Pregnancy and Crohn’s Disease
The incidence of CD peaks in the second and third decades of life. Pregnancy does not appear to affect CD, but disease activity before and during the pregnancy has been shown to directly influence the outcome of the pregnancy.
in a recent US study, 3/17 pregnancy CD patients delivered their babies prematurely (before 33 weeks gestation); 2 of these had had no disease activity during pregnancy. Overall 7 patients had disease flare-ups during pregnancy or soon after delivery. This consisted of recurrent diarrhea in 5 patients. Seven patients took medication during pregnancy, including prednisone, with no adverse effect on the baby.There was concern about possible complications with a normal delivery in the patients with perianal disease. In the only patient with perianal disease who had a normal delivery, disease was unaffected. None of the other 7 patients with normal delivery developed perianal disease. Caesarean section was performed in 9 patients, 4 of whom had perianal disease. However, recurrent perianal symptoms developed in 3 of these patients after delivery. Thus, the route of delivery should be based on obstetric indications and not merely on CD history recommend the authors of the study. their other advice is that disease symptoms should be brought under control to minimize the risk of premature delivery and problems during pregnancy.
Pentasa affects quality of life in CD
A study performed in the USA has shown that a Pentasa dose of 4g/day significantly improves quality of life compared with lower drug doses or placebo. In the study, 310 patients with mild to moderately active CD received slow release mesalazine at a dose of 1, 2 or 4g/day or placebo for 16 weeks. At different times during the study patients completed a quality-of-life questionnaire that asked about ability to sleep through the night, sexual relationships, performance of routine activities (eg work) and ability to participate in hobby and leisure activities. The results of the study showed that as the mesalazine dose increased, the quality-of-life of the patients taking the drug improved. With the 4g/day dose, patients' responses to all the above questions significantly improved compared with placebo. Patients taking the 2 g/day dosage only reported a significantly increased ability to participate in hobby and leisure activities. The effects of the 1g/day dose were not significantly different from those of the inactive placebo.
Mesalazine: decreased risk of recurrent Crohn's Disease after Surgery
Mesalazine (Pentasa/Asacol) 3g/day effectively reduces the risk of recurrent Crohn's disease after surgical resection, according to researchers in Canada and the US.
In their study, 163 patients with Crohn's disease underwent surgical resection and then received mesalazine 1.5 g twice daily or placebo, starting within 8 weeks of surgery even if symptoms weren't present. Long-term follow-up revealed that the calculated risk of relapse (over three years) in the respective patient groups was 26 and 45%. It was concluded that further studies would be required to determine the potential long-term quality of life benefits of starting mesalazine routinely after surgery rather than waiting until symptoms recur, as is the current practice.
Anemia
The term 'anemia' is used by physicians to indicate a low red blood cell count. Red blood cells carry oxygen to all cells of the body. A decrease in these cells affects many areas of the body, and because of this, quality of life is significantly diminished.
The frequency of anemia in those suffering from IBD is reported to be as low as 30% of patients and as high as 70%. Its onset is usually gradual sometimes taking years to develop, and many patients may not immediately realise the effect on their daily performance. Occasionally, a low red blood cell count is the initial clue to the diagnosis of IBD, but in general, anemia occurs well after intestinal symptoms have begun.
The main manifestations produced by anemia are weakness and fatigue. Shortness of breath, especially with physical activity, is also common. Patients often find they just can't do things with as much energy as they used to. Lightheadedness and nausea are also frequently noticed. In older patients or those with coronary artery disease, anemia can lead to chest pain (angina) because of the decrease in oxygen supply to the heart. Headaches and other neurological symptoms also may occur due to the diminished oxygen level in the brain.The frequency and severity of a decrease in the blood count is directly related to the severity of inflammation. This is because several of the chemicals (cytokines) produced in IBD interfere with the development of red blood cells. Therefore, controlling the inflammatory process is key to improving anemia. Additional steps including replenishing nutrients that have been lost as a result of the intestinal inflammation.
