- Crohn's Disease can cause small bowel obstruction.
- Crohn's Disease is an inflammatory bowel disease, usually occurs in the ileum (maybe called ileitis or enteritis), but it can affect any part of the digestive tract. It's symptoms include diarrhea (three or more stools a day), rectal bleeding, anemia, weight loss, and fever.
- Inflammatory Bowel Disease involves either or both small and large intestines and includes Crohn's Disease and ulcerative colitis as the best known forms.
- The inferior pancreaticoduodenal artery does not supply the stomach. All of the other arteries supply the stomach. Gastrocolostomy is used to establish a communication b/w the stomach and colon, bypassing the small intestine when the patient has Crohn's Disease and small bowel obstruction.
- No generally accepted regimen exists for the treatment of acute exacerbation of Crohn's Disease. Many different treatments are used including antibiotics, azathioprine, sulphasalazine, and steroids, often without controlled trials to support their efficacy. Patients with Crohn's Disease often have a negative nitrogen balance as a result of anorexia and reduced protein intake, diminished absorption by the small intestine, losses by exudation from inflamed mucosa, and systemic effects of chronic inflammation. Total parenteral nutrition and elemental diets have been used in an attempt to reverse this metabolic imbalance before operative intervention. As these patients improve nutritionally the indications for operation often recede, raising the possibility that “artificial” nutrition might be useful as a primary treatment for Crohn's disease. Total parenteral nutrition requires careful monitoring, and serious complications have been reported. An elemental diet regiment is safe, non-toxic, and easy to administer.
- According to a study by O'Morain et al in 1980 in the British Medical Journal, an elemental diet may be valuable as the main treatment of acute Crohn's disease. In 19 of the patients the diet was the only treatment given initially. All of the patients who completed the diet treatment were considered to be in clinical remission at four weeks. There was an initial loss of weight probably due to the low residue and the gradual build-up of energy intake. At the end of the treatment period the patients' nutritional state had improved as evidenced by the rise in serum albumin concentration and weight gain. At six months six of the patients had relapsed. Three of the patients, who had symptoms of subacute obstruction, all eventually required operations. The diet, though unpalatable, was tolerated by mouth in all but two of our patients. With encouragement patients adapt to the diet, particularly when they notice an improvement in their symptoms.
- The exact mechanism by which an elemental diet induces remission of this disease is not clear. The diet may alter the course of the disease by modifying the nutritional state of the patient. Administration of a balanced diet containing adequate energy and amino-acids is likely in itself to be beneficial in any disease associated with anorexia, vomiting, diarrhea, and resultant undernutrition. In addition the diet may have a more direct effect by supplying essential vitamins and minerals or excluding ingested toxins.
- An elemental diet may be beneficial in Crohn's Disease by inducing a critical change in the intestinal microflora. Some workers have found a significant increase in Gram-negative anaerobic rods and Gram-positive rods in stools from patients with Crohn's disease. Some reports suggest a dramatic reduction in micribial flora in healthy volunteers fed an elemental diet. These results were not confirmed by other workers who used more sensitive techniques, but changes in species type were noted. Crohn's disease may be induced or perpetuated by constituents of a normal diet, possibly by an immunological mechanism. Formation of granulomas, a characteristic histological feature of Crohn's disease, may result from the persistence of luminal contents within the mucosa. A wide range of antibodies against dietary proteins are readily detectable in the serum. These antibodies may have developed against dietary proteins that may themselves be pathogenic, or cause tissue damage after the formation of immune complexes. Equally probably, however, this antibody production is a result rather than the primary cause, b/c foreign protein would be expected to penetrate the bowel wall through a damaged mucosa, thereby promoting a secondary immunological reaction. The removal of oral protein by treatment with an elemental diet may cause these patients to improve by removing either the primary cause or the offending protein responsible for secondary immune-mediated tissue damage.
- Patients with Crohn's Disease of the colon improve after diversion of the faecal stream. An elemental diet contains amino acids, hexose sugars, essential fatty acids, minerals, and vitamins and is absorbed in the upper intestinal tract. It also reduces both pancreatic and gastric secretions. It may therefore act as a medical bypass by preventing the food and the secretions from gaining access to the inflammatory lesions in the bowel thereby giving them a chance to heal. The depression of gastrointestinal secretion may be important in the healing of intestinal fistulae, and elemental diets have been found useful in the treatment of fistulae.
- Crohn's Disease is a reduced absorptive capacity of intestinal mucosa due to inflammation.
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