Kristen Kirkham
SLCC
Crohn’s Disease
Kristen Kirkham
Anthropology 1020
Human Origins: Evolutions and Diversity
Nathan Harris
04/29/14
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Kristen Kirkham
What is Crohn’s disease? How does is affect the person who has it? Does it affect
certain people more than others? Who is more likely to have it? Are there factors that
influence who has it? Are there mutations of it? And if you have Crohn’s are you likely to
have other diseases associated with it? These are all questions I had once I picked this
topic. And what I found is very interesting.
What is Crohn’s disease?
It is a disease in the intestines that causes scarring and thickening of the intestine
walls. It causes diarrhea, cramping, loss of appetite, and loss of weight. (Merriam-Webster
Incorporated, 2014) Crohn’s is a life long disease that affects the whole GI system from the
mouth to the anus. It can be very painful. It affects everyday life because you have to be
careful what you eat.
So who is most likely to have Crohn’s and what causes it?
It has been often thought that Crohn’s disease was a cause of diet. In a study, thirty
people having Crohn’s Disease were asked about their diets before they had Crohn’s. It was
thought, from conclusions of the study, that a diet high in refined sugar and low in raw
fruits could favor development of Crohn’s Disease (British Medical Journal, 1979). It is also
thought that Crohn’s could be a cause of genetics. It is stated that about 20 to 25 percent of
those with Crohn’s have relatives with it as well (Humira, 2013). Crohn’s can be found in all
types of people. It has been studied and found that Crohn’s is found more in Ashkenazi Jews
than any other ethnicity (Elsevir B. V. , 2014). In this study they took 64 Jewish families and
147 non-Jewish families to study. The conclusions of this study showed that there was a
trend toward increased mean allele sharing at two markers in the Jewish families. In nonJewish families the mean allele at all markers with a peak at only one of the same markers
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as the Jewish families. The conclusions also showed that, due to an increased frequency of a
haplotype in the Jews and it being non-present in non-Jews, suggested an existence of a
Jewish specific predisposing disease factor. (Sugimura, Kazuhito, Taylor, Lin, Hang, Wang,
Tang, Fischel-Ghodsian, Targan, Rotter, Yang, 2003)
Triggers for onset of Crohn’s Disease include environmental factors.
Studies have shown that smoking is detrimental in Crohn’s Disease. A heavy smoker
with Crohn’s had an increased risk of needing an operation. Heavy smokers also have
bowel disease more often that people with lower life time exposure and less smoking.
Smoking isn’t a known cause of Crohn’s Disease but it does affect those who have it. Those
who have Crohn’s should not be smoking. (Lindenberg, Jarnerot, Huitfeldt, 2014)
Another environmental factor is diet. It was thought that milk, sugar, breakfast
cereals, fiber, and breast-feeding all had an affect on Crohn’s disease. The most consistent
difference is a diet high in sugar. Foods high in sugar, such as cakes, chocolates, candy,
soda, and honey, should be avoided. (Mayberry, Rhodes, Allan, Newcombe, Regan,
Chamberlain, Wragg, 1981)
The third environmental factor is the use of antibiotics and nonsteroidal antiinflammatory drugs (NSAIDs). Use of these can cause nonspecific inflammation, break the
mucus barrier and be responsible for an innate immune response. It can cause infection
and bacteria and cause more inflammation. (Sartor, 2006)
The fourth environmental trigger is stress. It may be the cause of some onset but it
is more common to cause the disease to come out of remission. Stress can affect the course
of the disease and make it worse. Every day little stress can cause a stress on the disease
and cause it to flare up. (Garrett, Brantley, Jones, McKnight, 1991)
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Does Crohn’s Disease affect pregnant women and pregnancy?
I found an article that says that took 112 married women with Crohn’s disease that
were younger than the age of 45. The study said that infertility in women with Crohn’s
Disease is about the same as the general population. They took 55 of the women and
interviewed them about their fertility. Ten of the women were not fertile but only four
were by choice. About twelve percent of women with Crohn’s disease are not fertile. A lot
of patients have been advised not to get pregnant if they have Crohn’s Disease. There
seemed to be quite a few spontaneous abortions in the some of the pregnancies. There
were also a few chosen abortions. There was only one still birth. Women who conceived
while in remission seemed to have a higher live birth rate. Overall, most of the pregnancies
were normal and went well. Overall it didn’t seem like Crohn’s Disease affected pregnancy
that much. (Khosla, Willoughby, Jewell, 1984)
Are there mutations of Crohn’s disease?
