery are more likely to have unresolved fertility problems than Crohns Disease patients who have had no surgery.²⁷² Several studies have shown men with Crohns Disease have an increased incidence of oligospermia,²⁷³ problems with sperm maturation not caused by sulfasalazine therapy,²⁷⁴ and poor sperm quality, reflected by decreased motility and density.²⁷⁵ Current studies are investigating the link between proven zinc deficiencies in men with Crohn's Disease and infertility and sperm function.²⁷⁶

Miscellaneous Sequelae

Other conditions reported in Crohns patients include liver abcesses,^277,278 life-threatening bacterial infections due to immune deficiencies or Crohns drug therapy,²⁷⁹ and ischemic stroke, probably due to B-vitamin deficiency and the hypercoaguable state observed in Crohn's Disease.¹²⁶

Conclusion

Crohns disease results in significant morbidity with potential life-threatening sequelae. Conventional treatments have been only partially successful in curbing acute flare-ups and extending remission. When these drugs fail, surgical intervention is often employed. Surgery removes localized inflammation but does nothing to address the causes of Crohns Disease, including abnormal gut immunity, increased intestinal permeability, systemic inflammation, and deranged colonic milieu, or the nutrient deficiencies associated with the disease. Natural therapeutics in the form of dietary modification, nutrient repletion, probiotics, omega 3 essential fatty acids, anti oxidants, anti inflammatory botanicals and other nutrients can provide benefit in bringing balance to a severely imbalanced system.



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