The causes of anemia in IBD are generally due to many factors, with iron deficiency being the most common. This is usually due to blood loss, which is either obvious to the patient, or occurs in such small amounts as not to be noticed (occult blood loss). Rarely in CD, with extensive involvement of the upper gastrointestinal tract, is iron absorption affected. the diagnosis is made by blood tets that can document the decrease in body iron. In some cases, however, these tests are misleading, and then an examination of a specimen of bone marrow is necessary.Traditional treatment of 'iron deficiency anemia' is usually successful with replacement of iron taken orally. These preparations commonly produce undesired effects on the gastrointestinal tract, including constipation, diarrhea and excessive gas. This can be overcome by using a different type of iron product (e.g. gluconate instead of sulfate) or by taking medication with food. However, eating within one hour of taking iron decreases its absorption. Tolerance can also be improved by starting out with low doses and gradually increasing intake over several days. After the blood count returns to normal, treatment for three months or more is needed to bring iron levels back to where they should be. all attempts should be made to replenish iron orally and avoid the hazards of intravenous or intramuscular administration. Patients should also refrain from using any medication that increases bleeding from the intestinal tract, such as aspirin or non-steroidal anti-inflammatory drugs (ibuprofen).
Another important causes of anemia in IBD is decreased absorption of vitamin B-12. This vitamin needs a well-functioning stomach and ileum for absorption. Therefore, patients with CD who have inflammation in these areas or who have had surgery involving these organs, frequently develop a B-12 deficiency.Excessive growth of various bacteria in the intestinal tract can also lead to poor B-12 absorption. B-12 deficiency takes years to develop because of the body's large reserve supply. It is important to realise that B-12 deficiency also has a serious effect on the nervous system. The cause of the anemia can be identified by the abnormally large blood cells and by measurement of B-12 levels.Traditional treatment of B-12 deficiency has been intramuscular injection on a monthly basis, and lifelong replacement is sometimes needed. Recently, a nasal administration system, Nascobal has become available which avoids the need for repeated injections.
Folic acid deficiency is yet another cause of IBD-related anemia and is due to poor nutrition or decreased absorption. Another important cause is related to medications. Azulfadine and methotrexate can both interfere with the bodys metabolism of folic acid. The diagnosis is made with similar techniques used to identify B-12 deficiency. Replacement is usually needed for several months in order to normalize body supplies. Some instances of anemia do not improve despite the above treatments and are resistant to all therapies. In the last few years, cytokines have played an important role in preventing normal blood cell formation. Medications that can overcome these effects are now being used in some cases to improve red blood cell counts.
Crohn's Disease on Increase
The results of a retrospective study of the incidence of paediatric IBD over an 11 year period have recently been made public. The research taken at the University Hospital of Wales in Cardiff, revealed that the incidence of Crohn's disease more than doubled from 1.3 cases per 100,000 childhood population per year in the period 1983-1988, to 3.11 cases per 100,000 population per year in the year 1989-1993. In contrast, the incidence of UC remained the same throughout the study period at 0.71 per 100,000 per year. Results from an English study in 1983 showed similar trends.These findings are in direct contract to figures published in mid-80s on children in Scandinavia. The annual incidence of crohns disease was only 2.5 per 100,000 per year, but the incidence of UC was much greater than 4.3 per 100,000 per year. In Norway and Sweden, the incidence of UC was greater than that of CD. The reasons for such a variation in the incidence of CD in some areas is unknown. In 1993, the prevalence of CD in the childhood population of Wales was 16.6 per 100,000 and of UC, 3.42 per 100,000.
