The increase in Crohn’s disease cases is worrying

Shelley Martin, Manhattan contadora, He was in his late sixties when, after a routine colonoscopy, he learned he had the Crohn’s disease, a chronic inflammatory disorder characterized by abdominal pain and diarrhea. Martin said that when his friends learned of his diagnosis, many said, “How is that possible? Crohn’s disease begins in childhood. “

In fact, this often debilitating disease, which often affects the area where the small intestine meets the colon, can occur at any age. “If you are born with the right genetics, it may first appear in young children up to people of 80 or 90 years’ he claimed Joseph D. Feuerstein, gastroenterologist at Beth Israel Deaconess Medical Center in Boston. “Its incidence and prevalence are increasing worldwide,” he noted, and gastroenterologists are still trying to find out why it appears at some point in different people.

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Crohn’s disease was first described in 1932 by Burrill B. Crohn and colleagues, and it is one of two chronic inflammatory bowel diseases (the other is ulcerative colitis) that does not have a specific cause. Together, they affect approximately three million people in the United States. In adults, Crohn’s disease usually begins in the 1930s, with a peak incidence between the ages of 20 and 30 and a second peak around the age of 50. The disease is usually inherited, but the genetic risk is not great. Between one in ten and one in four patients have a close relative with the disease, and only half of identical twin pairs have it.

In recent decades, it was believed that Crohn’s disease It mainly affected people of Ashkenazi Jewish descent, but “now we see it everywhere: in Asia, in Latin America, all over the world,” Feuerstein said.

Experts assume that the increase in cases is in some way linked to industrialization and a Western-style diet rich in meats and processed foods. Some suggest that there is a relationship with living in an overly hygienic environment, which can cause the immune system to attack healthy body tissue rather than infectious organisms.

Although the intestine is the most important target of the disease, “it can also affect the eyes, joints, liver and skin,” said Gary R. Lichtenstein, gastroenterologist at the Faculty of Medicine. ‘University of Pennsylvania. “It’s not an obvious disorder: more than 200 genes associated with Crohn’s disease have been identified. It is the result of a complex interaction between environment and genetics ”and can be initiated by an individual’s response to exposure to different things, from infectious agents to drugs.

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There are two well-defined promoters: the frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and the naproxen, and the smoking. Both can trigger the onset of the disease or cause flare-ups in those who already have it, Lichtenstein said. In fact, he added, not only does smoking increase the risk of developing Crohn’s disease, it can also lead to a more aggressive course of the disease.

Unlike Martin, who had no indication that anything was wrong until his routine colon exam, most people with Crohn’s disease have unexplained symptoms for several months, if not years, before. until the correct cause is determined. Upon diagnosis, Martin said she had developed “mild but troublesome diarrhea,” although she considers herself relatively lucky given the potential complex of symptoms associated with the disease.

In addition to abdominal pain and diarrhea which can be bloody, signs and symptoms include unexplained weight loss, anemia, fever, fatigue, nausea and vomiting, loss of appetite, eye and joint pain, and red, tender bumps on the skin. In children, the disease can cause stunted growth.

Feuerstein pointed out that it is very important to have early diagnosis and adequate treatment to eliminate inflammation in the digestive tract, as delay can lead to scar tissue and strictures that are not reversed with medication. Another possible serious complication is the development of a fistula, an abnormal connection between different organs, such as the colon and the bladder, which requires surgical repair which, in turn, can cause further damage to the intestines.

As is logic, the illness may be accompanied by stress, anxiety and depression considerable, and may even make symptoms worse. Last summer, when Martin’s disease suddenly spiraled out of control after being treated with breast cancer medication, severe diarrhea kept her tied to the bathroom in her Manhattan apartment. Lichtenstein noted that the type of medication Martin took, called checkpoint inhibitors, is especially difficult for Crohn’s disease patients who may have to choose between trying to prevent cancer from coming back and clearing their bowel disease. because cancer drugs can sometimes cause inflammation of the colon.

Yes when Crohn’s disease is diagnosed, there is severe inflammation and debilitating symptoms, patients are usually treated with steroids to control the disease before receiving specific drugs. “Steroids,” Feuerstein said, “are a band-aid to stop the inflammatory process, but then we have to do something to suppress the disease and allow the body to heal.”

A veces, antes de iniciar la medicación, se somete a los pacientes a una dieta líquida restringida y temporal para que el intestino descanse y tenga la oportunidad de sanar, aseveró Lichtenstein, principal authority of the últimas directors of the management of the imprisonment of Crohnadas for him American College of Gastroenterology.

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There are now several drug options for treating Crohn’s disease, although controlling symptoms often involves a process of trial and error. For example, following Martin’s diagnosis five years ago, the specialist he saw told him that there were four possible oral medications he could try in turn. Each of them worked for several months, but after the fourth drug stopped relieving her symptoms, she was given a dose of a remedy called Entyvio, which she said “immediately worked like a miracle.”

Entyvio, the commercial name of vedolizumab, This is called a biologic drug, a drug made from living cells that is usually given by infusion or injection, one of many such drugs currently available for Crohn’s disease. It works specifically in the gut to counter inflammation, and because his colon is still inflamed, Martin needs to be treated with the drug every four weeks. If this one stops working, you can try one of the others.

However, Martin knows that Crohn’s disease is not curable and that most patients have to continue taking medication indefinitely. This can be another obstacle. Organic products are very expensive, have an average cost of over $ 100,000 per year, and although they are usually covered by insurance, the deductible is high. To pay for therapy, many patients rely on deductible assistance programs run by pharmaceutical companies, Feuerstein said.

However, Martin recently learned that Medicare covers the cost if it’s administered in a hospital or if your doctor can arrange for a nurse to come to your home to administer the drug.

By Jane E. Brody @ 2021 The New York Times