Talk:Crohn's disease

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To-do list for Crohn's disease:	edit · history · watch · refresh
~~Convert lists to prose~~ ~~Add a prognosis section~~ Potentially expand epidemiology section Clean up the treatment section, moving much more to the dedicated article Expand pathology section to actually be pathophysiology with some discussion of proposed mechanisms of action, etc. Reference everything which is not already referenced Thorough copyedit Peer review

[edit] Gross Images

Can someone remove some of the most gross/offensive images in the article? I have CD, and like to read the contents on this article, but the images stress me. Particulary the red colon image, and the cancer image. Thanks.

I'm sorry, but generally we don't remove otherwise informative images because they cause offence. However, if they do distress you, why don't you browse the article with image downloading disabled on your browser?

In my personal opinion, as a sufferer of Crohn's disease, I find the images in the article extremely informative and useful, and not gross at all. For me at least, the human body is a fascinating mechanism, even the icky parts. --Robert Merkel 01:32, 5 June 2006 (UTC)

[edit] Diet Changes

Diet changes? I've suffered Crohn's since I was a teenager, and as far as I can tell diet makes absolutely no difference to my symptoms. I'm told my experience is reasonably typical in that sense (though people who've had surgery are often a little restricted in what they can eat). --Robert Merkel 12:22 Jan 24, 2003 (UTC)

Hmm. You mean to tell me you can eat lots and lots of fiber and roughage, including things like corn on the cob, broccoli, mushrooms, etc. without a worsening of symptoms? I think that would be pretty atypical. Chadloder 12:24 Jan 24, 2003 (UTC)

My symptoms get worse with some foods, but I don't always care. Some things are worth it :).

Aren't Asacol and Pentasa different brand names for the same stuff? I remember, back when Asacol was somewhat efficacious, being curious as to why Pentasa made me throw up and Asacol didn't when according to the labels on the bottles they're both mesalamine. --Calieber 20:12, 29 Sep 2003 (UTC)

I've had Crohn's for five years now and have been lucky in some areas, and not so in others.

I've never had anything really serious like fistula but did have extensive ulceration and bleeding, along with something which feels vaguely like a cross between Flu and a really early morning all day and every day.

My diet restrictions are quite severe as a great many things have an adverse effect, basically anything with and abundance of fibre (fruit, veg, wholemeal breads, nuts etc...) or anything containing chilli, much to my sadness.

I can pretty much eat as much junk as i can handle with no noticeable effects, and strangely i can drink wine & spirits with no problems, but beer has the predictable undesired effects.

Currently I consume vast quantities of Balsalazide and Azathioprine which keep things under control most of the time, but when I need a little bit of extra oomph to keep on top of things I've found that combining any over-the-counter products containing Loperamide and Codeine is very effective in stopping things short.

Grey Area 12:16, 30 March 2006 (UTC)

I too have Crohn's, and I eat pretty much anything. Never had another outbreak. Have broccoli almost every night

I'm surprised no-one has mentioned the infamous SCD (Specific Carbohydrate Diet ) that was being plugged around the forum boards a while back. My recommendation is to try different foods, and delete the ones that give you trouble, and know your safe ones in case of attacks.

Dairy is often mentioned as a problem in Crohns, however one of my safe foods is cheese on toast. GO figure

I can't believe I'm saying it, but SCD is popular enough that it should probably be mentioned in the article as an alternative treatment -- Samir धर्म 05:25, 3 June 2006 (UTC)

I am a medical doctor from India and am 48 years old. I had been suffering from Crohn's disease from 1982. It was a rollercoaster ride for me and it finally landed me with surgery and I was minus 100 cms. of ileum from 2001. Afterwards also I was not free from other problems and I suffered from TB pleural effusion. But with time I learnt that milk products, refined sugar products, wheat and especially tamarind donot agree with me. I excluded these from my diet and I am happy now.[drmallik@hotmail.com-India]

I know this is anecdotal, but SCD has worked for me for the past 2 years. This after major gut pain, diarrhea, fistula, and abcesses. When I was clinically diagnosed, the Dr. said diet makes no difference. For those interested, you don't have to buy the book to see what is included in the diet. http://www.breakingtheviciouscycle.info I agree, SCD should be added to the "Alternative" section.