The above information was supplied by Sarah Krein
Crohn's disease and milk
That Gut Feeling :
Scientists at St Georges hospital in London are claiming there is a link between Crohns disease - a debilitating digestive problem that affects more than 40,000 people in the UK - and drinking milk. Professor John Hermon-Taylor, a surgeon, and his team have reported finding minute traces of an organism known as myco-bacterium paratubercolosis in two thirds of the intestinal tissue removed from Crohns patients after surgery and although the National Dairy Council has disputed such claims on the basis of its own studies, the hospital researchers say they have also found the organism in supplies of whole, pasteurised milk. Hermon-Taylor and his colleagues are suggesting mycobacterium, which causes Johnes disease in sheep and cattle (a condition similar to Crohns disease in humans), is being transferred through food and water systems and can sometimes survive the process of pasteurisation. The full results of the study will be published in September and these may be convincing enough for sufferers to be told, for the first time since the condition was originally diagnosed in 1932, that scientists have discovered a concrete cause. Although public awareness of the condition is still limited, 3000 new cases are diagnosed every year. Crohns affects both men and women equally. The incidence has doubled in the past 20 years. Crohns disease can affect any part of the digestive tract but is more commonly found in the small intestine where it causes inflammation, deep ulcers and scarring to the intestinal wall. The main symptoms - tiredness, urgent diarrhea and loss of weight - can be controlled by drugs but surgery is frequently necessary to remove the damaged or narrowed sections of the intestine. There is no known cause, and no known cure, for Crohns, although there is evidence of a genetic predisposition.
Sisters Sue Middleburgh 44, and Ruth Ardley, 40, have both suffered from Crohns disease since their teens. Middleburgh, a financial adviser who was first diagnosed at 16, remembers passing out from the crippling stomach pain but being told her symptoms were psychological "After one operation at the age of 24, I turned to acupuncture and for the past 12 years I have coped with the disease without further surgery, although there are times when it does get me down", she says. Ardley a part time book-keeper and mother of two, says Crohns affects not only her life but her whole family. "Fortunately, I have an understanding husband but it is a difficult disease to live with. When you need the toilet you have to go straight away and people don't understand the urgency". The national association for Crohns and colitis (NACC) issues its 24500 members with a can't wait card, designed to facilitate quicker access to public lavatories in shops and also runs support groups across the country for sufferers. Richard Driscoll the NACC director is cautious about the new research linking Crohns with milk and says one problem is that no other research group has as yet been able to repeat the results reported by the group at St Georges hospital. "Aside from the genetic aspect we believe there may be environmental factors that give rise to the disease. There must be something about our modern way of living that is causing an increase in sufferers" he says. "It may be there is more than one external agent that triggers the disease, but the sad fact for sufferers is that, once they have it, it is a lifelong condition for which there is no cure" Researchers at the Royal Free hospital in London have suggested the measles virus may be linked to the disease. The hypothesis is that measles may cause lasting damage to the blood vessels lining the bowel wall, triggering the onset of Crohns in some people.However like the milk hypothesis, this research is in its infancy and, despite a suggestion that a measles vaccine given to children could lead to Crohns in later life, the consensus of medical opinion is that the benefits of the vaccine outweigh the unproven risks of a link with Crohns. Driscoll emphasises that there is no link between Crohns and irritable bowel syndrome - one does not lead to the other and there is in fact, no tissue inflammation with the latter and no obvious sign of damage to the intestine. Another problem facing Crohns sufferers is that it can take up to a year to rule out similar conditions and many are sent packing by their GP's who mistakenly believe the symptoms to be psychosomatic. "The best way to describe the condition to non-sufferers is to tell them to think of the worst tummy bug they have ever had on holiday and then to try to imagine living that every day," Driscoll says. "Sufferers never know how they will feel from one day to the next, which is debilitating enough and although Crohns is more common that multiple sclerosis and almost as prevalent as Parkinsons disease, people know very little about it"
http://www.ibduk.com/startpage.htm
In Friendship Katherine Findlay United Kingdom Adhesion Society mailto:kath.findlay@adhesions.org.uk http://www.adhesions.org.uk