Crohn’s Disease and its Complications

Crohn’s disease is an inflammatory disease of the bowel that can affect any part of the intestinal tract, from the mouth to the anus. It symptoms, may include abdominal pain, diarrhea, bloody stools, abdominal distention, and intestinal malabsorption.  It can also cause extra intestinal symptoms, such as fever, joint pain, skin rashes, eye problems and generalized fatigue.  Currently, it affects 0.32 percent of people in Europe and North America and its prevalence has been increasing over the past decades.

This condition is caused by a combination of genetic and environmental factors. There are several genes known to be strongly associated with the presence of Crohn’s disease¹. In addition, an environmental risk factors such as tobacco exposure, seems to be equally important. It is known that tobacco smokers are twice as likely to be affected by this entity than non smokers².

There are various degrees of severity for Crohn’s disease and it can be complicated by intestinal obstruction, fistula formation, gastrointestinal bleeding, intestinal perforation and abscesses. There is a higher risk of cancer in the areas of inflammation caused by Crohn’s disease. Due to the inflammatory nature of the condition, food malabsorption can develop leading to weight loss and malnutrition.

The treatment of Crohn’s disease has to include lifestyle changes such as stopping smoking and following dietary recommendations such as low dietary fiber, low casein and gluten free diet. In addition to this, there are certain medications that may be used for the exacerbations of the disease, such as steroids and some long term medications like methotrexate and biological therapies. At this point, the advise of a gastroenterologist is the most valuable tool.

Marco A. Ramos MD

References

1. Genome-wide association defines more than thirty distinct susceptibility loci for Crohn's disease. Barrett JC, Hansoul S, Dan L. Nicolae DL, et al. Nat Genet. 2008; 40(8): 955–962

2. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice. Cosnes J. Best Pract Res Clin Gastroenterol. 2004; 8(3):481-96

The Importance of Organ Donation

Organ donation is extremely important. Many people are currently in waiting lists for kidney, liver, heart, lung, pancreas and intestine transplants. A significant percentage of these patients, pass away before receiving the transplant.

The situation for every organ is different. While people in need for a kidney transplant or a liver transplant can receive an organ (or part of it) from a living donor (provided that the donor is immunologically compatible with the recipient), the other organs need the donor to be a deceased person. Also, while people with kidney insufficiency can undergo dialysis treatments while waiting for a kidney transplant, the situation is different for the other organs because besides medical treatment, there is no effective way of replacing the organ functions. 

How to become an organ donor? There are a couple of ways. Any person, at the time of registering for an state ID or (renewing it) can register as an organ donor. In addition, there are state organ donation registries, accessible through the internet. It is important to carry a card that can provide consent for a donation of organs in the event of sudden death. Living donation is also possible in the event of a friend or relative needing an organ. There are also “paired donation programs” by which, in the event the donor is not compatible with the intended recipient, there could be a “cross donation” by which an organ will be given to a compatible recipient provided that this recipient has a donor compatible with the first recipient.

There are medical conditions that a living donor must not have in order to qualify to donate an organ . These are HIV disease, diabetes mellitus, malignancies or any chronic infectious problem. Also, the donor must not have any condition that may be worsened by organ donation like, for example, chronic kidney disease.

Finally, it is important to say that for the transplant recipient, the problems are not over after receiving the donated organ. They have to continue with lifelong immunosuppressive therapy which has risks of their own. However, overall, it is a second chance for enjoying life.

For further information visit: www.organdonor.gov

Marco A. Ramos MD