crohns - simple tips that may help

Dalziel first described Crohn's disease in Scotland in isolated cases in 1913. However, in 1932, Crohn and colleagues named the disease Regional Ileitis. This was later changed to Regional Enteritis when, after further work, it was discovered the disease affected other areas of the gut.

It is a chronic inflammatory disease, which can affect the whole of the alimentary tract (digestive tube) from mouth to anus. The inflammation extends through all layers of the gut wall (transmural) and is characteristically patchy in distribution (skip lesions) with areas of normal tissue between.

The most commonly affected sites are the terminal ileum (the lower part of the small intestine), and the large intestine. It frequently affects the anus.

The disease has several characteristics:

1. The course of the disease is chronic with periods of remission, when patients are symptom-free, and relapses, when symptoms flare up.

2. It has a wide range of symptoms.

3. Complications outside the intestine are common.

4. There is a strong tendency for it to recur after surgery.

In many ways the best treatment for Crohn's disease is diet. This can lead to long remissions without the risk of the side effects produced by so many drugs and may reduce the need for surgery. However the diet varies from one patient to another and must be tailored to each individual carefully and conscientiously under the supervision of a qualified dietitian.

How do diets work?

Food residues which have not been digested and absorbed in the small intestine pass down into the lower bowel and are fermented by the bacteria that live there. It is believed that an immune reaction against the bacteria living in the bowel is a very important factor in the cause of Crohn's disease and that the activity of these bacteria can be modulated by diet. Diet does not work in Ulcerative Colitis, probably because the bacteria involved rely not on food residues but on substances which naturally occur in the bowel, such as mucus, for their energy requirements. The reaction to foods is quite different to allergy where special antibodies are circulating in the blood. This means that skin prick and blood tests for allergy are of no help in deciding which foods need to be avoided.

How is a Crohn's diet constructed?

There are 3 stages in dietary treatment

1. The patient stops eating normal food stuffs and is given a liquid enteral feed as the sole source of nutrition. Symptoms normally disappear after 2-3 weeks.
2. When all symptoms have cleared normal foods are reintroduced to see which ones cause symptoms and which ones may be eaten without difficulty. Those provoking symptoms are subsequently excluded.
3. When all foods have been reintroduced those irritating the bowel are tried again to make certain they genuinely cause difficulties and the dietitian checks the resulting diet to make sure it is nutritionally adequate and advises on any supplements needed.