Effective Home Remedy to Cure Crohns Disease

Cured My Crohns

If you've ever gotten the fateful diagnosis you've got Crohns, you will know the massive upset that it can have on your way of life and how you feel about yourself and your relationship to other people. If you talk to your doctor about natural diets or some other method of curing your Crohns disease they will tell you that there is no way to fix it. However, there is often more to the story than modern medicine will tell you. New Age medicine is not a bunch of nonsense that hokey people subscribe to; New Age medicine fills in the gaps of knowledge that we have with modern medicine and helps us understand what is going on with our bodies. You will learn how to cure Crohns from someone who has cured it himself and has lived for over 10 years completely free of disease!

Cured My Crohns Overview


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The Fastest Way To End Digestive Pain Forever

Digestive Pain Gone In As Little As 1 Day even if diets, drugs & surgery failed. Soon you will be able to: Stop the burning pain in your chest and throat. Swallow normally again without pain. Eat delicious, yummy foods you love. Sleep peacefully all night long without special pillows. Get off antacids, proton pump inhibitors, H2 Blockers. End constipation (often caused by medications) Eliminate bloating, gas, diarrhea and cramping. Lose 5-50 lbs without even trying. Reduce and eliminate Adhd symptoms. Feel a Lot more energy. As you know, digestive disorders can make your life miserable. Words like Acid Reflux, Gastritis, Diverticulitis, Diverticulosis, Colitis, Crohn's (Ibd), Ibs, Ulcer and Hiatal Hernia strike fear in the hearts of many. And the associated heartburn, diarrhea, constipation, gas, bloating and the drugs and surgery makes the living hell complete.

The Fastest Way To End Digestive Pain Forever Overview

History of Crohns Disease

The initial description of Crohn's disease may date back to Giovanni Morgagni, who in 1761 described ileal ulceration and enlarged mesen-teric lymph nodes in a young man who died of an ileal perforation. More suggestive early instances of Crohn's disease include an 1806 report by H. Saunders and one in 1813 by C. Combe and Saunders. Nineteenth century descriptions of disease consistent with today's concept of Crohn's disease were authored by J. deGroote, J. Abercrombie, J. S. Bristowe, N. Moore, and S. Wilks. In 1913, T. Kennedy Dalziel described a group of patients with findings closely resembling those recorded in 1932 by B. B. Crohn, L. Ginzburg, and G. D. Oppenheimer. Many reports of a chronic inflammation of the last portion of the small bowel appeared subsequently. F. J. Nuboer in 1932 described two patients manifesting the same findings that Crohn described. Soon after Crohn's 1932 paper, A. D. Bissell reported on two patients. The first had symptoms including cramps, diarrhea,...

Early Life Experiences

Other studies have extended the focus from gynecologic to gastrointestinal symptoms, because they are related to organ systems that are targets of abuse. Reilly et al. (1999) studied male and female adult patients with nonepileptic seizures or irritable bowel syndrome and compared them with a similar group of patients with epilepsy and Crohn's disease. The authors concluded that adults presenting with functional neurologic and abdominal symptoms had an increased recollection of sexual and physical abuse, as both children and adults.

Inflammatory Bowel Disease IBD

This is an umbrella term that comprises Crohn's disease as well as ulcerative colitis. IBD is a miserable condition where the lower intestine becomes inflamed, causing abdominal cramping, pain, fever, and mucus-laden, bloody diarrhea. IBD is not known to occur more often in thyroid disease patients, although the effects of too much or too little thyroid hormone may worsen its symptoms. If you have IBD, it's best to ask to be referred to a gastroenterologist (also know as a GI specialist), who is the specialist to manage it. This is not to be confused with irritable bowel syndrome (IBS), a stress-related disorder that often masks hyperthyroid symptoms.

Further Information On Spinal Gastrointestinal And Hepatic Tb

Ileocaecal TB may present with constitutional features, chronic diarrhoea, subacute obstruction, or a right iliac fossa mass. Diagnosis rests on barium examination of the small and large bowel, or on colonoscopy, if available. The differential diagnosis includes ileocaecal Crohn disease, carcinoma of the caecum, appendix abscess, lymphoma, amoeboma and tubo-ovarian abscess.

