Crohns Disease

Crohns Disease

Crohn’s Disease is a long term inflammatory condition of the gastrointestinal tract which can cause diarrhea, abdominal pain, fever and weight loss. It can also be associated to intestinal obstruction, ulcers and skin nodules. Any area from the mouth to the anus can be virtually affected and can extend deep into the layers of the involved tissue.  ^{[1] [2]} Crohn’s disease is frequently confused with ulcerative colitis. Both belong to a group of medical conditions called Inflammatory Bowel Disease (IBD). ^[3]

Epidemiology

More cases are reported in regions with temperate climates and more industrialized areas like Western Europe and North America. Most patients have age less than 30 years old. Generally, there is no gender predilection although some studies suggest that the incidence is slightly higher among females. ^[4]

Causes

The exact cause is yet to be determined. Experts suggest that the disease is a result of the combination of several factors. These include genes, immune system, previous infection, environmental factors and smoking. ^[5]

Signs and Symptoms

The signs and symptoms can range from mild to severe. Patients usually have a period of time when they experience no symptom at all. This time frame is called remission period. However, when they are at the active phase, symptoms include abdominal pain and cramping, diarrhea, blood in the stool, loss of appetite and unintentional weight loss. ^[2] Generalized fatigability and low grade fever are also frequently reported. Some patients with gastroduodenal area involvement may have vomiting and nausea. Obstruction can also result secondarily and may cause bloated feeling, cramping pains and constipation. ^[4]

Diagnosis

After getting the medical history of the patient, a physical examination is done which may show abdominal tenderness, mouth ulcers and blood in the anal part. Laboratory tests that may be done include upper GI series, colonoscopy, CT scan of the abdomen, stool culture, endoscopy and enteroscopy. ^[1]

Treatment

Currently, there is no cure. The aim is to control the symptoms. It is important for patients to eat a well-balanced diet and avoid foods that can worsen diarrhea. Pain medications and anti-diarrheal drugs may be prescribed by the physician. Some patients especially those who had intestinal damages due to the disease may need surgery. ^[1]

References:

1.      http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295/

2.      http://www.mayoclinic.com/health/crohns-disease/DS00104

3.      http://www.medicinenet.com/crohns_disease/article.htm#what_is_crohns_disease

4.      http://emedicine.medscape.com/article/172940-overview#a0156

5.      http://www.nhs.uk/Conditions/Crohns-disease/Pages/Introduction.aspx

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Venus Flytrap Extract (Carnivora, Dionaea Muscipula) [1, 11, 12, 13]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that Venus flytrap extracts can help in the treatment of crohns disease. More research is needed.)

Grade of Evidence: Very low quality of evidence

Turmeric [1, 5, 6, 7, 8, 9, 10]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that turmeric can help in the treatment of Crohns. More research is needed.)

Grade of Evidence: Very low quality of evidence

Chlorella (Green Algae, Chlorella Pyrenoidosa) [1, 2, 3, 4]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor  (One study indicates that Chlorella may help treat the symptoms of ulcerative colitis, but more research is needed)

Grade of Evidence: Low quality of evidence

Moxibustion:

Recommendation: No recommendation (there is insufficient evidence to show that Moxibustion helps in treating Crohns Disease in any way)

Grade of Evidence: Very low quality of evidence

Acupuncture [14]:

Recommendation: Weakly in favor (Early studies show that acupuncture may be able to help those with Crohns disease. More studies are needed)

Grade of Evidence: Low quality of evidence

Cannabis (Marijuana) [15, 16]

Recommendation: Weakly in favor (Early studies show that cannabis may be helpful to those with Crohns Disease. More studies are needed)

Grade of Evidence: Low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. Nakano, S et al. “Maternal-fetal distribution and transfer of dioxins in pregnant women in Japan, and attempts to reduce maternal transfer with Chlorella (Chlorella pyrenoidosa) supplements...” Chemosphere 2005 Dec; 61(9): 1244–55.

3. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=11347287&dopt=Abstract

4. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/chlorella

5. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/turmeric

6. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-turmeric.html

7. http://nccam.nih.gov/health/turmeric/index.htm

8. http://news.bbc.co.uk/2/hi/health/1668932.stm

9. http://www.mirror.co.uk/news/top-stories/2009/10/28/curry-kills-cancer-cells-and-other-health-benefits-of-the-nations-favourite-dish-115875-21779950/

10. http://clinicaltrials.gov/ct2/results?term=turmeric

11. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/venus-flytrap

12. Parimala, R. & P. Sachdanandam 1993. Effect of plumbagin on some glucose metabolizing enzymes studied in rats in experimental hepatoma. Molecular and Cellular Biochemistry 12(1): 59–63.

13. http://jpet.aspetjournals.org/content/318/2/484

14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138481/

15. http://www.ncbi.nlm.nih.gov/pubmed/23648372

16. https://www.karger.com/Article/FullText/356512

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