Crohn’s disease strikes young and old

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DEAR DR. DONOHUE: I am the grandmother of a 10-year-old boy diagnosed with Crohn’s disease. We did not know that this disease affects a child so young. Please fill us in with information on this illness. — J.G.

 DEAR DR. DONOHUE: I am a 32-year-old woman with Crohn’s disease. I don’t understand exactly what it is. Will you please explain? — S.C.

 ANSWER: Crohn’s disease inflames the digestive tract, and any part of the tract from mouth to rectum can be involved. Most of the time, it is limited to the small intestine, where food is absorbed, or to the colon, where water is removed from the food residue, or to both. The inflammation results in ulcerations of the tract. The ulcers can bore through the muscular intestinal wall. The illness strikes at any age, but two prominent peaks are the ages between 15 and 30 and between 60 and 80.

 Crampy abdominal pain, diarrhea, weight loss and sometimes rectal bleeding are its principal signs. Inflammation of the small intestine leads not only to weight loss but also to deficiencies of vitamins and minerals. In untreated children, growth can be stunted.

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 The cause hasn’t been pinned down with absolute assurance. Genes, perhaps intestinal bacteria and an immune system that has turned against the tract are important players in the genesis of this illness. In addition to the digestive tract, joints might become swollen and painful, the eyes can be inflamed and patients are more susceptible to having kidney stones and gallstones.

 Relief of symptoms, prevention of complications and restoration of normal growth for children are the goals of treatment. The complications of Crohn’s include things like fistulas and bowel obstruction from scarring of the tract. Fistulas are tunnels connecting the inflamed intestine with noninvolved portions of the tract or with other organs. Asacol or Dipentum often can control mild Crohn’s. Prednisone, one of the cortisone drugs, calms severe inflammation. And newer medicines such as infliximab (Remicade) inactivate the chemicals that produce inflammation. I haven’t mentioned all possible treatments.

 The Crohn’s and Colitis Foundation of America provides reams of information for patients. It can be reached at www.ccfa.org or at 800-932-2423. The Crohn’s and Colitis Foundation of Canada provides the same services. Its Web site is www.ccfc.ca, and its toll-free number is 800-387-1479.

 DEAR DR. DONOHUE: We don’t hear much about AIDS anymore. Why not? Is the epidemic over? — C.S.

 ANSWER: You don’t hear as much about AIDS because medicines can effectively control it. AIDS is still with us and still disrupts life and health. However, most infected people live a nearly normal life span.

 Around 56,000 new cases of AIDS occur yearly in the United States. The epidemic is far from over. More than a million people are infected. Of that million, 20 percent are unaware that they have the disease.

 DEAR DR. DONOHUE: I have two questions. I have been sold on the idea of digestive enzymes. What is your opinion? My digestion isn’t what it used to be.

 I feel the lack of testosterone. What is your opinion of herbal remedies on the market? What should I do? — T.M.

 ANSWER: Our saliva and pancreatic juice supply us with digestive enzymes. If they are in working order, we don’t need outside help. They usually work well all through life. What do you mean when you say your digestion isn’t what it used to be? It would be best for you to find out what has gone wrong. The possibilities are many, and digestive enzyme lack is really toward the bottom of the possibility list.

 I am not aware of an herbal preparation that supplies testosterone. If there is one, such a preparation isn’t subjected to the same kind of stringent standards that medicines are. If you really are testosterone deficient, a blood test will prove it, and a prescription testosterone can be obtained.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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