Aids And Tuberculosis

The abdominal manifestations of tuberculosis in patients with AIDS frequently include weight loss, abdominal pain, abdominal masses, disseminated lymphadenopathy, anemia, fever, and diarrhea. Massive gastrointestinal hemorrhage, bowel obstruction, perforation, or abscess formation occur commonly. These complications require differentiation from Crohn's disease, neoplasms, sarcoidosis, blastomycosis, and actinomycosis. Treatment of these combined diseases requires investigation to assess the nature of the tuberculosis and its spread to the gastrointestinal or genitourinary tract or other sites. Sometimes emergency surgical therapy is needed (25). Similarly, the HIV may require systemic therapy because of opportunistic infections of some system or organ in the body. Depending on the site, and types of infections, either medical or surgical therapy or both may be required.

Peripheral Blood Lymphocyte Stimulation Assay

Peripheral blood lymphocytes of patients with Crohn's disease and healthy controls were isolated from heparinized blood on a Ficoll-Hypaque gradient (Pharmacia LKB, Uppsala, Sweden). The cells were washed and resuspended in RPMI-1640 medium (Gibco, Paisley, Scotland) supplemented with penicillin, streptomycin, glutamine, and 5 autologous plasma. Cells were cultured at a concentration of 1 x 106 cells ml in 96-well round-bottom culture plates (Falcon, Lincoln Park, NY). For stimulation with mycobacterial hsp 65 (gift from Dr. J.D.A. van Embden, National Institute of Public Health and Environmental Hygiene, Bilthoven, The Netherlands), a final concentration of 1 and 10 Hg ml was used. The following other antigens and mitogen were also used for stimulation, each at an indicated final concentration that has been shown in previous experiments to induce optimal T-cell proliferation streptokinase-strep-todornase 100 IU ml (Lederle, Belgium), Candida albicans 0.5 ng ml (Haarlem Allergenen...


Nine patients with Crohn's disease and seven controls were examined. Routine histology of hematoxylin eosin-stained sections confirmed the diagnosis of Crohn's disease. Hsp 65 was expressed in a scattered pattern in the mucosa and, to a lesser degree, in the submucosa and tunica musculosa of tissue specimens (both ileum and colon) from patients with Crohn's disease (Fig. la,b). The degree of hsp 65 expression correlated with the severity of transmural inflammation. In tissue segments from patients with Crohn's disease that were normal on macroscopy and routine histology, expression of hsp 65 was detected as well. In controls, hsp 65 expression was absent or very scarce and staining positivity was much less intense than in patients with Crohn's disease (Fig. lc). Figure 1 Expression of hsp 65 and B7 in intestinal tissue biopsies, (a and b) Biopsy specimen from a patient with Crohn's disease. Hsp 65 staining with LK1 monoclonal antibody, (c) Biopsy specimen from a control patient. Hsp...

Antibodies Against Hsp 65 and Peripheral Blood Lymphocyte Stimulation Assay

Refused because of prior tuberculosis. There was no difference in age or gender between patients and controls (p > 0.1, x2)- The patient population was representative for the whole spectrum of Crohn's disease activity. The concentrations of antibodies against hsp 65 were 129 195 for patients and 55 55 for controls (mean SD p < 0.05) (Fig. 2). There was a considerable overlap between both groups, but 45 of the patients with Crohn's disease had anti-hsp 65 antibody titers that exceeded the 90 confidence limit of the antibody titers of the controls. Proliferation of peripheral blood lymphocytes in patients with Crohn's disease on stimulation with hsp 65 in vitro was observed. The peripheral blood lymphocyte stimulation index for hsp 65 was, however, significantly lower (p < 0.05) for patients than for controls. The SI for the other antigens or mitogen did not differ significantly between patients and controls (Table 1). There was no correlation between SI for hsp 65 and SI for...

Overview Of The Induction Of Bt In Experimental Animals

Ulcerative gastrointestinal lesions that occur in chronic ulcerative disorders such as ulcerative colitis and Crohn's disease permit the direct entry of enteric bacteria into the lymphatic and vascular systems through holes in intestinal mucosa. It is surprising at first glance that gastrointestinal bleeding is a common method of inducing BT and bacterial infections. Whether this process is related to the decrements in mesenteric arterial blood flow or to breaks in the integrity of the gastrointestinal mucosa or both is not clear. Clearly, the introduction of a variety of bacterial species into the GI tract appear to stimulate bacterial overgrowth in the intestinal tract, which is frequently a prerequisite to BT. A number of other gastrointestinal disorders also predispose to BT. They include intestinal obstruction and biliary obstruction. Intestinal transplantation might be expected to induce BT, and, indeed, it does.

