Crohn’s Disease Its Underlying Causes

. Rosh: The last decade has brought marked advances in our understanding of the etiology of the (IBD = Crohn’s Disease and Ulcerative Colitis). Long recognized as conditions that lead to chronic, poorly regulated inflammation of the , 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 (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.

.com: -Who is more at risk and how does Crohn’s disease affect the daily lives of patients?

Chronic 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 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

About Rob Hill

In 1994, Rob was a fit, healthy 23-year-old, an amateur runner and athlete. Until that time, he had never really been sick. He didn’t even have a regular doctor. When the illness started, it progressed rapidly. Daily diarrhea. Sustained stomach cramps. The diagnosis was Crohn’s disease, an inflammatory condition of the digestive tract. It got worse, and his weight plummeted from 185 to 105 pounds. After a year and a half, it became clear that his large intestine, his colon, needed to be removed. Rob decided he had to do something about it. The Seven Summits campaign, which we call “No Guts Know Glory” grew from Rob’s love of sport, adventure and the outdoors. By taking it to the extreme, and on a global basis, Rob hopes to show people everywhere that having these diseases or having an ostomy, like Rob does, shouldn’t stop you from leading a full life. You may not be able to climb mountains, but there are so many other things you can do. To further this goal, Rob started the Intestinal Disease Education and Awareness Society (IDEAS), from his home base in Vancouver, British Columbia.

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