I have found that there aren’t any mutations of the actual Crohn’s disease but there
are mutations that are believed to cause Crohn’s disease. It is in the NOD2 where they think
this mutation occurs. The NOD2 is an intracellular receptor for bacteria. Alpha defensins
are affected by antibiotic molecules in cells in the ileum, which is where NOD2 is found. The
alpha defensis are important to the mucus membrane and their diminished expression can
explain the inflammation of Crohn’s Disease. (Wehkamp, Harder, Weichenthal, Schwab,
Schaffeler, Schlee, Herrlinger, Stallmach, Noack, Fritz, Schroder, Bevins, Fellermann, Stange,
2004)
Are there other diseases associated with Crohn’s Disease?
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There have been links of those with Crohn’s disease and ankylosing spondylitis and
autoimmune hepatitis. Either disease can precede the other. (B. Hammer, P. Ashurst, J.
Naish, 1968). Those who have Crohn’s disease are often found having other
gastrointestinal diseases. A common one associated with Crohn’s disease is ulcerative
colitis. Ulcerative colitis is only found in the intestine though, and Crohn’s can be found in
any part of the gastrointestinal tract. Those with Crohn’s Disease are often found also
having celiac disease. Celiac disease is where you are allergic to the protein in wheat. It
causes your intestines to swell, which makes the cilia not be able to absorb nutrients
needed to feed the body. In other word it starves your body. It has common symptoms to
Crohn’s Disease. Symptoms include severe stomach aches, feeling bloated, diarrhea, and
sometimes vomiting occurs. These are just a few diseases that can be associated with
Crohn’s Disease.
How to treat Crohn’s Disease.
There are many methods to treat Crohn’s Disease. One method some doctors used is
to inject patients, intravenous, with infliximab. For the trial run they took 573 patients and
infused them with infliximab. There were three groups with three different methods. The
patients in group one were assessed after two weeks and then reassessed every two weeks
for forty six weeks. Group two was re-infused with infliximab every two weeks for forty six
weeks. Group three was re-infused with the same amount of infliximab at weeks two and
six. After weeks two and six they were infused with double the amount of infliximab. The
results were that 58% of patients responded to infliximab within two weeks and their
Crohn’s went into remission. At week thirty 21% of group one went into remission, 39% in
group two went into remission, and 45% of group three went into remission. The results
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showed that people in groups two and three were more likely to sustain remission.
(Hanauer, Feagan, Lichtenstein, Mayer, Schreiber, Colombel, Rachmilewitz, Wolf, Olson,
Bao, Rutgeerts, 2002).
Corticosteroids are a large and most common treatment for Crohn’s Disease. But
corticosteroids can be highly toxic and addictive. Some doctors came together and wanted
to see what injections of methotrexate would do. Methotrexate is a drug that is considered
a low dose of chemotherapy. What the doctors did is they took 141 patients and injected
ninty one of them with methotrexate and 47 of them with placebo for 16 weeks. The
patients also received prednisone once a day and tapered over ten weeks. After the sixteen
weeks 39.4% of the methotrexate group were in remission and 19.1% of the placebo group
were in remission. Methotrexate is a somewhat effective treatment for Crohn’s Disease.
(Feagan, Rochon, Fedorak, Irvine, Wild, Sutherland, Steinhart, Greenberg, Gillies, Hopkins,
Hanauer, McDonald, 1995)
Crohn’s Disease in a disease in the gastrointestinal tract and can be very inhibiting.
You may and will probably have to change your diet if you are diagnosed with it so that you
can manage the pain better. Lowering stress can help pain management. Make sure you
know if you have any other diseases that can be associated with Crohn’s Disease. There are
many other treatments for Crohn’s disease. There is stress management, hormone therapy,
biological therapies, corticosteroids, other medicines, and new methods coming out all the
time. As time goes on I think technology will keep getting better and solutions or
treatments for Crohn’s Disease will get better.
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Works Cited
"What Is Crohn's Disease?" Official Website for HUMIRA (adalimumab). N.p., 2013. Web. 28
Apr. 2014.
Sugimura, Kazuhito, Kent D. Taylor, Ying-chao Lin, Tieu Hang, Dai Wang, Yong-Ming Tang,
Nathan Fischel-Ghodsian, Stephan R. Targan, Jerome I. Rotter, and Huiying Yang. "A Novel
NOD2/CARD15 Haplotype Conferring Risk for Crohn Disease in Ashkenazi Jews."