Human Disorders That Induce Bt

Ambrose et al. studied 46 patients with Crohn's disease prior to surgery and compared these results with a control group of 43 patients with a variety of nonulcerative abdominal disorders (72) (see Table 7.2). They were able to culture intestinal bacteria from the mesenteric nodes in 33 of patients with ulcerative lesions compared to only 5 in the control group (p < 0.01). Poten tially pathogenic bacteria were cultured from the serosa of the Crohn's group twice as frequently as from the control group (p < 0.05). The authors postulated that enteric bacteria escape from the lumen via the ulcerations and account for the frequent mesenteric lymphadenopathy. The common occurrence of BT and the frequent occurrence of fistulae, wound sepsis, and intra-abdominal abscesses in patients with Crohn's disease support this hypothesis.

General Characteristics

Ulcerative colitis and Crohn's disease share similar demographic features. Ulcerative colitis apparently has stabilized or diminished in many areas of the world, with several exceptions. It Similarly, Crohn's disease is common in Britain, the United States, and Scandinavia, on the rise in Japan, but less frequent in central and southern Europe and uncommon in Africa and South America. It has been increasing throughout much of the world but appears to have stabilized in some localities. The worldwide prevalence of Crohn's disease, especially in industrialized areas, and the similarity of its features regardless of geographic and sociocul-tural differences, are noteworthy. The IBD are more frequent among whites than blacks, but Crohn's disease is increasing among black populations of the United States and Britain. Ulcerative colitis and especially Crohn's disease are much more common among Jews of the United States, Britain, and Sweden than among other groups. Ulcerative colitis and...

Therapeutic Relevance Of Gi Stem Cell Plasticity

The ability of a transplanted bone marrow stem cell to transdifferentiate into intestinal subepithelial myofibroblasts may prove therapeutic in the inflammatory bowel diseases ulcerative colitis and Crohn's disease, which are associated with an increased risk of bowel cancer (Tomlinson et al., 1997). A bone marrow transplant or mobilization of a patient's own bone marrow stem cells to colonize a diseased tissue could potentially lead to regeneration of damaged tissues. Additionally, the use of bone marrow stem cells in gene therapy is conceivable and appears preferential to current possibilities of directly transfecting differentiated cells such as hepatocytes. Manipulation of a bone marrow stem cell in

Preoperative Preparation

Elective procedures provide an opportunity to maximize nutritional status for patients with Crohn's disease. Anemia is corrected with blood transfusion, and total parenteral nutrition (TPN) is occasionally indicated in patients who are chronically ill. Controversy still exists regarding TPN, and some authors have not found preoperative nutrition to be of benefit in ileocolic Crohn's disease.1 ' In a study of 395 Measurement of the remaining noninvolved small bowel during surgery is a crude but useful intraoperative maneuver. This assessment provides a future basis for potential surgical procedures and avoidance of the most severe complication of Crohn's disease short bowel syndrome. The small bowel is best measured with a suture or umbilical tape of known length immediately on exploration by laying the suture or tape A randomized study of 68 patients with Crohn's disease who underwent either a stapled or a hand-sewn anastomosis1 ' reported that although operation times were shorter in...

Impaired Wound Healing

In one review,1 ' dehiscence or incisional hernia after intraperitoneal surgery in steroid-treated patients was reported as 13 versus 2 for non-steroid-treated patients. In another review of 658 intestinal anastomoses in 429 operations for Crohn's disease, the postoperative complication rate was significantly higher in the group treated for the long-term with steroids.1 ' Furthermore, in an animal model

Causes of Pelvic and Rectal Pain

Common anorectal disorders that present as perineal or pelvic pain readily lend themselves to diagnosis these include abscesses (cryptoglandular, intramuscular), fistulas, Crohn's disease, and ulcerative proctitis. These conditions must be excluded as the source of pelvic pain.

