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Crohn's Disease and Ulcerative Colitis FAQ's

What is Crohn's Disease & Ulcerative Colitis?

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Do you have IBD or IBS?

What causes Crohns & Colitis?

What are the symptoms of Crohns Disease?

What is the treatment for Crohns Disease and Colitis?

What are the drug names & side effects used in Crohns & Colitis?

How Common is Inflammatory Bowel Disease (IBD)?

Who Gets Inflammatory Bowel Disease - IBD?

What are the complications of Crohns Disease?

How is Crohns Disease diagnosed?

What is the difference between CD and UC?

What about Diet and Nutrition for Crohns Disease & Colitis?

Can people with Crohn's or Colitis use aspirin?

Is Crohns Disease or Colitis caused by emotional stress?

What are the different types of Crohns Disease?

What is the history of Crohns Disease?




What is Crohn's Disease and Ulcerative Colitis?

Crohn's Disease, as well as Ulcerative Colitis, is part of a group of conditions that is known as Inflammatory Bowel Disease, shortened by using the initials IBD. The part of the body that is affected is the digestive tract which, in technical jargon, is referred to as the gastrointestinal tract, and also referred to as the GI tract .i.e. the area of the body where digestion of food happens.

The conditions that arise cause inflammation in some part of the intestines. The part of the intestines that have inflammation become red and swollen. The inflammation extends into the lining of the affected organs. Sometimes sores and even ulcers occur in the walls of the intestine.

The condition becomes chronic and the inflammation continues for some time and it results in digestive symptoms like cramping, diarrhea, abdominal pain, even rectal bleeding, as well as fatigue. There are natural, safe antiinflammatories that can help reduce inflammation. Serrapeptase, FYI and Aloe Concentrate are ones that you can use that don't have any harmful side effects.

These supplements can reduce the amount of inflammation present anywhere in the digestive tract or even other parts of the body.

You see, some people have symptoms that are not only associated with digestion and the GI tract, but have signs and symptoms of Inflammatory Bowel Disease - IBD, in other parts of their bodies. It can involve their joints, their eyes, skin, bones, liver and even their kidneys. These symptoms are called 'extraintestinal expressions of IBD'. This is because even though they are associated with Inflammatory Bowel Disease, they occur outside of the digestive system.

Crohns Disease and Colitis are often misdiagnosed as Irritable Bowel Syndrome. Genova Laboratory provides an easy to administer, home stool test that you can order from Crohns.Net that will tell you within a couple of weeks whether you have IBS or IBD - its as simple as that! Symptoms of food poisoning, gastroenteritis, or appendicitis can be similar as well. That's because the pain is located in the same place - the lower right-hand quadrant of the abdomen. Also, many symptoms overlap. Remember too, that Crohns Disease may also be called Ileitis or Enteritis and Ulcerative Colitis may be referred to as Colitis.




Do you have IBD Inflammatory Bowel Disease or IBS Irritable Bowel Syndrome?

Inflammatory bowel disease, IBD, including Colitis and Crohns, is not the same as Irritable Bowel Syndrome (IBS). Irritable Bowel Syndrome is a far less serious problem known a 'functional disorder'. This means that the digestive system 'looks' normal but doesn't 'function' properly. It is a syndrome rather than a disease per se. IBS does not lead to inflammation, ulcers or other damage to the bowel. Instead symptoms of IBS include crampy type pain, bloating, gas, even mucus in the stool, with diarrhea and constipation or even or alternating bouts of the two, with urgency and bloating. IBS is also known as spastic colon or spastic bowel.

People with IBS sometimes have other functional disorders like as fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, as well as temporomandibular joint (TMJ) disorder. Unlike ulcerative colitis patients, IBS sufferers show no sign of disease or abnormalities when the colon is examined.

However, Irritable bowel syndrome (IBS) can produce some symptoms similar to those of inflammatory bowel disease (IBD), but they are not the same condition. Therefore, getting an accurate diagnosis is essential to managing your condition properly. The stool test that we can order for you, can very easily help you know which of these 2 conditions you have.

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Genova Lab CDSA 2.0 includes several important parameters including calprotectin which will tell you whether you are dealing with Inflammatory Bowel Disease or Irritable Bowel Syndrome as Irritable Bowel Disease will not lead to an increase in calprotectin levels.

So, IBS it is a less serious condition. It doesn't result in permanent harm to the intestines, intestinal bleeding, or the harmful complications that often occur with Inflammatory Bowel Disease. Fortunately, people with IBS are not as high risk for colon cancer as those with IBD, nor are they more likely to develop IBD or other gastrointestinal diseases.

Irritable Bowel Syndrome seldom requires hospitalization, and treatment does not usually involve surgery or powerful medications, such as steroids or immunosuppressive drugs. Irritable Bowel Syndrome sufferers respond extremely well to using a combination of probiotics and dietary changes.




What causes Crohns Disease & Colitis?

There are many theories about what causes Crohns disease and Colitis, but none has been scientifically proven. Studies indicate that the inflammation in IBD involves a complex interaction of factors including:

In 2009 a study by Dr. Marcel Behr, of the Research Institute of the MUHC and McGill University, provided insight into the curious mutation of NOD2 gene. This gene is important in determining how the body responds to some bacterial products. A mutation is found in 25% of Crohn's disease patients but it is not yet known how this mutation influences the disease.

Foreign substances (antigens) in the environment can also be the direct cause of the inflammation in Crohns Disease. Alternatively, these antigens can stimulate the body's defenses to produce an inflammatory response that appears to be permanent.

Researchers think that once the IBD sufferer's immune system is "turned on," it does not know how to properly "turn off" at the right time. This they think, results in inflammation damage to the digestive tract and causes the painful symptoms of Inflammatory Bowel Disease - IBD.

