Medical Moment - Informing | Motivating | Empowering Story URL:
Crohn’s Disease and Irritable Bowel Syndrome – Two Gut Feelings
with Helmut Ammon, M.D., gastroenterologist, Columbia St. Mary’s
Last Updated: June 1, 2003
Crohn’s disease is not to be taken lightly. There’s no self-treatment that works and it can’t be treated with over-the-counter drugs. And, according to Dr. Helmut Ammon, it’s got a wide spectrum of severity. “On one end it’s a mild condition where a patient has occasional cramping and occasional diarrhea. On the other end, if it goes untreated, death can be the outcome. And in some young children who have it, there can be a serious failure to thrive.”
Dr. Ammon, of Madison Medical Affiliates in Milwaukee, is chairman of the Division of Gastroenterolgy at Columbia St. Mary’s Hospital, and is a clinical professor of medicine at the Medical College of Wisconsin.
Who is at risk?
Crohn’s is a chronic inflammatory disease of the bowel, he explained. It usually occurs between the ages of 14 and 35. But there are more cases being reported in children and other ages.
“Technically anybody is at risk,” said Dr. Ammon. “It can start at any age, and affects both sexes. There are certain populations where the incidence is higher, such as Jewish people. And there’s some familial clustering.
“Its ultimate cause is not known, but it’s thought that the body’s immune system reacts abnormally to a virus or bacteria by causing ongoing inflammation of the intestine,” said Dr. Ammon. “In certain patients we know that it’s due to genetic abnormalities, which we can identify, but we don’t know how the genes directly relate to Crohn’s
Symptoms of Chrohn’s disease
“It mainly effects the colon and the lower part of the small intestine, but can sometimes affect the upper GI tract – the esophagus, the stomach, the duodenum, and cause ulcers of the mouth. It’s characterized by changes of inflammation and ulceration and it can skip areas. Normal segments of bowel can alternate with diseased segments.”
Crohn’s disease is chronic but occasionally it burns out and the patient is fine afterwards.
The symptoms include diarrhea, cramping abdominal pains, weight loss, anemia, fever, rectal bleeding and digestive problems.
The most obvious complication, according to Dr. Ammon, is fistula formations, mainly around the rectum, and in women around the genitalia. “Another complication is an obstruction of the bowel, due to inflammation or scarring. Pain is associated with this, as well as nausea and cramping,” he said. “Like any bowel obstruction, it needs to be treated. A Crohn’s patient may sometimes need surgery for abscess formation or complications of stricture formations, or medically intractable disease.”
Treatment for Crohn’s depends on the location and severity of the disease, complications and previous treatment. Drug therapy is effective in most cases. The goals are to control inflammation, correct nutritional deficiencies and relieve the symptoms. Treatments can help control Crohn’s, but as of now there is no cure.
Dr. Ammon advises anyone who has recurrent symptoms, such as diarrhea, weight loss or persistent cramping, to see a doctor.
Irritable bowel syndrome
While the symptoms of irritable bowel syndrome (IBS) may be similar to Crohn’s, Dr. Ammon said that it’s a totally different condition. “IBS is a nuisance – not serious. It’s a functional disorder in people who have a different perception of pain than the average person. Although the bowel is normal, it causes problems because of its autonomous response to stress. Virtually everybody has these symptoms once in a while,” he said.
How to treat IBS? “After any organic disease such as Crohn’s is ruled out, the patient’s mind should be relieved of anxiety. Fiber supplements will help relieve cramping, constipation or diarrhea. Usually an IBS patient can learn to live with it.”
Learn about new developments in GI testing for Crohn’s disease from Dr. Drew Elgin.
Get the Facts