Pharmacokinetic Data

CEA is expressed in a variety of carcinomas, particularly of the gastrointestinal tract (e.g., Crohn's disease, inflammatory bowel disease, post-radiation therapy to the bowel) and can be detected in the serum. IMMU-4 is specific for the classical 200000-Da CEA that is found predominantly on the cell membrane. mTc-CEA-Scan complexes the circulating CEA and binds to CEA on the cell surface. Imaging efficacy and safety have been evaluated in four clinical trials to evaluate the presence, location, and extent of colorectal cancer, primarily in the liver and extrahepatic abdominal and pelvic regions.

Howard S Kaufman Mary L Harris

Crohn's disease is an inflammatory disease of unknown etiology that may affect the entire gastrointestinal tract from the mouth to the anus. Epidemiologic studies suggest that both genetic predisposition and environmental factors contribute to the development of this chronic relapsing disorder that is manifested by an unrestrained inflammatory response in the intestines. Effective medical therapy for Crohn's disease is based on anti-inflammatory, immunosuppressant, and immunomodulating strategies. Although it is not curative, most patients with Crohn's disease will require surgery for palliation of the complications of this disorder. This chapter highlights the epidemiology, pathogenesis, evaluation, and medical management of Crohn's disease of the small intestine.

Indications For Surgery

Although most patients suffering from Crohn's disease require at least one surgical procedure as part of the overall management of their disease, the decision in favor of surgery and its optimal timing is often a difficult one. Important considerations entering into the final decision to recommend surgical therapy include the location of the disease, the extent of bowel involvement, the length of normal intestine, the feasibility of bowel-sparing techniques, the possibility of a temporary or even permanent stoma, and the likely changes in the quality of life that surgery may produce. Other important factors, such as personal or work-related commitments, may also influence the timing of surgical treatment. Because of the complex nature of the disease, along with the frequent need to balance objective findings and medical requirements with personal considerations, it is essential that the patient be fully informed of the rationale behind the clinical decision process and that the...

Fabrizio Michelassi Roger D Hurst

Although Crohn's disease can Involve any portion of the alimentary tract, the small bowel Is most commonly affected. Terminal Ileal disease, with or without extension Into the proximal colon, represents more than half of all cases of Crohn's disease. Involvement of the more proximal small bowel and duodenum Is less common and accounts for about 10 of Crohn's disease cases.1 ' 1 ' The surgical management of small bowel Crohn's disease Is often challenging because dense Inflammatory adhesions, abscesses, and complex fistulas are common. Thorough knowledge of the wide range of manifestations and experience with the various surgical strategies necessary for managing complicated Crohn's disease are crucial for the surgeon facing this challenging disease.

Congenital triangular alopecia Brauer nevus temporally limited alopecia

A granulomatous disease of the bowel. Cutaneous manifestations include pyoderma gangrenosum, exfoliative dermatitis, erythema multiforme and Stevens-Johnson syndrome, urticaria, herpes zoster, palmar erythema, cutaneous Crohn's disease, and necrotizing vasculitis.

Noninvasive Diagnostic Procedures

Angioplasty For Liver How Its Done

Plain film of the abdomen in this 32-year-old woman with Crohn's disease and a pericoIonic phlegmon demonstrates irregular linear lucencies overlying the periphery of the liver (arrowheads). These images represent gas in small intrahepatic portal vein radicals and are related to the colonic inflammatory process.

Types Of Jejunostomy Sabiston Book

Witzel Jejunostomy

A, Strictureplasty is a useful adjunctive technique for treating segments of small bowel narrowing as a result of chronic inflammation. Stricturoplasty is most commonly employed in the treatment of patients with Crohn's disease. When chronic scarring has caused obstruction secondary to a short-segment stricture, a stricturoplasty analogous to a Heineke-Mikulicz pyloroplasty may be used. Sutures are placed, and a longitudinal incision is made through the full thickness of the bowel wall. B, Tension on traction sutures converts the longitudinal incision into a transverse opening. The stricturoplasty is closed in a single layer using interrupted nonabsorbable seromuscular sutures (see inset). C, If the stricture is longer than 1 to 2 cm in length, a stricturoplasty analogous to a Finney pyloroplasty may be used. Seromuscular sutures approximating the bowel wall in the area of the stricture are placed. An incision traversing the stricture (dashed line) is...

