DEAR DR. GOTT: My 19-year-old grandson was diagnosed with Crohn’s disease two years ago. At that time, he was a 234-pound linebacker entering his senior year of high school. Now he is a 174-pound 19-year-old struggling with life in general and would easily pass for 40. He has practically missed two years of his life due to extreme pain, which resulted in hospital trips and everything else associated with this condition.
He has taken every medication I can imagine, including Humira injections into his stomach. At present, he is taking hyoscyamine and Apriso plus pain medication when it gets too severe. He has a colonoscopy every year. When he has one of these “attacks,” the pain is so severe that he gets in a fetal position and can barely walk. He has been to the hospital at least 15 times in the past two years. He recently went twice in one week and before that, in just a three-month span, he went seven times.
He is unable to work because he is sick or too weak to function at least five days a week. He has never used drugs, alcohol or tobacco. Surgery has been suggested, but we are trying to avoid that if possible. He has seen at least six different doctors, and we are now hoping that you can help us. Please.
DEAR READER: Crohn’s disease is a type of inflammatory bowel disease (IBD). It can be debilitating and may lead to life-threatening complications, so it should be taken seriously by the sufferer and the treating physician(s). While there is no cure, there is good news. Today’s treatments can greatly reduce symptoms and may even lead to long-term remission.
The most common symptoms include diarrhea, abdominal pain and cramping, reduced appetite, weight loss, ulcers and blood in the stool. Others, especially those with severe Crohn’s, may also experience inflammation of the liver or bile ducts, arthritis, fever, fatigue, skin disorders and eye inflammation. Children may experience delayed growth or sexual development.
Complications include bowel obstruction, malnutrition, anal fissures, ulcers, fistulas (an abnormal connection between different parts of the intestine) and more. There is also an increased risk of colon cancer; however, the vast majority (more than 90 percent) of sufferers never develop it.
There are several types of treatment available. The first type is anti-inflammatory drugs, such as the Apriso (mesalamine) that your grandson is on, as well as azulfidine and corticosteroids. Immune-system suppressors are also used. Your grandson was placed on at least one of these, Humira (adalimumab). There are several others in this category. Antibiotics, which may be helpful in treating some of the complications, such as ulcers, abscesses and fistulas, may also be beneficial for those without complications, as many researchers believe that antibiotics will reduce levels of harmful bacteria within the intestine, as well as suppress its immune system.
Commonly used medications include pain relievers, antidiarrheals, iron supplements, laxatives, vitamin B12 injections, calcium and vitamin D, and/or special diets, such as nutrients introduced directly into the veins, which can bypass the stomach and intestine, thus reversing malnutrition.
Finally, surgery. If diet, lifestyle changes, medication and other treatment fail to relieve symptoms, surgery to remove a damaged portion, close fistulas or remove scar tissue may be recommended. Unfortunately, at best, surgery can provide years of remission, but it will be temporary. Nearly three-quarters of patients who undergo surgery will experience recurrence, with approximately half of them requiring a second procedure or more. Even if signs and symptoms improve, medication is often prescribed following surgery in an attempt to reduce the risk of recurrence.
I suggest your grandson try some of the following lifestyle and home remedies and at least meet with a surgeon to discuss his situation. He is clearly suffering, and if medications have not worked for him thus far, surgery may be his best option.
There is no evidence that diet can cause IBD, but certain foods and drinks may aggravate symptoms. He should limit his dairy intake; eat smaller meals; drink plenty of fluids; eat foods lower in fat, especially if the Crohn’s is affecting his small intestine; consider taking multivitamins to supplement lost nutrients; avoid foods that worsen symptoms; experiment with fiber to find the foods that cause the least upset but help reduce diarrhea; and finally, consider consulting a dietician familiar with the disorder to get further suggestions. He should also try to keep his stress levels down by exercising within his limits, practicing relaxation and breathing techniques and, perhaps, even learning biofeedback. He may also wish to see a Crohn’s specialist at a nearby teaching hospital.
To provide related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome.” Other readers who would like a copy should send a self-addressed stamped envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
About Dr. Gott