Activation of the immune system in the intestines occurs. The immune system consists of immune cells and the proteins that these immune cells produce. Usually, these cells and proteins defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. The vulnerablitiy to abnormal activation of the immune system is genetically inherited. Therefore, brothers, sisters, children, and parents of people with IBD are more prone to develop Crohns.

Many scientists now say that the interaction of outside agents (such as a virus or bacteria) with the body's immune system may either trigger Crohns Disease or cause damage to the intestinal wall which, in turn, leads to chronic (ongoing) inflammation in the intestine.

Those with Crohns Disease or colitis generally display abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or as a result of the inflammatory bowel disease. Crohns Disease & Colitis is not known to be caused by emotional distress although stress is known to intensify Crones Colitis Symptoms.

According the conservative medical opinion there is no known cause of or cure for Crohn's disease or ulcerative colitis. However, over 30 years of clinical practice in complementary medicine has shown me that even though there are many diverse reasons for 'causing the symptoms', they can be identified. And now there are alternate approaches in the field of complementary medicine that have proved extremely successful, not only in relieving acute symptoms of Inflammatory Bowel Disease, but also in offering relief to chronic sufferers using a drugless approach.

There are effective treatments to help control these digestive diseases. There are several considerations to help achieving remission, which relates to not having any symptoms, also to controlling the flare-ups and maintaining health and if nothing else, most importantly to improving quality of life. Please review our Crohns & Colitis Protocol




What are the symptoms of Crohns Disease?

Most Common

  • Crampy abdominal pain (often in the lower right area)
  • Persistent diarrhea (loose, watery, or frequent bowel movements)
  • Weight Loss

Less Common

  • Loss of appetite
  • Fever may also occur.
  • Night sweats
  • Rectal Pain
  • Bleeding may be serious and persistent, and may lead to anemia.
  • Swelling of the tissue of the anal sphincter, the muscle at the end of the colon that controls defecation.
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  • Ulcers and fissures (long ulcers) within the anal sphincter.
  • These ulcers and fissures can cause bleeding and pain with defecation.
  • Anal fistulae ie abnormal tunnels between the anus or rectum and the skin surrounding the anus. Mucous and pus may drain from the openings of the fistulae on the skin.
  • Abscesses or collections of pus in the anal and rectal area. These abscesses can cause fever, pain and tenderness around the anus.
  • Crohns Disease is not always limited to the GI tract; it can also affect the joints, eyes, skin, spine, bile ducts and liver.
  • Fatigue is another common complaint.
  • Children who have Crohns Disease may suffer delayed growth and sexual development.

Symptoms can range from mild to severe as Crohns & Colitis are chronic diseases with periods in which the disease flares up and is active, followed by times in which symptoms disappear or decrease, and good health returns. In general, people with Crohns Disease lead full, active, and productive lives.


What is the treatment for Crohns Disease & Ulcerative Colitis IBD?

Physicians state that there is no medication that can cure Crohn's disease. Since there is no cure for Crohn's disease, the goals of drug treatments are to try and induce or maintain remissions and minimize side effects of the very treatments used.

Medications for treating Crohn's disease & Colitis include anti-inflammatory agents such as 5-ASA compounds, corticosteroids, topical antibiotics, immuno-modulators other medications. These drugs have a number of side effects.

Treatment for Crohns Disease & Colitis also depends on the location and severity of the disease, any complications that may exist, and responses to previous treatment.

The goals of treatment for Crohns are to:

Today, there are many physicians who advocate the use of probiotics or friendly bacteria to help relive symptoms of Crohns Disease and Ulcerative Colitis. There are books about the benefits of probiotics. Also see what nutritionist, Anne Louise Gittleman, has to say about probiotics.

See our effective Crohn's Protocol using natural supplements & diet. We offer unlimited, on line support when you purchase tests and supplements from us

Some people with Crohns have long periods of remission, sometimes years, then they are free of symptoms. However, Crohns Disease usually recurs at various times during a person's lifetime.

This changing pattern of Crohns means that it is not always possible to tell when a treatment has been successful or not. Predicting when a remission may occur or when symptoms will return is not possible.

Dietary intervention alone has been extremely helpful for many sufferers. Elaine Gottschall's SCD diet helps thousands of Crohn's sufferers. There are also several Recipe Books that will help reduce the inflammatory load of the digestive system: EHC Cookbook, Recipes for Specific Carbohydrate Diet and Crohns, Colitis, Celiac, IBS Recipe Book



What are the names of & side effects of the drugs used in Crohns Disease & Colitis?

Pharmaceutical Drugs used in the treatment of Crohns Disease & Ulcerative Colitis are:

  • Aminosalicylates: Oral 5-ASAs include balsalazide (Colazal), olsalazine (DiPentum), mesalamine (Asacol and Pentasa), and sulfasalazine (Azulfidine). Rectal 5-ASA treatments include mesalamine enemas (Rowasa) and suppositories (Canasa)
  • Corticosteroids: Prednisone, Budesonide (Endocort & Uceris)
  • Immunomodulators: Azathioprine [Imuran], 6-MP [Purinethol], Methotrexate, Infliximab [Remicade]
  • Antibiotics: Metronidazole [Flagyl], Ciprofloxacin [Cipro]
  • Biologic therapies: Adalimumab, Certolizumab, Pegol, Infliximab, and Natalizumab.

Here are the details:

Aminosalicylates:
These include aspirin-like compounds that contain 5-aminosalicylic acid (5-ASA). These drugs are given orally or rectally. They do not suppress the immune system but decrease inflammation at the wall of the intestine itself, and are used to help heal both in the short- and long-term. They are used to treat mild-to-moderate episodes of IBD. They also are sometimes used to prevent relapses. They do have extensive side effects.