Postoperative Management

Postoperative prophylaxis, or adjuvant therapy, has also become commonplace. In a prospective randomized trial, 1 3 g day mesalamine significantly reduced the risk of recurrent Crohn's disease from 0.628 (90 confidence interval, 0.40 to 0.97) to 0.532 (90 confidence interval, Figure 9-6 Recurrence versus margin histology in subjects with a proximal margin length of less than or greater than 5 cm. (From Wolff, B.G. Factors determining recurrence following surgery for Crohn's disease. World J. Surg., 22 364-369, 1998, with permission from Springer-Verlag.) -7 Recurrence versus margin histology in subjects with normal features or nonspecific findings on light microscopy. (From Wolff, B.G. Factors determining recurrence following surgery for Crohn's disease. World J. Surg., 22 364-369, 1998, with permission from Springer-Verlag.) Figure 9-8 Recurrence of Crohn's disease according to operation. (From Wolff, B.G. Factors determining recurrence following surgery for Crohn's disease. World J....

General Considerations

Typically, the name of a fistula is derived from the involved and connected organs or structures. Examples include gastrocolic, jejunoileal, and aortoenteric fistulas. Internal fistulas communicate between the intestine and another hollow viscus or structure and may not be suspected for some time because symptoms may be minimal. Relatively rare, such fistulas have been reported between adjacent segments of the gastrointestinal tract as well as between the small intestine and the biliary tree, genitourinary system, and arterial and venous trees ( Table 29-1 ). By contrast, external or enterocutaneous fistulas, by far the most common type of small intestinal fistula, are usually readily recognizable. Fistulas may also be classified as primary, arising spontaneously from an inflammatory process such as Crohn's disease, or secondary, resulting from invasive trauma or surgical procedures. Small Intestinal fistulas can form In a number of ways. Enterocutaneous fistulas most commonly follow...

History of Ulcerative Colitis

Hippocrates recognized that diarrhea was not a single disease entity, whereas Aretaeus described many types, including one with foul evacuations, chiefly in older children and adults. An apparent ulcerative colitis was described by Roman physicians, including Eph-esus in the eleventh century. Noncontagious diarrhea flourished for centuries under many labels, such as Thomas Sydenham's bloody flux in 1666. In 1865, U.S. Army physicians described the features of an ulcerative colitis-like process. (Several of these cases actually suggest Crohn's disease more than ulcerative colitis.) Worldwide attention was directed to the disease at the 1935 International Congress of Gastroenterology, and the amount of literature increased rapidly after this. By the 1940s, ul-cerative colitis was recognized more often than Crohn's disease. However, by the end of World War II, Crohn's disease had become more frequent. Concurrently with an apparent stabilization of ulcerative colitis in the United States,...

Sandra L Wong Susan Galandiuk

PCI can also be classified as primary (idiopathic) or secondary, the latter being associated with a wide variety of both gastrointestinal and nongastrointestinal lesions ( Table 32-1 ). PCI of the left side of the colon is usually idiopathic, whereas PCI of the small bowel or ascending colon is usually secondary. 1 I 1 Secondary PCI accounts for about 85 of reported cases and has been described in association with chronic obstructive pulmonary disease, high positive-pressure ventilation, necrotizing enterocolitis, pseudomembranous enterocolitis, diverticulitis, intestinal strangulation, appendicitis, gallstones, volvulus, pyloric stenosis, peptic ulcers, Crohn's disease, ulcerative colitis, esophageal stricture, tuberculous enteritis, scleroderma, blunt abdominal trauma, diaphragmatic hernia, jejunoileal bypass, steroid use, chemotherapy,

Does microbial flora affect vulnerability against pathogenic infections

In addition, it has been found that loss of biodiversity of the bacterial flora of the intestine is associated with inflammatory bowel diseases (IBD) 100 , perhaps due to excessive growth of specific bacteria species 101 triggered by the loss of diversity 102 . Association between loss of diversity in bacterial flora and autoimmune disorders is documented even in cases of CD and ulcerative colitis. A recent study revealed that diversity of bacterial flora in Crohn's disease (CD) patients and ulcerative colitis was reduced by 50 and 30 compared to the healthy control group, respectively, and such reduction of diversity was attributed to the loss of normal anaerobic bacteria including Bacteroides species, Eubacterium species, and Lactobacillus species 100 . These bacteria that are significantly lost in the population are consistent with specific species that are observed to have high intra-division biodiversity 103 such as Cytophage-Flavobacterium-Bacteroides (CFB) and the Firmicutes....