[edit] List of sufferers

Most illnesses and conditions on this site have a list of famous sufferers. It might be worth having one for Crohn's. The only one I know of is the English snooker player Allister Carter. --MartinUK 17:34, 2 May 2006 (UTC)

These lists are evil. I reckon Allister doesn't tell the whole world about this condition, and the same applies to many other public figures with such conditions. One can make exceptions for people known independently because of their disease (e.g. Michael J. Fox and Parkinson's, Kylie Minogue and breast cancer). The one Crohn's patient I can think of who has made the condition more or less part of her public persona is the singer Anastacia. JFW | T@lk 23:08, 2 May 2006 (UTC)

Carrie Grant (famous UK vocal coach/tv personality) is fairly prominent; she receives cheques from fundraisers on behalf of the NACC (UK charity for the disease), and so on. I think if we can find more sufferers, as long as they aren't private about it then it'd be nice to have a list. -- Dandelions 17:22, 9 May 2006 (UTC)

Two suffers that spring instantly to mind are Mike McCready (guitarist of Pearl Jam and Daryl Palumbo (frontman of Glassjaw). Both McCready and Palumbo's entries on here mention their suffering of the illness, and more lately McCready has played in several benefit shows for the CCFA. McCready's suffering was also mentioned on the BBC news site too. -- Lugnuts 14:56, 14 May 2006 (BST)

I am against any list of sufferers because it doesn't seem to serve a purpose in the article unless they are a willing spokesman for the disease. BTW, Eisenhower had it. --Ignignot 16:28, 15 May 2006 (UTC)

That's the whole point - Mike McCready is a spokesman and does lots of benefit gigs for chairty. -- Lugnuts 18:04, 15 May 2006 (BST)

Singers Beth Orton and Anastasia have both mentioned their Crohn's Disease in interviews. M Halton

If the purpose is to highlight "spokespeople" with the dissease, I would suggest a different name than "List of sufferers"

I am for lists such as these. Knowing famous people suffer from this disease can encourage sufferers and show that the fact that they have a chronic disease doesn't mean they cannot make it! Just another way to show that our world is not 'only for healthy people'--Noy Halevy 10:37, 14 December 2006 (UTC)

[edit] Clarification

Somebody needs to clarify this, from para. 1:

It typically affects the terminal ileum and well demarcated areas of large bowel with relatively normal bowel.

What is "large bowel with relatively normal bowel"? I don't know the subject so I can't fix it, but this needs clarification. —Tkinias 18:56, 10 Dec 2004 (UTC)

I've made a stab at clarifying that sentence... (I have it) CJewell (talk) 20:59, 4 Apr 2005 (UTC)

It means that you can have normal intestinal mucosa next to inflamatory mucosa

[edit] Pentasa vs Asacol

Both Pentasa and Asacol contain the same drug -- mesalamine -- which acts asprin-like and antibotic-like. The difference is the coating the drug comes in. These coatings act as a delay mechanism. Pentasa's coating dissolves in the last couple feet of the small intestine, while Asacol's coating dissolves and releases the mesalamine in the colon. [Full details: http://www.gihealth.com/html/education/drugs/pentasa.html ]

Although sulfasalazine may have an antibiotic effect, I don't think the same is true for mesalazine, which has only the aspirin like effect.M dorothy 03:41, 9 June 2006 (UTC)

[edit] Brain damage?

I've read many things on chron's disease but have never read anything other than this article that mentions indirect brain damage. What supporting evidence is there for this? Is it simply a result of the low grade fever that often accompanies the disease? Or is it just unsubstantiated guesswork?

