Crohn’s Disease Its Underlying Causes
Dr. Joel R. Rosh: The last decade has brought marked advances in our understanding of the etiology of the inflammatory bowel diseases (IBD = Crohn’s Disease and Ulcerative Colitis). Long recognized as conditions that lead to chronic, poorly regulated inflammation of the gastrointestinal tract, recent research has shed light on the underlying causes of IBD.
The gastrointestinal tract normally has a very active, local immune system. Our intestines are inhabited by 10 times more bacteria than human cells! The cross talk between the bacteria that live in our bowels and our local immune system is a dynamic and closely regulated process that finds its roots in our genes.
There are now more than 90 IBD susceptability genes that have been identified. Individuals with such genetic susceptability have an innate immune system (what you are born with) that is predisposed to loss of regulation. In such an individual, enviornmental factors that are yet to be fully described, affect this “hard-wired” immune system and the consequent adaptation is poorly controlled leading to the chronic inflammtion of IBD.
HealthNewsDigest.com: -Who is more at risk and how does Crohn’s disease affect the daily lives of patients?
Chronic gastrointestinal inflammation leads to symptoms such as abdominal pain, diarrhea and fever and weight loss. In pediatric patients, this can have a profound effect on growth and development. Such unrelenting symptoms can have a profound affect on quality of life issues including secondary anxiety and depression, lost work and school productivity, etc.
HND: – What are the complications of Crohn’s disease?
Dr. Joel R. Rosh: The inflammatory process in Crohn’s disease (CD) starts in the lining of the intestine but can involve all layers of the wall, that is, full thickness changes. This can lead to long term complications which can require multiple surgical interventions and hospitalizations. Such complications include scarring of the wall (strictures) and perforation through the wall leading to infection (abscess) or abnormal connections (fistulas) to other structures including the abdominal wall, other loops of intestine, bladder and uterus. Such perforations could also be spontaeous, profound and life-threatening leading to emergent operations.
HND: – Based on a recent study published in The American Journal of Gastroenterology, most patients with Crohn’s disease will require major abdominal surgery within 20 years of being diagnosed. What can be done to help provide better outcomes for these patients?
Dr. Joel R. Rosh: – While mild disease can respond to topical anti-inflammatory therapy, patients with moderate disease activity or a relapsing course have been identified as those who should receive immune modifying agents. The short-term goal of therapy remains the relief of clinical symptoms while the long-term goal is to improve quality of life while changing the natural history of the disease by decreasing the incidence of adverse outcomes such as the need for surgical intervention. Careful disease monitoring, including assessment for ongoing inflammatory activity even in the absence of gastrointestinal symptoms, is likely to be our best strategy to alter the natural history of Crohn’s disease.
Crohn’s Disease and Its Underlying Causes – An Interview with Joel R. Rosh, MD …
Dr. Joel R. Rosh: The last decade has brought marked advances in our understanding of the etiology of the inflammatory bowel diseases (IBD = Crohn’s Disease and Ulcerative Colitis). Long recognized as conditions that lead to chronic, poorly regulated …