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Crohn's Disease

Crohn's Disease is a condition that affects men and women.  It is characterized by an inflammation of the bowels, most commonly the small intestine.  For this reason Crohn's Disease is also referred to as Inflammatory Bowel Disease (IBD).  Symptoms of this condition are similar to that of ulcerative colitis and Irritable Bowel Syndrome (IBS).

Currently, there is no known cause for Crohn's Disease.  Scientists believe that it may be caused by a combination of factors.  Individuals whose primary relatives have been affected with this condition are more likely to experience Crohn's Disease.  Scientists also believe that abnormalities of the immune system may also be a major factor; whereby, the immune system attacks the intestines either without known cause or because there is a certain unknown bacteria present.  Individuals whose NOD2 gene has mutated are also more likely to develop Crohn's Disease.

The early stages of Crohn's Disease are characterized by small, shallow erosions called aphthous ulcers, which become deeper and larger with time.  As these ulcers grow the bowels become narrowed and with time will finally become fully obstructed causing severe complications.  In some cases, the ulcers will puncture a hole in the wall of the intestine allowing bacteria and infection to spread to other organs.  In other cases, the growing ulcers may create tunnels to other organs.  Ulcer tunneling, whereby a channel has been formed between two organs is called a fistula.  In the case of Crohn's Disease a fistula may form between the intestines and other organs such as the abdomen or rectum.  This will allow the excretion of gas and feces through other organs which can lead to infection and in some cases abdominal abscesses: a collection of infected pus inside the of abdominal cavity.

Symptoms

There are several non-specific symptoms associated with Crohn's Disease:

bulletabdominal pain
bulletdiarrhea
bulletweight loss
bulletpoor appetite
bulletfever
bulletnight sweats
bulletrectal pain and bleeding

Crohn's Disease also has a few sub-classifications depending on the areas of the bowel that are being affected:

bulletCrohn's Colitis: inflammation of the colon.  Characterized by abdominal pain, diarrhea, anal fistula and peri-rectal abscesses.
bulletCrohn's Enteritis: inflammation of small intestine.  Also known as Crohn's Ileum.  Untreated, this condition will, most probably, result in an obstruction of the small intestine.
bulletCrohn's Terminal Ileitis: inflammation of the very end of the small intestine (terminal ileum).
bulletCrohn's Entero-Colitis/Ileo-Colitis: inflammation of the small intestine and the colon.

The development of Crohn's Disease may also show symptoms in the anal area:

bulletswelling of anal sphincter, which controls defecation.
bulletdevelopment of ulcers on anal sphincter.
bulletdevelopment of anal fistulae, causing drainage of pus, gas and feces through an opening close to the anus.
bulletdevelopment of peri-rectal abscesses, which can cause fever, pain and tenderness in the abdominal area.

Complications

There are two types of complications resulting from Crohn's Disease: intestinal and extra-intestinal.  The following are intestinal complications:

bulletfistula
bulletabscesses
bulletinternal bleeding
bulletobstruction of bowel
bulletperforation of bowel, which will require surgery.
bulletrisk of colon cancer

Extra-intestinal complications most commonly affect the skin, joints, spin, eyes, liver and bile ducts:

bulleterythema hodosum: painful, red, raised spots on skin
bulletpyoderma gangerosum: ulcerating skin condition on ankles
bulletarthritis: stiffness of joints
bulletepiscleritis: an eye condition that causes pain and impaired vision.
bulletlower back inflammation (sacroiliac joint arthritis) and spine inflammation (anklyosing spondylitis), resulting in pain and stiffness in these areas.
bullethepatitis
bulletbile duct inflammation (primary schlerosing cholangitis): resulting in jaundice, infection, cirrhosis and possibly, cancer of the bile ducts.

Diagnosis

Diagnosis of Crohn's Disease is primarily based on symptoms.  Physicians will conduct further lab and blood tests to diagnose Crohn's Disease in patients that are suffering from any of the above symptoms.  If the patient suffers from Crohn's Disease, the lab tests will show elevated white blood cells, a sign of inflammation, and low red blood cells, protein and minerals, which may result from diarrhea. 

The physician may also opt to perform a barium x-ray.  Barium is a white, chalky substance that shows up on a x-ray machine.  After the patient ingests barium or has it inserted as an enema, the physician can monitor its flow through the digestive system and determine if ulcers, fistulae or a narrowing of the bowel has occurred. 

Another procedure which is used to diagnose Crohn's Disease and is more reliable than a barium x-ray is a colonoscopy.  During a colonoscopy, a thin viewing tube is inserted into the rectum and colon in order to determine if there are areas of inflammation.

Finally, a CAT (Computerized Axial Tomography) Scan can be used to gain a detailed view of the entire abdomen and pelvic area.

Treatment

There is no medical cure for Crohn's Disease.  Individuals suffering from Crohn's Disease may either be in a state of relapse or remission.  During remission, the individual either does not suffer from symptoms or the symptoms are very mild.    Remission may occur with medication, surgery or no treatment at all.  If treatment is necessary, its primary purpose is to:

bulletinduce remissions
bulletmaintain remission
bulletminimize side-effects
bulletimprove quality of life

There are general measure that can be taken to reduce symptoms and help alleviate some of the discomforts associated with Crohn's Disease.  For example, fiber is difficult to digest and may aggravate the bowels; thus, a low-fiber diet may be recommended.  Anti-diarrheal agents such as Imodium and anti-spasmodic agents can also reduce symptoms such as cramps and diarrhea.  In some cases, the intestines may be severely overworked; in such cases, the patient may be fed intravenously or given a liquid diet.

There are several medications available to help treat Crohn's Disease.  They fall into different categories, depending on the type of medication and the way in which it is applied:

bulletAnti-Inflammatory Agents such as mesalamine, which act via direct contact with the affected area.
bulletCorticosteroids: systemic medication, which means it affects the entire body, has no direct contact with the affected area and has several side-effects.  There are topical corticosteroids available, which involve direct contact with the affected area and have less side-effects.
bulletTopical antibiotics such as metronidazole.
bulletImmuno-modulators: reduce inflammation by reducing the number of immune cells in the body.  By minimizing the ability of the immune system with this type of medication, the individual would be more susceptible to infection and disease; however, the benefits of this medication are thought to greatly outweigh the disadvantages of a lowered immunity.

There are many side-effects associated with these medications.  Each medication will have a different set of side-effects.  Here are some of the most common:

bulletacne
bulletincrease in body hair
bulletweight gain
bullethigh blood pressure
bulletcataracts
bulletglaucoma
bulletweakness
bulletdepression
bulletinsomnia
bulletmood swings
bulletpersonality changes
bulletirritability
bulletosteoporosis (especially with corticosteroids)
bulletasceptic necrosis-degeneration of hip bone

Another type of treatment is surgery.  Surgery is most often used in cases where the patient is not responding to medication or the condition has become so advanced that surgery is the only option.  Such situations include:

bulletthe removal of an obstruction
bulletdrainage of abscesses
bullettreatment of anal or other internal fistulae that are causing infections.

Patients undergoing surgery can expect to be symptom free for a period of time, often years.  However, the disease often returns (relapse), and inflammation begins around the same area as before.  There are some medications such as Pentasa that have been helpful in reducing the chances of relapse.

Cirrhosis of the Liver
Colorectal Cancer
Crohn's Disease
Gallstones
GERD
Hemorrhoids
Hepatitis
IBS
Lactose Intolerance
Pancreatitis
Ulcerative Colitis
Ulcers

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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