Low-grade fever does not cause brain damage. There is an increased incidence in white-matter lesions of unknown significance, and an increased incidence of multiple sclerosis. If in doubt, have a look on Google or Pubmed, and if this does not satisfy you, please feel free to rephrase or remove the contentious paragraph. JFW | T@lk 18:41, 8 Jun 2005 (UTC)

I have never read anything by any major Crohn's disease researcher or organization that cites minor brain damage as a symptom of Crohn's disease. There is a higher incidence of other autoimmune disorders, including MS, in anyone with an autoimmune disorder, not just Crohn's, but this is not directly related to having Crohn's disease itself. I think this should be removed from the list of symptoms or reworded to include a reference or two. --Kerry 17:45, 24 August 2005 (UTC)

I suspect that the general poor nutritional status of your average sufferer, is more likely to cause brain effects rather than the disease directly. Especially if its topped off with a nice bit of aneamia and some of the meds we have to take

I believe here is a study supporting this... Add if you would like. [1] Josh --68.82.65.116 20:46, 24 September 2006 (UTC)

[edit] Dietary aids

I was diagnosed with Crohns disease and now suffer from None of the sypmtoms I feel fine. 2 times a week I take a stomach enzyme called Azeo Pangen and Acidopholus. All my symptoms went away within a month and now I often forget im afflicted.

If you think this is significant, do you have any references (web or medical journal) that support this approach? JFW | T@lk 06:46, 3 August 2005 (UTC)

Wait a few years then come back here. The seriousness of Crohn's varies greatly. I was diagnosed at 10 and didnt have another inflammation until 17. Since then I've had one serious case of Crohn's symptoms every 6 months (I'm now 20).

Ive had it for 4 years now and taking those named above enzymes my stomach problems have ceased

The problem i had was my sugars were not getting digested properly they would decend to my intestines and begin to ferment causing horrible gas problems Shortly after starting my gas problems went away and my stomach pains stopped I would also get spasms in my stomach thru my back that would make me curl into a ball it would hurt violently for up to 5 minutes and then just Stop My doctor prescribed me with Lactaid and i asked him if i could take the said medications prescribed by my dietary aid and he said Absolutely not i now realized he said No because he cant make money off of it. Try eating more Yogurt that may help you if it seems to do any good try Acidopholus two a day if that seems to help a little but it doesnt seem to completely remove the problem i take one teaspoon of Colidol Silver twice a week for 2 weeks 2 Acidopholus 2 Omega Three Fatty Acids 1 azeo pangen every other day and that seems to do the trick 100% My stomach doctor didnt believe me that it helped me and shortly after i told him he moved away still in disbleief

I dont think its necessarily that you have a malfunction Maybe its that we've all come to the convenience of fast foods and Pop Our ancestors didnt have any of those and supposedly its more prevelant in Industrialized nations 1 in 300 in the US Try eating more fishes and Yogurts and cheeses Stop drinking pop its one of the worst things for your stomach out there

[edit] Naming convention

I am annoyed by leaving the possessive standalone. I think all instances of "Crohn's" standalone should be replaced with "Crohn's disease".

This is an extremely common form and used by patients as well as doctors. It would be overkill to mention "disease" in every instance. JFW | T@lk 00:40, 18 August 2005 (UTC)

I have Crohn's disease, and, most of the time, I refer to it as Crohn's. Once the proper name is used in the introduction, I think it's okay to just refer to it as Crohn's. -- Kerry 17:47, 24 August 2005 (UTC)

[edit] Marshall Protocol for Crohn's Disease

Dr. Trevor Marshall, a medical research scientist, developed a treatment for all TH1 type diseases, such as Crohn's disease, based on the concept that the root cause of these diseases is infection with intercellular bacteria (L-forms or cell wall deficient forms). Doctors around the World have been trying this treatment on their patients with TH1 type diseases with great success. He and others involved in this treatment are looking for funds to support clinical studies to bring this treatment into the mainstream.

For more information see www.marshallprotocol.com.

