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In this tutorial.Learn how Crohn's disease affects the body See illustrations of its complications Find out about treatments Take the next step to learn more or seek treatment Overview: About Crohn’s DiseaseVoice Over: Crohn’s disease is a chronic and serious inflammatory disease of the gastrointestinal tract that affects more than 500,000 men and women in America. However, a diagnosis of Crohn’s disease can be difficult because the signs and symptoms of Crohn’s disease are similar to other bowel disorders. Self-Running Animation: Shows a full picture of the body. Abdominal wall fades to transparent bowel, which, after appearing within the outline of the body, zooms larger to show just the bowel. Key Differences Between Irritable Bowel Syndrome, Ulcerative Colitis, and Crohn’s Disease Voice Over:Irritable bowel syndrome, ulcerative colitis, and Crohn’s disease can share common symptoms, including abdominal pain, cramping, and diarrhea, but the way in which the disorders affect the body are very different. Watch closely as we illustrate these key differences. Common Symptoms: Abdominal pain Cramping Diarrhea Irritable Bowel Syndrome (IBS) Definition: Cause: Unknown, but is thought to be related to hypersensitivity in the nerve endings of the bowel. Symptoms: Diarrhea or constipation, bloating, abdominal pain, spasm, and/or nausea. Self-Running Animation: Picture-in-picture - Zooms into portion of colon to show hypersensitive nerve endings. (Caption): IBS occurs when there is a disturbance in the way the colon normally functions that is thought to be related to hypersensitivity in the nerve endings in the bowel. Ulcerative Colitis Definition: A type of inflammatory bowel disease which can be limited to the colon and where the entire rectum is affected. Inflammation appears in a continuous pattern, not in patches.3 Cause: Unknown. Symptoms: Bloody diarrhea, false urge to use the bathroom, pressure in the anal area, and abdominal pain or cramping. Self-Running Animation: Picture-in-picture - Zooms into colon and rectum, shows continuous appearance of ulcers. (Caption): Ulcerative colitis is a type of inflammatory bowel disease of unknown cause that occurs in the colon in a continuous pattern. Crohn’s Disease Definition: A type of inflammatory bowel disease that can be found along the entire GI tract, from the mouth to the anus. It is typically found in the lowest part of the ileum and the start of the colon; just at the bottom of the ileum; or limited to the colon. Sometimes it appears in patches. All three layers of the gut can be affected. Cause: Unknown. Symptoms: Diarrhea, abdominal pain, unexplained fever, and, at times, bloody stools, anal fissures and fistulas, and weight loss. Self-Running Animation: Picture-in-picture - Zooms into ileum and colon, demonstrates ulcerative “patch” effect, then zooms to cross section of bowel, showing all layers affected. (Caption): Crohn’s disease is a type of inflammatory bowel disease of unknown cause. It can typically occur in patches in the end of the ileum and the beginning of the colon; just at the end of the ileum; or just in the colon. Section I: Serious ComplicationsCrohn’s disease may cause complications which can happen over the course of the illness. Voice Over: People living with Crohn’s disease may experience serious complications that may require medical attention. These serious complications include obstructions, fistulas, abscesses and free perforations. Obstruction Obstructions can occur when the intestinal wall swells inward, reducing the capacity for fluids to flow through the intestine. Self-Running Animation: Picture-in-picture - Zooms into cross section of bowel to show swollen sides and narrow opening. The tissue swelling and scarring associated with Crohn’s disease can obstruct the intestine. When this occurs, a patient may experience painful cramps or vomiting due to food that is unable to bypass the obstruction. Patients who experience an obstructive episode are usually hospitalized and given intravenous fluids and electrolytes to compensate for fluid losses. Fistula A fistula is created when an abnormal connection occurs between a hollow structure and a skin surface, or hollow structures, for example, the bowel to the bladder, bowel to the vagina, or the bowel to another part of the bowel. Self-Running Animation: Picture-in-picture - Shows connecting “tunnel” from bowel to skin/organ. Sometimes ulcers caused by Crohn’s disease channel through the gut wall to adjacent organs including the skin, bladder, vagina, intestine, and perianal areas. These occurrences are known as fistulas, and may require medical or surgical therapy. Abscess An abscess is a localized collection of bacteria that eventually accumulates pus and places painful pressure on adjacent tissues. Self-Running Animation: Picture-in-picture - Zooms into close-up of area infected with abscess. A fistula that tracks into the abdominal cavity may produce infection and form an abscess. Abscesses may also occur in the pelvic tissues or the perineum, if a fistula fails to drain. Patients are usually given a course of antibiotics to reduce the risk of further infection, but surgery is sometimes required to drain the abscess. Free Perforation A free perforation is a formation of a hole in the bowel wall that allows intestinal contents to enter the abdominal cavity. In rare cases, deep, penetrating ulcers tunnel through the layers of the gut into the abdominal cavity. The infection that results is called peritonitis, and requires emergency surgery to seal the leak and cleanse the abdominal cavity to stop infection. Section