Interview with a Crohn's Disease Patient: An Anonymous Journey
Today, I had the privilege of interviewing a family member who has chosen to remain anonymous. She has been diagnosed with Crohn's disease and wants to share her story to raise awareness and offer support to others facing similar challenges.
What is Crohn’s Disease?
Crohn's disease is a chronic inflammatory condition of the gastrointestinal (GI) tract, which is part of a group of conditions known as inflammatory bowel diseases (IBD). It can affect any part of the GI tract from the mouth to the anus but most commonly affects the end of the small intestine (the ileum) and the beginning of the colon.
Symptoms of Crohn’s Disease
Symptoms of Crohn’s disease vary depending on the location and severity of inflammation. The family member we interviewed experiences symptoms such as abdominal discomfort, bloating, a sensation of fullness, frequent bathroom visits, and food sensitivities. Common symptoms include:
Abdominal Pain and Cramping: Often in the lower right abdomen.
Chronic Diarrhea: Sometimes with blood or mucus.
Weight Loss and Malnutrition: Due to poor absorption of nutrients.
Fatigue: Caused by the body's ongoing fight against inflammation.
Fever: Reflecting the body's inflammatory response.
Mouth Sores: Ulcers can appear in the mouth.
Diagnosis
Diagnosing Crohn's disease involves a combination of tests and procedures, including:
Blood Tests: To check for anemia and signs of inflammation.
Stool Tests: To rule out infections and check for blood in the stool.
Endoscopic Procedures: Such as colonoscopy and upper endoscopy to visualize the GI tract and take biopsies.
Imaging Studies: Including CT scans, MRI, and small bowel imaging to assess the extent of inflammation and complications.
The family member we interviewed underwent a colonoscopy, capsule endoscopy, regular endoscopy, and blood work to be diagnosed with Crohn’s disease.
Causes
Understanding the scientific mechanisms underlying Crohn's disease involves exploring genetic factors, immune system dysregulation, environmental triggers, and the microbiome.
Genetic Factors: There is a significant genetic component in developing Crohn’s disease. According to MedlinePlus, 15% of those with Crohn’s disease have a first-degree relative with the disease. Major genes related to this disease, including NOD2, ATG16L1, IL23R, and IRGM, produce proteins that help the immune system sense and respond appropriately to bacteria in the lining of the digestive tract. Mutations in these genes can lead to an altered immune response and chronic inflammation.
Immune System Dysregulation: Crohn's disease is associated with an exaggerated Th1 and Th17 immune response. These subsets of T-helper cells produce pro-inflammatory cytokines, such as interferon-gamma (IFN-γ), interleukin-17 (IL-17), and tumor necrosis factor-alpha (TNF-α). The overproduction of these cytokines and chemokines leads to chronic inflammation.
Environmental and Lifestyle Factors: Factors such as diet, smoking, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) can influence the development of Crohn's disease. Smoking, in particular, is a well-established risk factor that exacerbates symptoms and increases the likelihood of complications. The disease is also more prevalent in urbanized societies, suggesting a role for factors related to industrialization and sanitation.
Pathophysiology
Epithelial Barrier Dysfunction: The intestinal epithelium forms a barrier that prevents harmful substances and pathogens from entering the body. In Crohn's disease, this barrier is weakened, allowing bacterial antigens to penetrate the gut mucosa and trigger an immune response.
Granulomas: Crohn’s disease often involves the formation of granulomas, which are clusters of macrophages attempting to wall off foreign substances, indicating chronic inflammation.
Cellular Mechanisms: Macrophages and dendritic cells initiate and sustain the inflammatory response in Crohn's disease by presenting bacterial antigens to T cells, which become overactivated. Regulatory T cells (Tregs), which normally help suppress immune responses, are often dysfunctional. The NF-κB signaling pathway, central to the inflammatory response, is hyperactivated, leading to the transcription of genes involved in inflammation.
Treatments
While there is no cure for Crohn's disease, various treatments can help manage symptoms and induce remission:
Medications:
Anti-inflammatory Drugs: Such as corticosteroids and aminosalicylates.
Immune System Suppressors: Including azathioprine, methotrexate, and biologics like infliximab.
Antibiotics: To treat infections and reduce intestinal bacteria.
Antidiarrheal Medications: To manage diarrhea and improve quality of life.
The family member we interviewed is on the medication Pentasa (mesalamine), an aminosalicylate. Pentasa works by decreasing inflammation in the colon. She takes 1000 mg three times a day and has noticed significant improvement in her symptoms after just three weeks.
Nutritional Therapy: Specialized diets or nutritional supplements can help manage symptoms.
Lifestyle Changes: Dietary modifications, smoking cessation, and stress management can also be beneficial.
Advanced treatment targets for Crohn's disease include:
Anti-TNF Therapy: Biologics like infliximab and adalimumab target TNF-α to reduce inflammation.
Anti-Integrin Therapy: Drugs like vedolizumab block the migration of inflammatory cells to the gut.
IL-12/23 Inhibitors: Ustekinumab targets the p40 subunit shared by IL-12 and IL-23, reducing Th1 and Th17 cell activity.
Conclusion
Crohn's disease is a complex condition involving genetic predisposition, immune system dysregulation, microbiome alterations, and environmental triggers. Chronic inflammation in Crohn's disease results from a combination of these factors, leading to significant health challenges.
Words from Our Anonymous Interviewee
A message she would like to share with our readers about living with this condition:
“Everyone's symptoms are different, and I have found comfort in knowing and speaking with other people with Crohn’s and knowing that there are solutions to reduce the symptoms. I find it healthy to talk about it with friends and family. I am grateful that Pentasa is working for me.”
If you have any questions or are interested in being interviewed for a blog post, we would love to hear from you! Your experiences and insights are invaluable in helping us raise awareness and foster a deeper understanding of various health conditions. Contact us at sofiazamora2020@gmail.com or 619-888-5673. We look forward to connecting with you!