General Aspects And Technical Matters

From 70 to 90 of patients with Crohn's disease will, at some time, undergo an operation. By far the leading indication for operation is the failure of medical management. The most common complications leading to surgery are intestinal obstruction, which is rarely complete but is high grade spontaneous perforation with peritonitis fistula formation or abscess and gastrointestinal bleeding.1 ' Obstruction with nausea and vomiting is usually managed by inserting a nasogastric tube and intravenous feeding, but the obstructed segment is narrowed by chronic inflammation with fibrous scar tissue which is usually unresponsive to any medication. Abdominal pain, fever, malaise, and weight loss in a Crohn's patient usually portends perforation with fistula formation or abscess. Perianal complications, such as abscess and fistula, commonly in association with more proximal disease, may lead to surgery. Bleeding is very rarely severe but may be chronic, leading to anemia, and may contribute to the...

Somatostatin and Somatostatin Receptors

To date, five human somatostatin receptors subtypes (sst 1-5) have been cloned (see also Chapter 2). Because they have the distinct characteristics they were divided into two classes the class I includes sst2a, sst3 and sst5 somatostatin receptors and the class II sst1 and sst4 receptors. Importantly, each of the somatostatin receptors subtype has a distinct ability of internalization . The final effect of stimulation of somatostatin receptors results from the different effects of all receptor subtypes. It is important to remember that the expression of different subtypes of somatostatin receptors in the different types of NET cancers varies even in the same type of tumor the expression can change.4 In most of tumors located in the gut the expression of sst1 and sst2 was found, and only in few of them sst5 was observed. Receptor subtype sst3 was very rarely observed in the gut carcinoids. Receptor sst4 is present in 22-86 of NET tumors. Somatostatin receptors are expressed with...


Crohn's disease is an inflammatory bowel disease of unknown etiology. The diagnosis of Crohn's disease is based on clinical, pathological, radiological, and endoscopic features. The syndrome exhibits the classic pathological characteristics of chronic inflammation that is, an infiltration of macrophages and lymphocytes, including large numbers of plasma cells. In the active stage of Crohn's disease, there is an acute inflammatory component as well that is, an influx of neutrophils and monocytes into the inflamed mucosa (1,2).

Gene Therapy

Crohn's disease, which causes painful inflammation and ulcers, may be caused by a defective gene. In this disease, the immune system attacks the normal bacterial flora in the gut apparently a mutant form of the gene Nod-2 causes the body's normal controls to go awry. The normal gene encodes a protein that recognizes the bacteria belonging in the gut and prevents the immune system from attacking them. Crohn's patients produce a modified protein that cannot perform that function. Now that the defective gene has been identified, it may be possible to substitute the normal form and protect people from the disease.13

Bruce G Wolff

Crohn's disease represents a fundamental and frustrating challenge for the gastrointestinal surgeon. The only consistent factor in Crohn's disease is its inconsistency its variety of presentations and complications necessitate a thorough preoperative evaluation as well as intraoperative flexibility and ingenuity on the part of the surgeon. Nevertheless, since 1975, there have been major modifications in the philosophy and techniques of surgery for Crohn's disease. Wide resection has given way to narrow resectional margins, and even striving for negative margins has given way to the importance of small bowel conservation. This approach, coupled with adjuvant medical therapy and the introduction of newer agents, such as FK-506 (Tacrolimus) and infliximab (Remicade), has resulted in improved care of patients with Crohn's disease and has brought on an era of greater cooperation between gastroenterologists and gastrointestinal surgeons. Better perioperative techniques, improved...

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S., Brandt, L. J., et al. Healing of perineal Crohn's disease with metronidazole. Gastroenterology, 79 357, 1980. 8. Brandt, L. J., Bernstein, L. H., Boley, S. J., and Frank, M. S. Metronidazole therapy for perineal Crohn's disease A follow-up study. Gastroenterology, 83 383, 1982. 16. Cohen, Z., and McLeod, R. S. Perianal Crohn's disease. Gastroenterol. Clin. North Am., 16 175, 1987.

