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Crohns Disease Question: Discuss about the Crohns Disease.     Answer: Introduction: Crohn’s disease is a type of inflammatory bowel disease (IBD) that can involve any segment of the digestive tract of human starting from mouth to the anus. However, Crohn’s disease most frequently occurred at distal third of the small intestine and colon. Crohn’s disease is mainly characterized by transmural inflammation (Baumgart, 2012; Hendy and Hart, 2013).   Based on the location, Crohn’s disease can be classified as Crohn’s ileitis, Gastroduodenal Crohn’s disease and Jejunoileitis which affects ileum, stomach & initial segment of the small intestine and jejunum respectively. Based on the presentation, Crohn’s disease can be classified as stricturing, penetrating, and inflammatory, which produces narrowing of bowl, fistulae and inflammation respectively (Baumgart, 2012; Hendy and Hart, 2013). Crohn’s disease can be inherited and about 20 % of the people with Crohn’s disease can have immediate relation with Crohn’s disease patient. Crohn’s disease occur more in male as compared to the female. In most of the cases Crohn’s disease occur mainly in the third decade of life. Among children, there is more prevalence of Crohn’s disease as compared to the ulcerative colitis. On an average incidence of Crohn’s disease occurred at 8-10:100,000 people throughout the world. Approximately 0.4 % people in Australia develop Crohn’s disease. Crohn’s disease is more prevalent in developed countries as compared to the developing countries (Spehlmann et al., 2008). Symptoms of Crohn’s consist of abdominal pain, diarrhea, bloody diarrhea, flatulence, growth failure in children, bloating weight loss and fever. Other than digestive tract it produces effects like anemia, skin rashes, arthritis, eye inflammation, ankylosing spondylitis and bowl cancer (Baumgart, 2012; Hendy and Hart, 2013).   Diagnostic tests of Crohn’s composed of blood test like C-reactive protein and stool tests, X-rays of upper and lower digestive tract using Barium. Two types of endoscopy i.e. colonoscopy thorough annus and upper endoscopy through mouth can be performed. Biopsy can be performed for the pathological examination. Small intestinal imaging techniques like fluoroscopic x-ray, computed tomography (CT) scan and magnetic resonance imaging scan can also be used (Pawlowski et al., 2009). Treatment and management of Crohn’s disease includes lifestyle changes like smoking cessation and nutrition therapy like enteral and parenteral nutrition. Medications include anti-inflammatory drugs as first step like 5-aminosalicylates and corticosteroids, immune system suppressants to target immune system and also to reduce inflammation like azathiprine, mercaptopurine, methotrexate, tacrolimus and cyclosporine. Agents like infliximab, adalimumab, certolizumab pegol, natalizumab, vedolizumab and ustekinumab acting on cytokines and adhesion molecules of the immune system can also be used. Antibiotics like metronidazole and ciprofloxacin can be used along with other medicines to treat fistulas and abscesses. Other treatments for Crohn’s disease include anti-diarrheals, pain relievers, iron supplements, vitamin B-12, calcium and vitamin D. If above mentioned treatments don’t improve symptoms, surgery is recommended in 50 % of total patients of Crohn’s disease (Pawlowski et al., 2009).   Exact cause of Crohn’s disease is not known however, environmental factor like reactive oxygen species due to smoking, stress & diet is mainly responsible for greater prevalence of Crohn’s disease. Other factors include like genetic factor such as NOD2 gene, deregulated immune system & release of proinflammatory cytokines and microorganisms (Ng et al., 2012).     In conclusion, prevalence of Cohn’s disease is increasing rapidly, early diagnosis is required and Cohn’s disease can be prevented dietary and lifestyle changes. Smoking cessation and exercise also helps to prevent Cohn’s disease.    References: Baumgart, D.C. and Sandborn WJ. (2012). Crohn’s disease. Lancet, 380, 1590–1605.  Hendy, P. and Hart, A. (2013). A review of crohn’s disease. European Medical Journal Gastroenterol, 1, 116-123.  Ng, S.C., Woodrow, S., Patel, N., Subhani, J. and Harbord, M. (2012). Role of genetic and environmental factors in British twins with inflammatory bowel disease. Inflammatory Bowel Diseases, 18, 725–36. Pawlowski, S.W., Warren, C.A. and Guerrant, R. (2009). Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology, 136, 1874–86.  Spehlmann, M.E., Begun, A.Z., Burghardt, J., Lepage, P., Raedler, A. and Schreiber, S. (2008).  Epidemiology of inflammatory bowel disease in a German twin cohort: results of a nationwide study. Inflammatory Bowel Diseases, 14, 968–76.

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