- The Washington Times - Monday, November 28, 2005

Cassandra McClure has been ill for 19 years. Although some days are better than others, on a bad day, she has severe pain, diarrhea, cramping, joint pain, fatigue and depression.

She suffers from Crohn’s disease, which causes inflammation in the small intestine and other parts of the digestive tract. Though she has tried numerous medications, they all seem to fail her. The side effects of the medicines often are worse than the disease, she says.

“Tasks that are normal to some people become a chore to people with Crohn’s disease,” the 46-year-old Smithsburg, Md., woman says. “It becomes depressing, and insecurities come out.”

Crohn’s disease is a type of inflammatory bowel disease, a family of diseases that cause irritation in the intestines. Because no one knows exactly what causes the illness, it is hard to diagnose and harder to treat. In severe cases, surgery is performed to remove parts of the intestine.

The sickness is a disease of civilized nations, says Dr. Robert Hardi, who has a private practice at Metropolitan Gastroenterology Group in Northwest, Chevy Chase and Bethesda. He is associated with the Crohn’s and Colitis Foundation of America in Alexandria.

Some of the first reports of Crohn’s disease came in the late 1920s from the Mayo Clinic in Rochester, Minn. In 1932, Dr. Burrill B. Crohn and two colleagues, Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, published a paper that first described a chronic irritation at the end of the small intestine.

In more primitive cultures with parasitic worms, inflammatory bowel disease is uncommon, Dr. Hardi says. Worms give rise to certain immune-cell reactions in the body that decrease inflammation, he says. Studies are being conducted to see if a type of sanitized worm could treat the sickness.

It used to be thought that mostly young people got the disease. Now physicians are seeing a second demographic of people with the illness in their late 50s and 60s, he says.

Three decades ago, Crohn’s disease would be overshadowed by cancer, Dr. Hardi says. Because of better treatments for cancer, patients are living longer. Later in life, some of them are developing Crohn’s disease.

Although the sickness isn’t “curable,” doctors have successfully put it into remission for longer and longer periods of time, he says. Patients still should see a physician routinely.

“Once they have this disease in the large bowel, slowly they risk developing colon cancer above the general population,” Dr. Hardi says. “The increase is higher each year. They need to be checked periodically and treated earlier rather than later.”

When Alexandra Rize, 13, of Severn, Md., noticed she had blood and mucous in her bowel movements, her mother immediately took her to the doctor. She was later diagnosed with Crohn’s disease.

Her mother, Denise Rize, suffers from ulcerative colitis, a related illness, and she wanted Alexandra to be treated before her condition worsened. The teen takes Pentasa, Prevacid and a multivitamin. She also is on a restricted diet, which prevents further irritation of her digestive tract. She avoids nuts, kernels, skins of fruits and raw vegetables. Heavily processed foods also can cause a flare-up. Every other year, she undergoes a colonoscopy.

“My case isn’t as bad as some people that I know,” Alexandra says. “I’ve been very lucky. Every once in a while, if something annoys my intestine, I can feel it. I know when there is something wrong with me.”

Although researchers are unsure, many think an exposure to an environmental agent such as bacteria may be important for the development of the disease, says Dr. Timothy Koch, director of gastroenterology at the Washington Hospital Center in Northwest.

Helicobacter pylori, the bacteria that causes peptic ulcer disease, can be passed from parents to children, he says. Because the occurrence of Crohn’s disease parallels peptic ulcer disease, it would suggest that the illness also is caused by an infectious agent passed generationally, he says.

Along with bacterial infection, Crohn’s disease is genetic in nature, he says. For instance, research shows identical twins both will have Crohn’s disease 60 percent of the time, he says.

Therefore, if a person is genetically predisposed for Crohn’s disease, the right environmental agent could trigger the illness, he says.

Along with uncertainty about what causes the disease, doctors have varying opinions on how to treat it, Dr. Koch says. While various medications are used to treat Crohn’s disease, such as Remicade, most of them have severe side effects, including developing infections or auto-immune disorders, he says. If the inflammation in the digestive tract is not reduced, however, surgery could be necessary.

“Our goal is to try to keep patients with as few symptoms as possible,” Dr. Koch says. “We certainly want to reduce their risk of needing surgery and having nutritional problems that could develop over time.”

The two major symptoms of Crohn’s disease are abdominal pain and diarrhea. Blood in the stool, weight loss, fatigue, fever and poor growth in children may be other signs.

Because the same symptoms can be present in other conditions, Crohn’s disease is often hard to diagnose, says Dr. Aline Charabaty, assistant professor of medicine at Georgetown University Hospital in Northwest. A colonoscopy and a biopsy of the small intestines may help confirm the illness.

Smoking, non-steroidal anti-inflammatory drugs and stress are known to aggravate the illness, she says.

“Hopefully, by understanding how Crohn’s disease develops, we can block the process better,” Dr. Charabaty says. “It’s not an easy disease to have.”

“I was very, very ill,” says Stacy Sakellariou, 34, of Alexandria. “I lost a ton of weight. I was in a lot of pain. I couldn’t breathe it was so painful. I had to go to the emergency room quite a few times.”

Mrs. Sakellariou’s condition improved after she saw Dr. Suresh Malhotra, chief of gastroenterology at Inova Alexandria Hospital. She has responded to drug therapy.

“It’s a disease that is controllable and treatable,” Dr. Malhotra says. “We’ve come a long way with how we treat these patients.”

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