Http://www.sciencedirect.com. N.p., Mar. 2003. Web. 28 Apr. 2014.
Lindberg, E., G. Järnerot, and B. Huitfeldt. "Smoking in Crohn's Disease: Effect on
Localisation and Clinical Course." -- Lindberg Et Al. 33 (6): 779. BMJ Publishing Group &
British Society of Gastroenterology, 2014. Web. 28 Apr. 2014.
John F. Mayberry BS, MB, BC, Dr. John Rhodes MD, FRCP, Robert Allan MD, MRCP, Robert G.
Newcombe PhD, FSS, Gillian M. Regan SRD, Lynne M. Chamberlain SRD, Katherine G. Wragg
SRD. "Diet in Crohn's Disease - Springer." Diet in Crohn's Disease - Springer. N.p., 01 May
1981. Web. 28 Apr. 2014.
Sartor, R. Balfour. "Mechanisms of Disease: Pathogenesis of Crohn's Disease and Ulcerative
Colitis." Nature.com. Nature Publishing Group, 19 Apr. 2006. Web. 28 Apr. 2014.
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V. Diane Garrett, Phillip J. Brantley, Glenn N. Jones, G. Tipton McKnight. "The Relation
between Daily Stress and Crohn's Disease - Springer." The Relation between Daily Stress and
Crohn's Disease - Springer. Journal of Behavioral Medicine, 01 Feb. 1991. Web. 28 Apr. 2014.
R KHOSLA, C P WILLOUGHBY, AND D P JEWELL. "Crohn's Disease and Pregnancy." Crohn's
Disease and Pregnancy. BMJ Publishing Group, 1984. Web. 28 Apr. 2014.
J. Wehkamp, J. Harder, M. Weichenthal, M. Schwab, E. Schäffeler, M. Schlee, K. R. Herrlinger,
A. Stallmach, F. Noack, P. Fritz, J. M. Schröder, C. L. Bevins, K. Fellermann, E. F. Stange.
"NOD2 (CARD15) Mutations in Crohn's Disease Are Associated with Diminished Mucosal αdefensin Expression." -- Wehkamp Et Al. 53 (11): 1658. BMJ Publishing Group, 2004. Web.
29 Apr. 2014.
Hammer, B. A. R. B. A. R. A., P. A. M. E. L. A. Ashurst, and J. Naish. "Diseases associated with
ulcerative colitis and Crohn's disease." Gut 9.1 (1968): 17-21.
Roger Hällgren, Jean F. Colombel, Ronald Dahl, Kjell Fredens, Axel Kruse, Niels O. Jacobsen,
Per Venge, Jean C. Rambaud. "Neutrophil and Eosinophil Involvement of the Small Bowel in
Patients with Celiac Disease and Crohn's Disease: Studies on the Secretion Rate and
Immunohistochemical Localization of Granulocyte Granule Constituents."
Sciencedirect.com. American Journal of Medicine, n.d. Web. 29 Apr. 2014.
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Dr. Stephen B Hanauer, MD, Brian G Feagan, MD, Gary R Lichtenstein, MD, Lloyd F Mayer,
MD, S Schreiber, MD, Jean Frederic Colombel, MD, Daniel Rachmilewitz, MD, Douglas C
Wolf, MD, Allan Olson, MD, Weihang Bao, PhD, Paul Rutgeerts, MD. "Maintenance Infliximab
for Crohn's Disease: The ACCENT I Randomised Trial." Siencedirect.com. N.p., 4 May 2004.
Web. 28 Apr. 2014.
Brian G. Feagan, M.D., James Rochon, Ph.D., Richard N. Fedorak, M.D., E. Jan Irvine, M.D.,
Gary Wild, M.D., Lloyd Sutherland, M.D., A. Hillary Steinhart, M.D., Gordon R. Greenberg,
M.D., Richard Gillies, M.D., Marybeth Hopkins, R.N., Stephen B. Hanauer, M.D., and John W.D.
McDonald, M.D. "Methotrexate for the Treatment of Crohn's Disease — NEJM."
Methotrexate for the Treatment of Crohn's Disease — NEJM. The New England Journal of
Medicine, 2 Feb. 1995. Web. 29 Apr. 2014.
JRTHORNTON, PM EMMETT, KW HEATON. "Diet and Crohn's Disease:
Characteristicsofthepre-illnessdiet." British Medical Journal, n.d. Web. 28 Apr. 2014.
Merriam-Webster. Merriam-Webster, n.d. Web. 28 Apr. 2014.
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