Has this been published in a peer-reviewed publication? Are there prospective clinical trials? What does the treatment entail? JFW | T@lk 16:17, 30 August 2005 (UTC)

[edit] Current Research

I think there ought to be a section on current research in this article. I saw an article in Wired 2-3 months ago that described a number of them. Some added detail about Remicade should also be added, its association with arthritis and its effects on the disease. Dguido

Remicade is not research anymore. It is used when DMARDs fail or in fistulating disease. JFW | T@lk 08:57, 9 October 2005 (UTC)

I dropped the comment on Ashkenazi jews. Interesting notion, but there is not difference in port consumption between Ashkenazi and other jewish groups. The parenthetical comment was thus an interesting quip, but not supported. Still a good idea! Steve Kd4ttc 23:24, 3 February 2006 (UTC)

Obviously never heard about CARD15. JFW | T@lk 05:58, 5 February 2006 (UTC)

Thanks for pointing out the linkage disequilibrium research on NOD2 and Ashkenazi jews! Kd4ttc 18:07, 5 February 2006 (UTC)

[edit] Research methods...

I've been doing some research, and it seems that there are some "undergrounders" that say the Crohn's comes from cow's milk...

http://www.nomilk.com/crohns.shtml

very riteting article.

Also have read that it's the "myco-bacterium" found in cows (and goats) milk that cause the Crohn's, and oddly enough a similar type of 'disease' can be found in some cows and goats intestinal tracts!

I've also read about something called "Helminthic therapy (Current research)", which sounds a little weird for those who have weak stomachs...but it sounds promising.

What you guys have said about the Azeo Pangen, and the Lactobacillis Acidopholus...I'm going to give them a try (the Acidopholus first, because I already have some in the fridge!).

Food for thought...The Food Pyramid (developed by the US Department of Agriculture (USDA)). Can anyone say wholly conspiracy?! We all know you don't need dairy to be healthy (as long as you get your calcium, and your vit. D, etc.)...it's kind of funny that dairy is second on the list...

Anyways...happy hunting, and I'll be back to post my progress with the two afformentioned...one question:

1. I know that I avoid red meat (and pork)...and I noticed that Azeo Pangen... http://www.metagenics.com/products/catalog/detail.asp?pid=143 comes from Porcine Pancreas (for those of you who don't know: Pig Pancreas)!

---

Even ignoring sites such as "nomilk.com" linked by the previous poster, which sound a little less then objective, there does some to be some credible research on pubmed implicating infection (possibly from Cows) as a factor in Crohn's.

http://www.blackwell-synergy.com/doi/full/10.1111/j.1365-2672.2005.02598.x?cookieSet=1

This study also detected Mycobacterium avium in people suffering from Crohn's. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15380962&query_hl=3&itool=pubmed_docsum

Can anyone comment on this? I'm not too informed about current research in the area beyond what I've seen on pubmed.

152.3.198.219 00:48, 30 September 2006 (UTC)

-- It's true that in some studies, [MAP | http://en.wikipedia.org/wiki/Mycobacterium_avium_subspecies_paratuberculosis] has been cultured from people who have Crohn's disease. However, it seems most likely that MAP is just one of several pathogenic organisms that capitalize on a patient's damaged mucosal layer and inability to clear microbial infections properly. For more information, see this current review paper by Sartor: Link Spin2cool 23:12, 30 September 2006 (UTC)

[edit] Here's an interesting read!

http://www.biblelife.org/bowel.htm

This is an awesome site guys, a diet regimen, pro-biotics are recommended, it's a long read, but well worth it.

[edit] Wait! There's more

http://www.vsl3.com/VSL3/default.asp

My mother in law says that there's a gentleman that comes into her pharmacy who picks this probiotic up on a regular basis for his son. She asked him, and he says it helps to keep things under control. Not exactly sure what that means, but if he keeps dumping money into it...