Vitamin E

Vitamin E is fat soluble and found in abundance in vegetable oils and wheat germ. The recommended daily allowance is 10 mg (10 IU) for men, and 8 mg (10 IU) for women. Patients at risk for the development of vitamin E deficiency include those who have the following clinical conditions hypobetalipoproteinemia or abetalipoproteinemia (Bassen-Kornzweig syndrome) other disorders of the pancreas and liver, such as cystic fibrosis and primary biliary atresia PEM familial vitamin E deficiency due to a defect in alpha-TTP and other malabsorptive states that result in cholestasis (Crohn's disease, ulcerative colitis, and celiac disease) ( . Iable.40-4 ). Pregnancy increases vitamin E serum concentrations, but premature infants often have low levels of vitamin E due to a lack of adipose tissue as well as difficulty in transplacental migration of the vitamin. The majority of patients who have vitamin E deficiency are those with severe malabsorptive states present since birth, or rare familial...

Future directions

The host immune system is a complex and characteristic structure that has evolved to defend the host from a broad range of pathogenic threats. It has, however, several fragile points which are effectively exploited by a variety of pathogens. At the same time, the proinflammatory nature of cytokine network and risk of misrecognition by molecular mimicry make the host system prone to infection-triggered organ dysfunctions, such as ECM-induced heart failure, fulminent hepatitis, and a series of autoimmune disorders such as Crohn's disease.

Chronic Inflammation

The risk of colorectal cancer is increased in subjects with chronic or longstanding inflammation of the large intestine, notably due to ulcerative colitis and Crohn's disease. A possible mechanism may be genetic damage by reactive oxygen species (superoxide, H202 and hydroxyl radicals), in turn generated by the inflammatory mediators released by inflammatory cells such as neu-trophils and macrophages. Cycles of inflammatory damage and healing may also increase the rate of epithelial proliferation or change the microenvironment so that cells are more susceptible to the effects of luminal carcinogens.


Small intestinal Crohn's disease is a transmural process with a variety of classic gross and microscopic pathologic features. Early Crohn's disease may be manifested by subtle macroscopic changes identifiable to the experienced surgeon at laparotomy or laparoscopy and to the experienced endoscopist. These findings may include intraluminal abscess formation, marginal mesenteric thickening, neovascularization, and barely palpable circumferential strictures. As the disease progresses, mesenteric fat wrap, edema, and fibrosis result in progressive luminal narrowing.


The goal of intervention in patients with colonic obstruction is relief of the obstruction and treatment of the underlying cause. Management of the obstructed colon depends on both the cause and the location of the obstruction. Peritonitis requires urgent exploration regardless of the cause. A sigmoid or cecal colonic volvulus may be reduced by sigmoidoscopy or colonoscopy, permitting an elective approach for definitive therapy. Inflammatory lesions, such as diverticulitis and Crohn's disease, often improve with intensive medical therapy, bowel rest, and nutritional support, allowing resection on an elective basis. This is especially true if the obstruction is only partial.


The pathogenesis of Crohn's disease remains unknown. Research focuses at the possible initiating events, the proinflammatory mediators, and deficient down-regulatory mechanisms of intestinal inflammation. The role of the mucosal immune system is thought to be of major importance in this respect (3). There is accumulating evidence that a microbial factor may be involved in the initiation or amplification of the intestinal inflammation in Crohn's disease. In an animal model, nonsteroidal anti-inflammatory drugs (NSAIDs) induce an intestinal ulceration and an enhanced permeability of the intestinal wall similar to that found in Crohn's disease. NSAID-induced intestinal inflammatory lesions do not develop readely in germ-free animals and are greatly reduced by the administration of antibiotics to conventional animals (4,5). In human Crohn's disease, antibiotics also favorably influence signs and symptoms of active inflammatory bowel disease. Furthermore, the recurrence of Crohn's disease...


Destructive inflammatory skin disease. In pyoderma gangrenosum, a painful nodule or pustule breaks down to form an enlarging ulcer with a raised, undermined border and a boggy, necrotic base. Pyoderma gangrenosum has also been observed in association with Crohn's disease and many other systemic diseases, especially hematologic malignancies, monoclonal gammopathies, and various arthritides.

Patricia L Roberts

Crohn's disease, a transmural inflammatory disease of the bowel, is associated with rectovaginal fistula in more than 10 of women with the disease. 1 ' Anorectal suppurative disease, including abscesses in the rectovaginal septum and anterior horseshoe abscesses, may be associated with rectovaginal fistulas.