II: Chronic ComplicationsThe likelihood of experiencing complications depends upon the severity of the disease, and varies from patient to patient. Voice Over: People with Crohn’s disease may experience chronic complications that require ongoing management. These chronic complications can include anemia, malnutrition, skin disorders, and growth retardation. Anemia Anemia is a condition that results from a lack of red blood cells. Self-Running Animation: Picture-in-picture - Zooms into close-up of pale skin/low red blood cell count. Anemia in Crohn’s disease may be the result of chronic blood loss; bone marrow depression; or failure to absorb iron and folic acid, which are important in the production of red blood cells. To combat most cases of anemia, vitamin supplements and a diet rich in iron may be recommended. Malnutrition Malnutrition occurs when the body does not receive enough nutrients to grow and develop properly. Self-Running Animation: Picture-in-picture - Full picture of body outline shrinks incrementally. Loss of protein, low energy levels, tissue breakdown due to steroid use, poor diet, and in some cases, failure to absorb nutrients can result in weight loss and nutritional deficiencies. Nutritional supplements may be used to avoid the complications that result from deficiencies in vitamins. Skin Disorders Skin disorders are rare, and can include red bumps, blisters or deeper ulcerations that occur in conjunction with a flare-up. Self-Running Animation: Picture-in-picture - Zooms into close-up of red bumps/blisters on shin area of leg. Skin disorders are rare but the most common type of skin disorder experienced by people with inflammatory bowel disease (IBD) is called erythema nodosum. People with this skin condition have red bumps that are painful and tender, which are usually found on the shins, other parts of the leg, or on a person’s arms. This skin condition may be exacerbated by an IBD flare-up, but usually gets better upon treatment of the IBD. Growth Retardation Growth retardation can occur in some children with IBD, depending upon the severity of the disease and the length of time it remains active. Self-Running Animation: Picture-in-picture - Full picture of body outline shrinks incrementally. About one third of children diagnosed with Crohn’s disease experience growth retardation which may be permanent. For children who have not yet reached their growth spurts, and for whom modifications in diet have not been successful, surgery to remove the affected section of bowel may provide hope. Section III: TreatmentsVoice Over: Each case of Crohn’s disease may warrant a different type of treatment, depending on the severity of the case, and whether complications are present. Anti-inflammatory medication. Most people who have Crohn’s disease receive one or more different types of drugs designed to control inflammation. These may include sulfasalazine, medications containing mesalamine (known as 5-ASA agents), and corticosteroids. Immunosuppressive medication. These drugs block the body’s immune response that leads to inflammation. Immunosuppressive medications used to treat Crohn’s disease include azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine. Antibiotics. Antibiotics may help heal abscesses and fistulas and include metronidazole and ciprofloxacin. Other antibiotics may be prescribed to treat bacterial growth in the intestine caused by obstruction or abscesses. Antidiarrheal medication. Antidiarrheal medication offers some relief for the diarrhea many people with Crohn’s disease experience. Loperamide, codeine, and even fiber powders can help alleviate symptoms. Nutritional supplements. Nutritional supplements are helpful for people who lose calories and nutrients from diarrhea or decreased appetite. Supplements can help fuel the body and replenish iron, calcium, other minerals, and vitamins. Surgery. If other treatments do not effectively control symptoms, a gastroenterologist may recommend surgery to close fistulas or remove part of the intestine where the inflammation is most severe. Unfortunately, this procedure usually leads to only temporary remission of symptoms. The inflammation often returns near the area where the tissue was removed. REMICADE REMICADE works by neutralizing a protein that contributes to the inflammation in Crohn’s disease, reducing inflammation. Section IV: About REMICADEIn Crohn’s disease, the body produces more TNF-alpha, a key regulator of inflammation in Crohn’s disease. When REMICADE binds with a TNF-alpha molecule, the TNF-alpha is neutralized so it can’t continue the inflammation process. REMICADE is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in patients with moderately to severely active Crohn’s disease who have had an inadequate response to traditional therapy. REMICADE is also indicated for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in patients with fistulizing Crohn’s disease. REMICADE is given by IV infusion and most patients just require treatment once every 8 weeks after the first 3 doses. REMICADE is a monoclonal antibody that reduces the inflammation that produces the symptoms of Crohn’s disease. Self-Running Animation: Fade from picture to picture. Mode Of Action Picture 1 - Caption: TNF-alpha is circulating in the bloodstream. Mode Of Action Picture 2 - Caption: REMICADE binds to TNA. Mode Of Action Picture 3 - Caption: General overview picture of REMICADE in the bloodstream Section V: Action ChecklistVoice Over: Now that you have gotten an inside look at Crohn’s disease, select an item from the Action Checklist for more information and tools for discussing Crohn’s disease with your gastroenterologist. |