While VSL3 has been shown in randomized controlled trial to be useful for pouchitis treatment, my understanding is that it has not shown a similar benefit for CD -- Samir धर्म 07:03, 27 January 2006 (UTC)

[edit] References

129.143.100.146 added a huge list of references, but it is unclear which reference refers to which factoid in the text. I've asked the contributor to improve this, but if this doesn't happen it may need to be deleted. JFW | T@lk 17:58, 10 January 2006 (UTC)

[edit] New Research

http://news.bbc.co.uk/1/hi/health/4740632.stm

The article's lead in: A weakened immune system - not an over-active one as had been suspected - may cause the intestinal disorder Crohn's disease, research suggests.

The main page needs a lot more research information: right now it reads like a booklet from your local public health nurse. I added one or two items taken from previous versions, but frankly the previous versions were a lot better.

[edit] Wikification

I began to wikify the article, but it needs a bit more tweaking by someone who knows about the subject. Foxjwill 01:04, 12 May 2006 (UTC)

I have also made a (hopefully) bold attempt to wikify this; however, as I went through it I could see that it needs a serious copy-edit. I had only intended to do a wikification and light copy edit, but as I got familiar with the text I began to notice the excessive redundancies and disorganization of the article. That's not to be critical, but its to say that I (not very) soon realized that I had bit off more than I could chew and this topic deserves a lot better attention than I could provide at one sitting. Someone who knows the topic could improve it that much more. Fluit 05:21, 12 May 2006 (UTC)

Another suggestion for wiki-fying the article well: have the entries for Crohn's ileitis and ileitis redirect to this article.

[edit] Material copied from Mayoclinic.com

I just noticed that a huge swath of text was copied from Mayoclinic.com. The edits replacing original content with Mayoclinic's text can be seen at [2]. --Uthbrian (talk) 07:18, 30 May 2006 (UTC)

Agree with reversion of copyvio info -- Samir धर्म 08:20, 31 May 2006 (UTC)

[edit] NPOV on stress section

Not referenced, and POV against medical therapy for CD. Please cite literature that hypnosis helps with CD symptoms -- Samir धर्म 09:31, 31 May 2006 (UTC)

[edit] Couple of things for this article

Rash

A few things; if anyone has them, it would be great:

Picture of erythema nodosum
Pathology slides of Crohn's disease, preferably showing granulomata (I think I have some but they are low resolution)

-- Samir धर्म 09:45, 3 June 2006 (UTC)

I have a nice jpg of what might be erythema nodosum. It hasn't been biopsied or officially pronounced, but I would email it if you wanted to look at it.M dorothy 03:12, 26 June 2006 (UTC)

Sure, send it over. -- Samir धर्म 06:21, 26 June 2006 (UTC)

This is not diagnosed. I could probably figure out how to rotate the image & upload again, if it was worth it. It looks more like a shin rotated.M dorothy 03:22, 13 July 2006 (UTC)

Doesn't really look like EN to me on first glance... was it palpable? -- Samir धर्म 03:21, 13 July 2006 (UTC)
- This is on the shin, where there is little skin. There is very slight swellling, and the surface of the skin has a slightly different texture. No itch, no pain. Came suddenly about 3 years ago. Smaller rash on other shin.M dorothy 03:32, 13 July 2006 (UTC)
  - It probably is an EN-like panniculitis, but it doesn't classically look like EN... looks more like macules that are discrete (aren't large and coalescent like EN usually is). But it's the best EN picture we have so far... -- Samir धर्म 03:41, 13 July 2006 (UTC)
    - Have you clicked on the image to look at it enlarged? Assuming this started as isolated red dots, they must have merged in the central area.M dorothy 03:50, 13 July 2006 (UTC)
      - I have. EN usually isn't red dots though, it's usually palpable plaques that coalesce. -- Samir धर्म 07:20, 13 July 2006 (UTC)
Andrew47 edited to describe EN as "exquisitly painful" instead of "painless". I have removed this, since I can't find any ref either way.M dorothy 15:14, 30 July 2006 (UTC)
- The classic textbook definition is painful, but I must say that most EN I've seen is painless -- Samir धर्म 08:18, 15 August 2006 (UTC)