Aminosalicylates have anti-inflammatory effects on the mucosa lining the organs of the GI tract. They also inhibit the function and production of immune system cells. Several aminosalicylates are available for the treatment of Crohn's disease. Oral 5-ASAs include balsalazide (Colazal), olsalazine (DiPentum), mesalamine (Asacol and Pentasa), and sulfasalazine (Azulfidine). Rectal 5-ASA treatments include mesalamine enemas (Rowasa) and suppositories (Canasa).


Corticosteroids:

  • Corticosteroids are a class of anti-inflammatory drug that are used mainly for treatment of moderate to severe flares of Crohn's Disease. They are used more sparingly because now there are effective treatments with fewer side-effects. The side effects of corticosteroids include Cushing's syndrome, mania, insomnia, hypertension, high blood glucose, osteoporosis, and avascular necrosis of long bones. These should not be confused with the anabolic steroids used to enhance athletic performance.
  • The most commonly prescribed oral steroid is prednisone, which is typically dosed at 0.5 mg/kg to achieve remission. Intravenous steroids are used in cases where oral steroids are not effective, or where oral steroids cannot be taken.
  • These are administered in the hospital setting. Because corticosteroids reduce the ability to fight infection, extreme caution must be used to make sure that there is no active infection, particularly an intra-abdominal abscess before the initiation of steroids.
  • Uceris releases the budesonide throughout the colon for Ulcerative Colitis. Also, the coating used is different. Uceris begins to dissolve as it enters the transverse and descending colon the area where colitis is usually most active. It is formulated with a matrix called as MMX, that exclusively dissolves in large intestine. It not advised to ever crush the pills ever as they will dissolve in the stomach in stead of making it's way down to the large intestine. There are precautions to pay attention to when using Uceris. Our blog post on the side effects of Uceris will give you that information.
  • Budesonide is an oral corticosteroid with limited absorption and high level of first-pass metabolism, meaning that less quantities of steroid enter into the bloodstream. It has been shown to be useful in the treatment of mild-to-moderate Crohn's disease and for maintenance of remission in Crohn's disease. Formulated as Entocort, budesonide is released in the ileum and right colon, and is therefore has a topical effect against disease in that area.
  • Budesonide is also useful when used in combination with antibiotics for active Crohn's disease.
  • Steroid enemas can also be used for disease of the lower colon and rectum, in order to treat symptoms. Hydrocortisone and budesonide liquid and foam enemas are being marketed for these reasons.

Immunomodulators:

This class of medications modifies the body immune system so that it cannot cause on-going inflammation. Immunomodulators are typically used in people where aminosalicylates and corticosteroids have not been effective, or have only been partially effective.

They may be useful in reducing or eliminating reliance on corticosteroids. They also may be effective in maintaining remission in people who have not responded to other medications given for this purpose. Immunomodulators may take up to three months to begin working.

  • Immunomodulators are drugs that weaken or suppress the immune system.
  • While the immune system protects the body from harmful bacteria, viruses, and other invaders, activation of the immune system results in inflammation.
  • Immunomodulating drugs decrease tissue inflammation by reducing the population of activated immune cells or interfering with the production of proteins that summon the immune cells to an organ.

Some of these drugs used to treat Crohn's disease include 6-mercaptopurine (6-MP or Purinethol), azathioprine (Imuran or Azasan), methotrexate and cyclosporine. Immunomodulator therapy has been shown to be more effective than steroids in maintaining remission. Remission may be achieved in over 60 percent of patients.

The drugs 6-MP and azathioprine (Purinethol and Imuran) are related molecules given orally for Crohn's disease of the small intestine and colon. They are quite effective in treating Crohn's disease but have a slow onset of effect (two to four months).

Because of this, they are often given along with a corticosteroid, with the intention of gradually decreasing the steroid dose as the 6-MP or azathioprine takes effect. Azathioprine rapidly gets metabolized in the blood to 6-MP. 6-MP in turn is metabolized in immune cells to the active compound 6-thioguanine (6-TG). It is the 6-TG that results in elimination of chronically activated immune cells. 6-TG can suppress the bone marrow, requiring close monitoring of the blood while on therapy.

  • Some people are genetically susceptible to bone marrow suppression with only small doses of azathioprine or 6-MP. They lack the normal enzyme (called TPMT) which rapidly detoxifies 6-TG. In addition, both can have a bad effect on the liver and pancreas. 6-MP and azathioprine also increase the risk of lymphoma and skin cancer, and with bone marrow suppression they aslo increase the risk of serious infections.

Methotrexate (Rheumatrex) is an alternative to 6-MP or azathioprine. It is typically given using an intramuscular or subcutaneous injection once a week. It is only effective in about 40% of patients with Crohn's disease who do not respond to steroids. Methotrexate is known to cause interstitial pneumonitis, which often presents as a cough and difficulty breathing.

Crohns sufferers need to be monitored for bone marrow suppression. Methotrexate can cause liver damage, especially in patients treated long-term and in those who use alcohol or have pre-existing liver disease. Cyclosporine (Sandimmune and Neoral), are also used to suppress organ rejection after a transplant. They are used in patients whose illness did not respond to steroid drugs particularly in fistulizing Crohn's disease. However, cyclosporine has a number of serious and uncomfortable side effects, including fever, rash, nausea, low white cell count, kidney failure, and hepatitis. Inflammation of the pancreas, or pancreatitis, may occur in 3 to 15 percent of patients on the drug. It is generally used as a last resort when other immunomodulators or anti-Tumor Necrosis Factor Alpha medications are not effective.

Antibiotics
Antibiotics have a modest effect on Crohn's disease, with greater evidence in clinical trials than the 5-ASA medications. There is evidence to show that antibiotics are more effective in Crohn's colitis than Crohn's ileitis. Antibiotics are particularly used to treat perianal disease, which includes fistulas, and in all abscesses associated with Crohn's disease.

