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DRUGS, SURGERY RELIEVE CROHN'S

Q. I'm a 36-year-old male and have recently been diagnosed with Crohn's disease. My doctors tell me to take the medicine and go on a very strict diet of about three grams of daily fiber, no fat, and to only eat certain fruits and vegetables that come in can form. Up to now, all I ever had to worry about with my health was high blood pressure and chronic pulmonary disease. Now this Crohn's comes out of nowhere, no family history at all. I'm very confused and I can't seem to get the answers I'm looking for.

-- J.N., North Canton, Ohio

A. Crohn's disease, while rarely life threatening, can have lasting effects on quality of life. In addition to the considerable physical problems associated with that condition, there can be profound emotional and social consequences.

Some 200,000 people in the United States have Crohn's disease. It tends to run in families and is most common in North America and Europe, with a greater incidence of the disease in urban and northern environments.

Crohn's disease in a chronic recurrent inflammatory disease characterized by patches of inflammation and ulceration on and within the lining of the gastrointestinal tract, anywhere from the mouth to the anus. The condition known as chronic idiopathic inflammatory bowel disease includes both ulcerative colitis and Crohn's disease.

The cause is not known, but it appears to be a disease caused by a person's immune system attacking the body's own tissue. Recent research has shown that the class of enzymes that seem to play a role in rheumatoid arthritis are very important negative factors in Crohn's disease.

Cramping abdominal pain and diarrhea are the usual symptoms, but some people also complain of low-grade fever, a general feeling of illness (malaise), weight loss (especially muscle mass) and loss of energy. Complications can include bowel abscesses, obstructions and fistulas (openings in the intestinal wall connecting to other abdominal structures).

Crohn's disease is a lifelong illness characterized by recurrences and remissions. There is no cure. Current treatment is directed toward relieving the symptoms and controlling the disease process.

Treatment begins with diet, but the dietary regimen must be customized for each person. If you don't feel your current diet is what it should be, you may want to consult a dietitian.

Two types of medications are used: 5-Aminosalicyclic acid is today the drug of choice for treatment of Crohn's disease and maintaining remission, but recent medical research has shown that methotrexate is also very effective.

Short-term steroids are used to reduce inflammation in moderate to severe Crohn's, but long-term use should be avoided because of side effects. Some recent research has shown that thalidomide can help reduce the dose of steroids taken.

Over half the people with Crohn's disease will require at least one surgery to remove a section or sections of intestine. People with active inflammation who are not getting relief from drugs are candidates for this surgery. While surgery is to be avoided when possible, removal of small sections of intestine can offer dramatic relief for years before the disease recurs.

For more information, you may wish to contact the Crohn's and Colitis Foundation, 444 Park Avenue South, 11th Floor, New York City, 10016-7374, (212) 685-3440, or www.ccfa.org.

Write to Allen Douma in care of kALIVE, 1777 N.E. Loop 410, San Antonio, Texas 78217; or e-mail him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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