[edit] Smoking

Most sources seem to suggest smoking increases the risk for Crohn's (and decreases for UC). Is this valid? should it be mentioned?M dorothy

You're absolutely right... typo that was my fault in the article. I've changed it back. -- Samir धर्म 13:20, 5 June 2006 (UTC)

Er, kind of not relevant but in an episode of "House" the Doctor advised a CD sufferer to smoke two cigarettes a day to help with loose stools. I find that smoking two cigarettes a day helps to solidify my stools, when i'm not smoking I pass far more fluid. Anyway, thought i'd add this. M Halton

I am having trouble sorting out the differential between UC and Crohn's. I have been told one or the other since my twenties. At age fifty-eight I was told I had BOTH. My Medical Gastroenterologist diagnosed me with "steroid-dependent Crohn's Ulcerative Colitis" two years ago. About smoking--When I mentioned that I was flaring up as I stopped tobacco, my GI physician prescribed Bentyl(R), dicyclonine HCl 20 mg.,T.I.D.User:W8IMP 06:31, 7 December 2006 (UTC)

[edit] Jargon report

As requested by User:Samir (The Scope)

Jargon can be treated in three ways:

By linking to a pertinent article (e.g. "systemic disease", "uveitis")
- Sometimes the article is not quite at the same location (e.g. small bowel obstruction → bowel obstruction)
By defining the term (e.g. "Ileitis(inflamation of the ileum)")
by replacing the term with a simpler one (e.g. "stool" → "feces", )

augmentation of the Th1 system of cytokine response in inflammation.
- Can this be made more detailed, or more links added to make it clearer? It is compeltely impossible to understand as is to the layman.
usually the area overlying lymphoid aggregates
They typically preent with fevers
- Typo?
evacuate the infected focus.

[edit] other

Testing for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammatory diseases of the intestine and to differentiate Crohn's disease from ulcerative colitis, but are not routinely used in practice.
- It has been evaluated: were the results conclusive?
and with susceptibility to certain phenotypes of disease location and activity.
- Could this be develloped a bit, with examples?
Oral contraceptives have shown an association with the development of Crohn's disease.
- Specific examples would be a very pertinent adition here. There is quite a range of formulations.
and metaplasia or change in the tissue type
- What does the tissue than becomes?
The splitting of treatments alongmedications is a poor organization, and contains too much subsections. Organizing it by uses, and then giving each medication a quick description, or inversely, would probably be a better idea.
Oddly enough, the statement Similarly, stress can worsen symptoms of Crohn's disease. Patients with Crohn's disease can find that their symptoms improve if they control the stress in their lives. is unsourced
how Crohn's Disease can cause several complications (Fistulas, abscesses, anal fissures, osteoporosis...) is not discussed
The history section is very sketchy: how has treatment and understanding of the disease changed in the last 70 years?

Circeus 19:19, 6 June 2006 (UTC)

I have tried to fix most of these comments, so they no longer relate to anything in the article. I have therefore removed what has been addressed.M dorothy 01:59, 13 July 2006 (UTC)

To answer one part of this, I'd call Crohn's a TYPE of ileitis, as far as small intestine involvemant is concerned. (It isn't the only type, as far as I understand. I could be wrong, however.) I've heard of "small intestine only" Crohn's called "Crohn's ileitis", just as "large intestine only" Crohn's is called "Crohn's colitis". — CJewell (talk to me) 06:40, 7 June 2006 (UTC)

Yup, ileitis is a generic term for any inflammation of the ileum, and as such, Crohn's involving the ileum is "Crohn's ileitis"

