1. Crohn’s Disease aka regional enteritis

2. Overview of Presentation
General historical background information
Description of the condition
Management of the Disease
Nutrition’s role in stabilizing the condition
Conclusion
Ethical dilemmas (M.D. vs Nutritional)
Opinion for managing the disease
What the audience should know

3. The naming of regional enteritis
First Chief of Gastroenterology at Mount Sinai in New York. Practiced medicine until he was 90.
1932 Crohn, with two colleagues, described a series of pateints with inflammation of the terminal ileum.
Colleagues, Dr. Ginzburg and Dr. Oppenhimer, helped publish the seminal paper, “Terminal Ileitis: A new clinical entity”. Disease was known as regional ileitis upon publication.
Believed the disease was caused by Mycobacterium paratuberculosis, which is responsible for a similar condition that afflicts cattle known as Johne’s disease.
Unable to isolate the pathogen- undetectable under an optical microscope.
Dr. Burril Bernard Crohn

4. Inflammatory Bowel Disease

5. Behavioral Classification
Stricturing
Penetrating
Inflammatory

6. Regional Tract Classification
Three most common sites of intestinal involvement are:
Ileititis ~30% of cases
Ileocolic ~50% of cases
Colitis ~20% of cases
Gastroduoldenal and Jejunoileitis are also common sites

7. Crohn’s Disease
Crohn's disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.

8. Anorectal fistulas
The lining of the intestine may ulcerate and form channels of infection, called fistulas. Fistulas tunnel from the area of ulceration, creating a hole which may continue until it reaches the surface of the organ, or the surface of nearby skin. These holes typically spread the infection that creates them, and life-threatening conditions such as peritonitis (inflammation of the lining of the abdomen) may occur.

9. Is it Crohn’s or Ulcerative Colitis?
Crohn’s Disease
Ulcerative Colitis
Defecation
Often porridge-like
Often mucus-like and with blood
Terminal Ileium involved
Commonly
Seldom
Colon involved
Usually
Always
Fever
Common
Indicates severe disease
Fistuleae
Weight Loss
Often
More Seldom
Endoscopy
Deep snake like ulcers
Continuous ulcer

10. Is it Crohn’s or Ulcerative Colitis?

11. Symptoms Other symptoms may include: Main symptoms include:
Crampy abdominal pain
Fever
Fatigue
Loss of appetite
Pain with passing stool
Diarrhea
Weight loss
Other symptoms may include:
Constipation
Eye inflammation
Fistulas
Joint pain and swelling
Mouth ulcers
Rectal bleeding
Bloody stools
Skin lumps or sores
Swollen gums

12. What’s causing Crohn’s disease?
Mycobacterium paratuberculosis
Diet and stress
Environmental stressors
Autoimmune disorder

13. Who’s at risk for Crohn’s disease?
Younger than 30
Elevated risk for whites and Eastern European Jewish descent
A close relative diagnosed
Smokers
Live in an urban area
Live in a northern climate
Diet high in fat or refined foods

14. Bio-medical Interventions
DIAGNOSIS
Colonoscopy most effective at detection (70%)
Endoscopy
Blood tests
MEDICATIONS
Anti-inflammatory drugs
Corticosteroids
Antibiotics
NUTRITION THERAPY
Vitamin B-12
Iron
Calcium
Vitamin D

15. Bio-medical Interventions
Surgery
Strictureplasty
Colon restructure
Colectomy
Treat symptoms
Pros
May lead to long-term remission
Cons
Disease often recurs

16. Treatment

17. Diet & Lifestyle Don’ts Do’s Drink lots of water Exclusion Diets
Multi-vitamin and mineral
Anti-inflammatory foods
Fish oil
Ginger
Raw foods
Prebiotics
Regular exercise
Stress-relief activities
Exclusion Diets
Food Journal
Avoid gas inducing foods:
High Fiber
Dairy
Stimulants
Spicy
High fat
Stop smoking

18. Vitamin D Qualitative research on 57 yr. old woman
Deficient while supplimenting
Tanning bed for 10 min., 3 times a week for 6 months at Boston University Med. Center
Serum Vit D increase of 357%
Maintained adequate levels 6 months later
Hypovitaminosis D

19. Alternative Therapy
Yoga
Tai Chi
Meditation
Biofeedback
Support Groups

20. Ethical Dilemma – Food v. Medicine
Nutrition
Medicine
Acute episodes often triggered by food
Poor absorption of nutrients requires intravenous feeding
No side effects from proper nutrition
Strong, possible quick reduction of symptoms
Lots of negative side effects and adverse reacations
Only potent solution to potent problems

21. Conclussion Treatment requires a multi-faceted approach
Support groups and experts necessary for proper education
Beware of snake-oil and testimonials
Get outside, get active, and gain control of your body

22. Need to know for the test
How ulcerative colitis differs from Crohn’s disease.
Nutritional guidelines for patients with Crohn’s disease.
Most common areas affected by Crohn’s disease.
What’s the lesser known name for Crohn’s disease.
Possible causes of Crohn’s disease
High risk categories
Likelihood of contracting a IBD if family has been diagnosed.

23. The End