Central  South  Dakota  Medical News
The Clinical View
  by P.E. Hoffsten, M.D.
10 October 2003

CROHN’S DISEASE – A FORM OF COLITIS

     One of the really miserable diseases that a human being can get is colitis.  The intestinal tract is around 30 feet long from the person’s mouth clear through to the person’s anus.  The last six feet is called the colon.  Its major job is to reabsorb about six quarts of water out of the intestinal contents and concentrate a person’s stool down to a small amount.  When the colon can’t do its job, all that water runs through to the colon and the person develops diarrhea.  Having several quarts of diarrhea a day is a miserable way to live.

     There are many diseases of the colon.  The most common of which is simple food poisoning and occasional viral infections.  Fortunately, these are self-limited conditions and the person gets over them in a day or two.

     There are however two conditions that result in chronic recurrent diarrhea, abdominal pain, bloating and often bleeding per rectum.  These two conditions are called ulcerative colitis and Crohn’s disease.  They are virtually indistinguishable based upon the person’s symptoms alone.  To this time, the cause of neither of these diseases has been determined, but recently there has been a breakthrough in the treatment of Crohn’s disease.

    The person for whom this column is written is a woman who was 32 years old when she developed abdominal cramping pain that occurred several days a week.  Sometimes she would have diarrhea with the cramps.  There were intermittent fevers.  Her first contact with doctors was frustrating because she had no objective demonstrable abnormalities and she was given Imodium pills to stop her diarrhea.  Unfortunately these pills had no beneficial effect on the cramping-abdominal pain.

     Then the crisis struck.  One evening she had unusually bad cramps and developed a fever.  She went to the emergency room where she was diagnosed as having a surgical abdomen that needed exploration.  Upon exploration she was found to have several isolated segments of small bowel that were very inflamed, one of which was almost totally obstructed.  The only treatment at that point was to place an opening for the intestine onto the abdominal wall so the obstruction could be bypassed.  She was at that point diagnosed as having Crohn’s Disease.  She was started on large doses of cortisone and another drug to decrease the inflammation in her bowel. Several months later her bowel was reconnected to its natural course.

     That was 16 years ago.  Since then she has had to have 6 more surgeries to relieve obstructions, has had 9 feet of her small bowel removed, and twice had to have transfusions because of bleeding into the bowel.  She remains on multiple medications to try to control her symptoms but they are inconsistently effective.  She provides the example of how miserable this disease can be.

     In the past, Crohn’s Disease has been treated as if it represented an inflammatory disease in which the person seemed to be over reacting to an infection or an allergy.  The patients were treated with large doses of cortisone that was sometimes effective. Very frequently when the cortisone doses were tapered back, the diarrhea and colitis recrudesced.  More recently other drugs that are immunosuppressive have been used to decrease the person’s inflammatory reaction. Again, these drugs seemed to work briefly but incompletely and side effects were substantial.

     Recently, two researchers working at Washington University in St. Louis, Missouri, made an observation and decided to use a different tactic.  They noted that patients with immune- deficiency diseases (the opposite of inflammatory diseases) often have severe diarrhea. When medications were found that corrected the immune deficiencies the diarrhea stopped. They reasoned that perhaps Crohn’s disease might be an immune-deficient state as opposed to an inflammatory condition.  If that were really the case, then treatment attempts all of these years would really have been counterproductive and directed the wrong way.

     So these reachers decided to stimulate the immune system of some patients with Crohn’s disease instead of suppressing the immune system as had been done up to this time.  They used a new biological preparation with the trade name Leukine.  This drug is now commercially available and has been shown to stop Crohn’s disease.  Individuals that use the drug stop having diarrhea very soon after it is started and the severe abdominal pain problems stop.  After a brief period of time, the patients have lost all symptoms including the diarrhea, the abdominal pain, the bloating and the bleeding.

     This research is an example of how incidental findings in one condition can lead to effective treatments in another.  The researchers working on Crohn’s disease made an observation in another condition called chronic granulomatous disease. That observation resulted in an effective treatment for Crohn’s disease.  While we still don’t know the cause of Crohn’s disease, at least now there is an effective treatment that prevents the symptoms of the disease and multiple surgeries it often requires.