For information about the different types of surgeries, http://www.ccfa.org/info/surgery/surgerycd is a good page to look at. To answer your direct questions, the first part I'd answer using what's already in the (Wikipedia) article, as for the removal question, sometimes they take the affected part out (resection), while other times strictures are expanded using a proceedure that sounds similiar to balloon angioplasty (called strictureplasty), and as for transplants, I remember hearing that small intestine transplant is experimental and done only in extremely severe cases where repeated resections have been previously done and the patient is running out of small intestine. [I'm a patient, not a doctor. I could be wrong.] — CJewell (talk to me) 06:53, 7 June 2006 (UTC)

SB transplant! Forgot to add it completely, and I work at the largest SB transplant centre in North America. David Grant would kill me! -- Samir धर्म 07:00, 7 June 2006 (UTC)

By the way, thanks immensely, Circeus. This was very useful -- Samir धर्म 09:24, 7 June 2006 (UTC)\

[edit] Length

One complaint is that the article is too long. I could address that by moving the details about drugs and treatment to a new article, and writing a summary in the main article. Any votes on this?M dorothy 03:37, 13 July 2006 (UTC)

[edit] Good Article

The article seems to be relatively well-written, (The vocabulary is very high, but I don't think its prohibitive, wikilinks should suffice) NPOV, (Though that might just because the symptoms of this disease creeped me out so much I might of missed it heh) Stable, the pictures are nice, (Though creepy) and the best part to me was the extensive references. If there is any way you can somehow lower the vocabulary level without getting the article off-topic i'd recommend it, and also, a few sections read sort of like lists, outlines, or outlines progressing through to some idea, I think one or two of those should be converted to paragraphs. Homestarmy 03:42, 17 June 2006 (UTC)

[edit] Whipworm emphasis?

I'm wondering if there should be greater emphasis on the roles of hygiene and the immune system and treatment using pig whipworms.

There is a line of thought out there that because the disorder is largely Western (where people rarely suffer from intestinal parasites, as opposed to the developing world), and because whipworms have had such a dramatic effect in treating Crohn's sufferers, that perhaps much of Crohn's is an auto-immune disease. The whipworms, in essence, serve to recalibrate an otherwise wayward immune system.

One poor study in Gut on the therapy. We should probably expand a bit on the hygiene hypothesis though. -- Samir धर्म 04:00, 20 June 2006 (UTC)

[edit] What's left for FAC

As I see it the following:

Prose: Point form looks like it is frowned upon
Referencing the lead (which is quite well written)
Reference for SB transplant (I need to pull up the Grant paper)
Referencing table of comparison
Referencing initial part of clinical manifestation (Podolsky or Hanauer reviews should suffice)
A statement on prognosis
Jargon as above; almost done

-- Samir धर्म 09:14, 25 July 2006 (UTC)

I think that references in the lead are unnecessary, and detract from it. Everything stated in the lead should be expanded upon in the article, and referenced there. The point of the lead is to try to get a one-screen summary that people can read and decide whether they want to read the entire article. Is there any official guidance on notes in the lead?

I put the comparison table in based on suggestions. If people like that version better, I would remove the pointy version.M dorothy 03:26, 30 July 2006 (UTC)

Table is good. Not sure about refs in lead (my bias would be to add refs, as introductions are done in scientific reviews). I'll check WP:MOS. -- Samir धर्म 03:55, 30 July 2006 (UTC)

[edit] Comparison text

Here is the comparison pointy text in case anybody wants to preserve it.

Crohn's disease:
- Can occur anywhere in the gastrointestinal tract but commonly involves the terminal ileum
- Has a patchy distribution in the intestine.
- Has transmural inflammation where it spreads deep into the layers of affected tissues.
- Can have granulomata on biopsy
- May spare the rectum on endoscopy
- Has characteristic features on endoscopy including deep, linear and serpiginous (or snake-like) ulcers
- Can be associated with fistulae, abnormal connections or passageways between the intestine and organs or vessels that normally do not connect.
- Can exhibit peri-anal symptoms around the anus.
- Often returns following surgical removal of the affected part of the intestine.