The most commonly used antibiotic is metronidazole (Flagyl), an antibiotic also prescribed for treating parasites and vaginal infections. It is used for Crohn's patients who have anal fistulas. Metronidazole interacts badly with alcohol, so people taking the drug should refrain from drinking. There are severe side effects. Chronic use at high doses has been associated with permanent nerve damage. The drug must be stopped if people experience numbness or tingling in their fingertips, toes, or other extremities.

Ciprofloxacin (Cipro), another antibiotic, is commonly used in treating mild to moderate Crohn's disease. It is sometimes prescribed in combination with metronidazole for Crohn's disease, particularly for abscesses and anal disease. They are also used for post-surgical problems such as pouchitis. Fortunately, VSL#3 Probiotics, regarded as a medicinal food, has been researched to show amazingly effective results in combating the chronic effects of pouchitis. See Mimura T, Rizzello F, Helwig U, et al Once Daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 2004;53:108-114.


Biologic therapies:
These therapies are genetically engineered to target very specific molecules involved in the inflammatory process. The newest class of therapy to be used in IBD, these include adalimumab, certolizumab pegol, infliximab, and natalizumab. These are not drugs, but proteins (antibodies) that target the action of certain other proteins that cause inflammation. These medications are indicated for people with moderately to severely active disease who have not responded well to conventional therapy.

They also are effective for reducing fistulas. (Fistulas, which may occur with Crohns disease, are small tunnels connecting one loop of intestine to another or two organs in the body that are usually not connected.) Biologics may be an effective strategy for reducing steroid use, as well as for maintaining remission.

There are many substances found in nature, such as herbs, foods, and vitamins, that are considered biologically-based practice. Unlike pharmaceutical products, natural remedies are not regulated by the FDA.

At Crohns.net we specialize in offering effective alternatives to drug therapies. We do not say that everyone will benefit from these supplements, however, they are safe, with no side effects. It is definitely worth starting off by using a non-invasive drugless approach before embarking on use of drugs that have serious short term as well as long term side effects.

Side Effects

Reports of bad reactions to prescription drugs increasing

Sulfasalazine [Azulfadine]

Common Side Effects

  • abdominal or stomach pain or upset
  • diarrhea
  • loss of appetite
  • nausea or vomiting
  • aching of joints
  • headache (continuing)
  • itching
  • increased sensitivity of skin to sunlight
  • skin rash

Less Common or Rare

  • aching of joints and muscles
  • back, leg, or stomach pains
  • bloody diarrhea
  • bluish fingernails, lips, or skin; chest pain
  • cough
  • difficult breathing
  • difficulty in swallowing
  • fever, chills, or sore throat
  • general feeling of discomfort or illness
  • loss of appetite
  • pale skin
  • redness, blistering, peeling, or loosening of skin
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellow eyes or skin

Mesalamine [Asacol, Pentasa, Mesasal, Salofalk]

Common Side Effects

  • abdominal or stomach cramps or pain (mild)
  • diarrhea (mild)
  • dizziness; headache (mild)
  • runny or stuffy nose or sneezing

Less Frequent or Rare

  • acne
  • back or joint pain
  • gas or flatulence
  • indigestion
  • loss of appetite
  • loss of hair

Less Common

  • abdominal or stomach cramps or pain (severe)
  • bloody diarrhea
  • fever
  • headache (severe)
  • skin rash and itching

Rare

  • anxiety
  • back or stomach pain (severe)
  • blue or pale skin
  • chest pain, possibly moving to the left arm, neck, or shoulder
  • chills
  • fast heartbeat
  • nausea or vomiting
  • shortness of breath
  • swelling of the stomach
  • unusual tiredness or weakness
  • yellow eyes or skin

5-ASA Drugs - [Dipentum]

People allergic to aspirin should avoid 5-ASA compounds because they are similar chemically to aspirin.

Common Side Effects

  • headache and malaise (a vague feeling of illness)
  • cramps and gas
  • watery diarrhea

Uncommon Side Effects

  • hair loss
  • skin rash

Rare Side Effects

The rare side effects of 5-ASA affect fewer than 1 percent of people who take these drugs, but these side effects are potentially very serious.

  • inflammation of the lung (pneumonitis)
  • inflammation of the tissue surrounding the heart (pericarditis)
  • inflammation of the pancreas (pancreatitis)
  • a paradoxical worsening of inflammation of the colon (colitis)
  • inflammation of the kidney (nephritis)
  • a fall in the number of platelets - thrombocytopenia; leading to bleeding

Rare instances of worsening of diarrhea, cramps, & abdominal pain that may be accompanied by fever, rash and malaise may occur. This reaction is thought to be an allergy to the 5-ASA compound.

5-aminosalicylates and pregnancy

The safety of the 5-ASA drugs during pregnancy and breastfeeding is still being studied. Preliminary studies suggest that they are safe when taken during pregnancy and that women should continue taking these drugs during pregnancy.

