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Crohn's Disease- Pathophysiology and Conventional and Alternative Treatment Options

Crohn's Disease

Table 1: Subcategories of Crohn's Disease

Table 2: Signs and Symptoms of Crohn's Disease and Ulcerative Colitis

Risk Factors

Diagnosis

Etiopathogenesis:

    The Genetic Component of Crohn's Disease

    Stress in the Etiology of Crohn's Disease

    Microbial Factors

    Inflammation/Immune Response

    Intestinal Permeability

    Other Abnormalities Contributing to the Etiopathogenesis of Crohn's Disease

Conventional Treatment of Crohn's Disease

Table 5: Conventional Medications and their Mechanisms in Crohn's Disease

Nutrient Deficiences in Crohn's Disease

Table 6: nutrient Deficiencies Associated with Crohn's Disease

Dietary Interventions in Crohn's Disease

Table 7: Diet Therapies Compared to Steroid Medications in Crohn's Disease

Probiotics in the Treatment of Crohn's Disease

Fatty Acids for the Treatment of Crohn's Disease

Table 8: A Summary of Omega-3 Fatty Acid Studies in Crohn's Disease

Glutamine

N-acetyl Glucosamine

Remicade Increasing Risk of Cancer

Botanicals in the Treatment of Crohn's Disease

Dehydroepiandrosterone (DHEA)

Potential Sequelae of Crohn's Disease

References




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 disease262,263 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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