Corticosteroids: Prednisone and Methylprednisolone

Very Common Side Effects

  • Weight gain. At first water retention only, then increase in body fat
  • increase in appetite
  • exacerbation of heart trouble or swelling in the legs
  • mood swings/personality changes
  • Nervousness/irritability/depression
  • difficulty in sleeping
  • increased susceptibility to infections

Common Side Effects

  • Mild weakness in the muscles of arms or legs
  • Blurred vision
  • Hair growth: both thinning and excessive growth
  • Easy bruising of the skin
  • Slow healing of cuts and wounds
  • Acne
  • Round face
  • Slowed growth in children and adolescents
  • Osteoporosis (loss of bone calcium), especially in:
    • women
    • people with chronic kidney disease
    • history of osteoporosis in the family
    • people who smoke
    • people who are not physically active

Occasional Side Effects

  • High blood pressure
  • Elevated blood sugar
  • Red or purple stretch marks on the skin
  • Stomach irritation or stomach ulcers, especially when also taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

Less Common Side Effects

  • Blurred vision from cataracts
  • Glaucoma
  • Fractures due to osteoporosis, most often in the hip and spine
  • Osteonecrosis, a serious and painful condition that occurs most often in the hip or shoulder when the bone is deprived of circulation
  • Severe weakness of the muscles (myopathy)
  • Psychosis, which is a severe disturbance of thinking
  • Serious infections due to suppression of the immune system

Immune modifiers:
Azathioprine [Imuran], 6-MP [Purinethol], Methotrexate, Infliximab [Remicade]



Azathioprine [Imuran]

Common Side Effects:

  • loss of appetite
  • nausea or vomiting

Less Common:

  • Skin rash
  • Cough, hoarseness
  • fever or chills
  • lower back or side pain
  • painful or difficult urination
  • unusual tiredness, weakness
  • Black, tarry stools
  • blood in urine or stools
  • pinpoint red spots on skin
  • unusual bleeding or bruising

Rare

  • fast heartbeat
  • fever (sudden)
  • muscle or joint pain
  • nausea, vomiting, and diarrhea (severe)
  • redness or blisters on skin
  • shortness of breath
  • sores in mouth, on lips
  • stomach pain
  • swelling of feet or lower legs
  • feeling of discomfort or illness (sudden)

Side effects of azathioprine and 6-MP also include:

  • increased vulnerability to infections
  • inflammation of the liver (hepatitis) and the pancreas (pancreatitis)
  • bone marrow toxicity (interference with the formation of cells that circulate in the blood)

Patients on long-term, high dose azathioprine to prevent rejection of the kidney after kidney transplantation have an increased risk of developing lymphoma, a malignant disease of lymph cells. There is no evidence at present that long term use of azathioprine or 6-MP, in the lower doses used in Crohn's disease, increases the risk of lymphoma, leukemia or other malignancies.

Remicade

Remicade is a monoclonal antibody. It is used to treat Crohn's disease in patients who have not been helped by other medicines and also in patients who have a type of Crohn's disease in which fistulas form. It is also used to treat rheumatoid arthritis.

Warning about Remicade

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. The following are important considerations:

  • Allergies: It is important to identify any unusual or allergic reaction to Remicade or to rodents (such as rats or mice). Mouse cells are used in the preparation of Remicade. Also any allergic reactions to any other substances, such as foods, preservatives, or dyes.
  • Pregnancy: Studies have not been done in either humans or animals. It is not known if Remicade causes harmful effects in the fetus.
  • Breast-feeding: It is not known whether Remicade passes into breast milk. Because there may be harmful effects in the nursing baby, it may be necessary for you to stop breast-feeding during treatment.
  • Children: Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of Remicade in children with use in other age groups.
  • Older adults: There is no specific information comparing use of Remicade in the elderly with use in other age groups. However, older adults generally get more infections than do younger adults, and it is not known if Remicade may affect the number of infections that senior citizens get.
  • Other medical problems: The presence of other medical problems may affect the use of Remicade especially:
    • Heart disease: Remicade is not recommended for those with congestive heart failure
    • Infection: Remicade is not recommended for patients with an active infection.
    • Inactive tuberculosis infection: Should be treated before starting Remicade therapy

Precautions Considering Remicade

  • It is important to have a tuberculin skin test to ensure that there is no inactive tuberculosis infection, as this could worsen while on Remicade therapy.
  • It is also important to have a heart check-up if you have existing heart disease and decide to take Remicade as this could worsen while on Remicade therapy

Side Effects of Remicade

Remicade may cause:

More Common Remicade symptoms

  • chest pain
  • fever
  • chills
  • itching
  • hives
  • flushing of face
  • troubled breathing within a few hours after taking it
  • abdominal pain
  • cough
  • dizziness
  • fainting
  • headache
  • muscle pain
  • nasal congestion
  • nausea
  • runny nose
  • shortness of breath
  • sneezing
  • sore throat
  • tightness in chest
  • unusual tiredness or weakness
  • vomiting
  • wheezing

Less Common Remicade Side Effects

  • back pain
  • bloody or cloudy urine
  • cracks in skin at the corners of mouth
  • diarrhea; difficult or painful urination
  • frequent urge to urinate
  • high blood pressure
  • low blood pressure
  • pain
  • pain or tenderness around eyes and cheekbones
  • skin rash
  • soreness or irritation of mouth or tongue
  • soreness or redness around fingernails or toenails
  • vaginal burning or itching and discharge
  • white patches in mouth and/or on tongue

Rare Side Effects

  • abscess (swollen, red, tender area of infection containing pus)
  • back or side pain
  • black, tarry stools
  • blood in urine or stools
  • bone or joint pain
  • constipation
  • falls
  • feeling of fullness
  • general feeling of illness
  • hernia (bulge of tissue through the wall of the abdomen)
  • infection
  • irregular or pounding heartbeat
  • pain in rectum
  • pain spreading from the abdomen to the left shoulder
  • pinpoint red spots on skin
  • stomach pain (severe)
  • swollen or painful glands
  • tendon injury, unusual bleeding or bruising
  • weight loss (unusual); yellow skin and eyes
Did you know? ... more information about Remicade (Infliximab)

The majority of the patients who responded to a first infusion of Remicade/infliximab developed recurrence of their disease within three months.

Response to infliximab after repeated infusions sometimes is lost if the patient starts to develop antibodies to the infliximab (which attach to the infliximab and prevent it from working).

TNF-alpha is an important protein for defending the body against infections. Infliximab, like immuno-modulators, increases the risk for infection. One case of salmonella colitis and several cases of pneumonia have been reported with the use of infliximab. There also have been cases of TB reported after the use of infliximab.

Because infliximab is partly a mouse protein, it may induce an immune reaction when given to humans, especially with repeated infusions.

In addition to the side effects that occur while the infusion is being given, patients often develop a "delayed allergic reaction" that occurs 7-10 days after receiving the Infliximab. This type of reaction may cause flu-like symptoms with fever, joint pain and swelling, and a worsening of Crohn's disease symptoms. It can be serious, and if it occurs, a physician should be contacted.

Although Infliximab is only FDA approved for a single infusion at this time, be aware that repeated infusions are likely to be required once Remicade therapy has been initiated.

Rare cases of nerve inflammation like inflammation of the nerve of the eye, has been reported with the use of infliximab.

Infliximab can aggravate and cause the spread of an existing infection. It must not be given to those with pneumonia, urinary tract infections or a localized collection of pus (i.e., abscess).

It now is recommended that people be tested for TB prior to receiving infliximab. People who previously had TB should inform their physician of this before they receive infliximab.

Infliximab can promote intestinal scarring which is part of the process of healing and, thus can worsen strictures which are the narrowed areas of the intestine caused by inflammation and subsequent scaring and lead to intestinal obstruction.

Remicade can cause partial healing/closure of anal fistulae. This interferes with the drainage of fluid through the fistulae, and may result in collections of fluid in which bacteria multiply, which can result in abscesses.

The effects infliximab on the fetus are not known.

The long-term safety and effectiveness is not yet known. Caution is warranted in its use.

Infliximab can cause the spread of cancer cells; therefore, it should not be given to patients with cancer. See more information on Remicade.

Adalimumab [Humira]

Common side effect

  • skin reactions at the site of injection - swelling, itching, or redness
  • upper respiratory infections
  • sinusitis
  • nausea

General Side Effects

Increases the risk of infection - it should not be given to patients with pneumonia, urinary tract infection or abscess (i.e. localized collection of pus).

Rare Side Effects

  • lymphoma (cancer of the lymphatic system)
  • nervous system inflammation with symptoms of numbness and tingling
  • vision disturbances
  • weakness in legs
  • symptoms that mimic systemic lupus like skin rash, arthritis, chest pain, or shortness of breath. These lupus-like symptoms resolve after stopping the drug.
  • worsening heart disease such as heart failure
  • severe allergic reactions with rash
  • difficulty breathing
  • severe low blood pressure or shock
  • serious allergic reactions after the fist injection or after many injections

Antibiotics - Flagyl, Cipro

Common Side Effects

Antibiotics destroy both good and bad bacteria. Replacement of good bacteria (probiotic category) is essential.

Metronidazole and alcohol together can cause severe nausea, vomiting, cramps, flushing, and headache.

Uncommon Side Effects

  • permanent nerve damage (peripheral neuropathy) - numbness and tingling in the fingertips, toes, and other parts of the extremities.
  • nausea
  • headaches
  • loss of appetite
  • a metallic taste
  • a rash
A good alternative to drugs it to follow the Crohn's Protocol and use natural supplements and diet to control symptoms effectively.



How Common is Inflammatory Bowel Disease (IBD)?

It is estimated that as many as one million Americans (one in 300) have Inflammatory Bowel Disease - IBD. The number is evenly split between Crohns Disease and Ulcerative Colitis.

Crohns Disease may occur in people of all ages but is mainly a disease of adolescents and young adults. Crohns generally affects those between 15 and 35.

In another much smaller group of people, Crohns develops between the ages of 50 and 70, a so-called "second wave."

Crohn's disease can also occur in people who are 70 or older and in young children as well. 10% of those affected (an estimated 100,000) are under the age of 18. Culturelle probiotics have been shown to help children with Crohns. See Gupta P, Andrew H, Kirschner BS, et al. Is Lactobacillus GG helpful in children with Crohns disease? Results of an open-label study. J Pediatr Gastroenterol Nutr 2000;31:453-457

Males and females appear to be affected equally.


Who Gets Inflammatory Bowel Disease - IBD?

  • We know that genes play a role in Inflammatory Bowel Disease as IBD tends to run in families. If a person has a relative with the disease, his or her risk is about 10 times greater than that of the general population. If that relative is a brother or sister, the risk of having Inflammatory Bowel Disease is 30 times greater. Studies have shown that about 20 to 25 % of people have a close relative with either Crohns Disease or Ulcerative Colitis.

  • Researchers have been working actively to find a link to specific genes that control the transmission of Inflammatory Bowel Disease. Recently, an important breakthrough was achieved when the first gene for Crohns Disease was identified by a team of IBD investigators. The researchers were able to pick out an abnormal mutation (alteration) in a gene called Nod2. This alteration limits the ability to fight bacteria. This mutation occurs twice as frequently in Crohns Disease sufferers compared to the general population. Unfortunately there is currently no method to screen people for this gene. There is also no way to predict which family members will develop Crohns Disease. The data also suggests that there may be more than one gene involved.

  • Inflammatory Bowel Disease (IBD) is largely a disease of the developed world, mainly the U.S. and Europe.

  • Crohns Disease and Ulcerative Colitis cases are found to be more common in urban than in rural areas, and in more in northern than in southern climates.

  • Also, the frequency of Inflammatory Bowel Disease increases when specific groups of people move from under-developed to developed countries.

  • Inflammatory Bowel Disease (IBD) also appears to affect certain ethnic groups more than others. American Jews of European descent are four to five times more likely to develop Crohns Disease or Ulcerative Colitis (IBD) than the general population.

  • Historically, Inflammatory Bowel Disease - IBD was thought of as a disease predominantly affecting the white population. (The number of people with Crohns Disease and Ulcerative Colitis at any given time is 149 per 100,000) among Caucasians. However, there has been a steady increase in reported cases of both Crohns Disease and Ulcerative Colitis amongst African Americans. The prevalence rates among Hispanics and Asians are lower than those for Caucasians and African Americans.

You can safely use natural supplements and diet to control symptoms of Crohns disease.


What are the complications of Crohns Disease?

The most common complication of Crohns is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, and therefore narrows the passage. Crohns Disease may also cause sores (ulcers) that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin.

The areas around the anus and rectum are often involved. These tunnels, called fistulas, are a common complication of Crohns and often become infected (VSL). Sometimes fistulas can be treated with medicine but in some cases they may require surgery.

Nutritional complications are common in Crohn's disease. Deficiencies of proteins (Goatein) and vitamins (Vitamin code) are well documented.

There is also an insufficient calorie intake (SCD recipe book) as a result of inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption)

Nutritional supplements, containing both vitamins and minerals, are advised. Supplementation of calcium (GOL Calcium), folate and vitamin B12 (b12 drops) is helpful when malabsorption of these nutrients is apparent.

Other problems associated with Crohns Disease

  • arthritis
  • skin problems
  • inflammation in the eyes or mouth
  • kidney stones
  • gallstones, or other diseases of the liver and biliary system.

Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.

Use a safe and effective drugless approach. Our Crohn's and Colitis Protocol uses all natural supplements and diet. We offer complimentary online support to help you choose what you need.


How is Crohns Disease and Ulcerative Colitis diagnosed?

Genova Labs offers an easy to administer home stool test with markers that tell the difference between IBD (Crohns and Ulcerative Colitis) and IBS (irritable Bowel Disease). If the test shows positive for IBD, further evaluation with a physician is appropriate.

A thorough physical exam and a subsequent series of tests may be required to diagnose Crohns Disease.

Blood tests are run to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count which is a sign of inflammation somewhere in the body.

The physician may do an upper gastrointestinal (GI) series to look at the small intestine. For this test, the patient drinks barium, a chalky solution that coats the lining of the small intestine before x rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine.

The physician may also do a colonoscopy. In this test, the doctor inserts an endoscope--a long, flexible, lighted tube linked to a computer and TV monitor--into the anus to see the inside of the large intestine.

The physician will be able to see any inflammation or bleeding. During the exam, the doctor may do a biopsy which involves taking a sample of tissue from the lining of the intestine to view with a microscope.

If these tests show Crohns Disease, further x rays of the upper and lower digestive tract may be necessary to see how much is affected by the disease.

Recently, video capsule endoscopy has been added to the list of diagnostic tests for diagnosing Crohn's disease. A capsule containing a miniature video camera is swallowed. As the capsule travels through the small intestine, it sends video images of the lining of the small intestine to a receiver carried on a belt at the waist. Video capsule endoscopy must not be performed in patients who have small intestine obstruction. The capsule may get stuck behind the obstruction and make the obstruction worse

While Crohns is a serious chronic disease with many complications, it is not considered a fatal illness. Most people with the illness continue to lead useful and productive lives.


What is the difference between Crohns Disease and Ulcerative Colitis?

Crohns Disease and Ulcerative Colitis are quite distinct diseases but in practice there are sometimes difficulties distinguishing between them. This is especially true in mild cases - these are usually simply classified as "Chronic Inflammatory Bowel Disease".

Both Crohns Disease and Ulcerative Colitis have one significant feature in common. They are both marked by an abnormal response by the body's immune system.

  • The immune system is composed of various cells and proteins. Under normal circumstances, these protect the body from infection. In those with Crohns Disease, the immune system reacts inappropriately.
  • The immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances, and thus it launches an attack. In the process, the body sends white blood cells into the lining of the intestines where they produce chronic inflammation.
  • These cells then generate harmful products that ultimately lead to ulcerations and bowel injury which manifest as symptoms of Inflammatory Bowel Disease - IBD.
  • Because the symptoms of these two illnesses are so similar, it is sometimes difficult to establish the diagnosis definitively. In fact, approximately 10% of colitis cases are called Indeterminate Colitis because it cannot be determined whether the condition is Ulcerative Colitis or Crohn's disease.

The patterns of inflammation in Crohn's disease are different from Ulcerative Colitis. In Crohns Disease, all layers of the intestine may be involved, and there can be normal healthy bowel in between patches of diseased bowel.

On the other hand, Ulcerative Colitis affects only the superficial layers (the mucosa) of the colon in a more even and continuous distribution, which starts at the level of the anus.

Although Crohns Disease most commonly affects the end of the small intestine (the ileum) and the beginning of the large intestine (the colon), it may involve any part of the gastro intestinal tract - colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.

In Ulcerative Colitis, on the other hand, the gastro intestinal involvement is limited to the colon (colitis) and recturm (proctitis). The inflammation also tends to be diffuse and uniform. All of the lining in the affected segment of the intestine is inflamed.

The inflammation caused by Crohn's disease is concentrated in some areas more so than in others and involves layers of the bowel that are much deeper than the superficial inner layers. This means that the affected segments of bowel in Crohn's disease can have deep ulcers with normal lining between these ulcers.


What about Diet and Nutrition for Crohns Disease and Ulcerative Colitis?

Dietary modifications for Crohns Disease and Colitis help reduce symptoms, replace lost nutrients, and promote healing. There are several cookbooks to choose from: EHC Cookbook, Recipes for Specific Carbohydrate Diet and Crohns, Colitis, Celiac, IBS Recipe Book

In Crohns Disease the appetite is often reduced. Also, chronic diseases like Crohns Disease, tend to increase the energy or caloric needs of the body. This is particularly true during episodes of disease "flares ups".

Crohns Disease is associated with diarrhea and poor absorption (malabsorption) of dietary protein, fat, carbohydrates, and water.

All these symptoms rob the body of fluids, nutrients, and a wide variety of vitamins and minerals. Restoring and maintaining proper nutrition is a vital part in the management of Crohns Disease and Colitis. Antioxidants, Vitamin B Complex, Iron, Vitamin C and Vitamin E are important considerations.


Can people with Crohn's Disease or Ulcerative Colitis use aspirin?

Those with Ulcerative Colitis and Crohn's Disease can experience flare-ups of their inflammatory bowel disease with aspirin or nonsteroidal anti-inflammatory drugs, so they should avoid aspirin.


Is Crohns Disease and Colitis caused by Emotional Stress?

There is no medical evidence to show that stress, anxiety, or tension is responsible for Crohns Disease and Colitis. No single personality type is more prone to develop Crohns and Colitis than others, and no one "brings on" the disease by poor emotional control.

However, because body and mind are so closely interrelated, emotional stress can influence the course of Crohns Disease and Colitis or any chronic illness. In fact, people often experience emotional problems before a flare-up of Crohns Disease or Colitis.

Some of this emotional distress is often a reaction to the symptoms of Crohns and Colitis themselves. Some find it difficult to cope with a chronic illness. Crohns Disease and Colitis affect their quality of life, their physical and emotional well-being, social functioning, and sense of self-esteem.

Although formal psychotherapy is generally not necessary, some are helped by speaking with a therapist who is knowledgeable about Inflammatory Bowel Disease or about chronic illness in general.

Another alternative is to seek emotional support from families, friends, and physicians. Relaxation techniques, in particular, greatly reduce the symptoms associated with Crohns Disease and Colitis.


What are the different types of Crohns Disease?

There are 5 types of Crohns Disease. The symptoms and complications of Crohns Disease differ depending on which part of intestinal tract is inflamed.

  1. Ileocolitis: The most common form of Crohns Disease. It affects the ileum and colon. Symptoms include diarrhea and cramping or pain in the right lower part or middle of the abdomen. Ileocolitis is often accompanied by significant weight loss.
  2. Ileitis: This type of Crohns Disese affects the ileum. Symptoms are the same as ileocolitis. Complications may include fistulas or inflammatory abscess in right lower quadrant of abdomen.
  3. Gastroduodenal Crohns Disease: This type of Crohns Disease affects the stomach and duodenum (the first part of the small intestine). Symptoms include loss of appetite, weight loss, and nausea. Vomiting may indicate that narrowed segments of the bowel are obstructed.
  4. Jejunoileitis: This type of Crohns Disease produces patchy areas of inflammation in the jejunum (upper half of the small intestine. Symptoms include abdominal pain (ranging from mild to intense) and cramps following meals, as well as diarrhea. Fistulas may form.
  5. Crohns (Granulomatous) Colitis: This type of Crohns Disease affects the colon only. Symptoms include diarrhea, rectal bleeding, and disease around the anus (abscess, fistulas, ulcers). Skin lesions and joint pains are more common in this form of Crohns Disease than in others.



What is the history of Crohns Disease and Colitis?

Crohns Disease

  • The disease is named after Dr. Burrill B. Crohn. In 1932, Dr. Crohn and his two colleagues, Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, published an important paper describing the features of what is known today as Crohns Disease. Crohns and the related disease, Ulcerative Colitis, are the two main disease categories that belong to the larger group of illnesses called Inflammatory Bowel Disease (IBD).
  • Crohns Disease was first described by Giovanni Battista Morgagni (1682-1771), with subsequent cases being described by John Berg in 1898 and by Polish surgeon Antoni Lesniowski in 1904. Scottish physician T. Kennedy Dalziel described nine cases of Crohns in 1913.
  • Burrill Bernard Crohn, an American gastro-enterologist, described fourteen cases in 1932, characterizing Crohns Disease as "Terminal Ileitis: A New Clinical Entity".
  • The description was changed to "Regional Ileitis" on publication. It is by virtue of alphabetization rather than contribution that Crohn's name appeared as first author. This was the first time the condition was reported in a widely-read journal. The disease has come to be known as Crohn's Disease for reasons of publicity rather than precedence. In Poland the disease is known as Lesniowski-Crohn Disease.
  • Crohns is often mispelled as Crones, Chrones, Krones, or Krohns

Colitis

  • The first description of Ulcerative Colitis dates back to 640 BC and many physicians up to 170 AD including Hippocrates described a condition with a type of chronic diarrhea associated with blood and ulcerations of the bowel.
  • There are some suggestions that Bonnie Prince Charlie – the young pretender may have had Ulcerative Colitis, which was aggravated by milk. This casts quite a different image of him, quite at odds with the rather dashing figure of history, film and folklore.
  • The Surgeon General of the Union Army, during the American Civil War, referred to Ulcerative colitis.
  • Colitis as a specific pathology was first described by Wilks and Moxon in 1875; they called it "Inflammation of the large intestine or idiopathic colitis".
  • During the 1920s “colitis” was a strangely popular (amongst doctors) diagnosis, for a wide range of gut related diseases. The number of individuals suffering from colitis increased steadily until the 1980s, after which the number has leveled out. Most recent reports show a kind of see saw effect, in which as the number of people with Ulcerative colitis decreases, the number of people with Crohn’s increases.

Start today with effective, natural supplements and a change of diet. Many people have been able to control their symptoms and encourage remission with a drugless approach. See our Crohn's Protocol. If you have any questions, please email customer service - we offer complimentary online support when you purchase products from us. We are happy to assist in helping you to create an individualized program to meet your specific needs. Each person is an individual and can be treated successfully with that in mind.