Ulcerative colitis:
- Usually affects only the large intestine and rectum
- Usually exhibits inflammation in a single area in a continuous fashion.
- Usually affects the only the mucosa, or the innermost lining of tissues.
- Has characteristic features on endoscopy including shallow, continuous ulcers and involvement of the rectum.
- Does not usually exhibit peri-anal involvement.
- Not usually associated with fistulae.
- Has a higher rate of primary sclerosing cholangitis ^[1]
- Can usually be cured by surgical removal of the large intestine.M dorothy 04:45, 30 July 2006 (UTC)

[edit] Famous sufferers

To include them? I think not. Need solid references if they are to be included. Personally, I think it's unencyclopedic. Other medical articles seem to have followed suit in removing them. See relevant section above at Talk:Crohn's disease#List of sufferers -- Samir धर्म 17:45, 30 July 2006 (UTC)

If it has become a problem, I typically create a list of famous sufferers page. InvictaHOG 17:59, 30 July 2006 (UTC)

Good idea for this one. I deleted these as they are unreferenced, but if there are credible references, it can go to List of individuals with Crohn's disease or somewhere similar. -- Samir धर्म 18:40, 30 July 2006 (UTC)

I have created the page per List of notable people diagnosed with dyslexia. Philip Stevens 19:01, 30 July 2006 (UTC)

I disagree about this omission- there are some high profile Crohn's sufferers in the UK who have done public interviews about Crohn's which can easily be found, referenced and quoted. It humanises the condition, and you'd be surprised at how often it comes up in conversation amongst IBD sufferers so is very relevant. They include Carrie Grant (BBC's Fame Academy) actor Jeff Hordely (ITV's Emerdale star Cain Dingle), actor Ken Stott and singer-songwriter Beth Orton. In the US, Pearl Jam's guitarist Mike McCready & sports star Ralph Benirshke (sp?).

Kez- 31 July 2006

- I think the spin off article is the way to go as long as its referenced. -- Samir धर्म 01:05, 31 July 2006 (UTC)

[edit] An addition (suggestion)

Can you add a bit about Metastatic Crohn's Disease (also called Cutaneous Crohn's disease). It's very rare but worth a mention as the only stuff on the net seems to be tiny pieces about it or medical abstracts. I would do it but find it difficult to reference things properly. Metastatic Crohn's Disease is very rare- it's where Crohn's affects other parts of the body.. not the bowel. It is significantly different from secondary extraintestinal symptoms in that it is primary Crohn's disease in itself.Hope that makes sense.

Thanks, Kez 31 July 2006

- I have a picture somewhere. It would make a good article. -- Samir धर्म 01:38, 31 July 2006 (UTC)

I found a lot on Google. Crohn's disease has extra-intestinal manifestations, such a EN. Why is this regarded as "Cutaneous Crohn's", as opposed to a really bad case of EN? If it really is different from EN, this rarer condition may be telling us something profound about the disease.M dorothy 05:31, 3 August 2006 (UTC)

EN is not Crohn's - EN is a secondary condition that can be associated with Crohn's and occurs as an extraintestinal associated symptom in less than 2% of Crohn's patients. It is a condition in its own right and can also be caused by streptococcus virus or more rarely, tuberculoisis as well as other causal conditions. Not to be confused with Crohn's disease of the skin which has a completely different pathology and does not cause the distinctive sub-cuteneous lesions indicative of EN. Kez 17th Aug 2006

- I need to find that picture and I think I have pathology specimens also -- Samir धर्म 21:06, 17 August 2006 (UTC)

[edit] Featured article candidacy

I took a look at the article today because I know that a lot of great work had been ongoing to get this to FAC. I liked what I saw and think that this is a wonderfully written, well-referenced, nicely laid-out article. My only concern is that the reliance on lists will really attract negative votes at FAC. I like them in this setting and think that they work well; however, sections such as the extraintestinal manifestations, pathology, and drugs used will most likely be targeted. The desire is always to convert to a paragraph style. The extraintestinal manifestations would not be hard. Pathology is practically there and might slide by as is since it's well done. The drugs I don't know what to do with. It will be interesting to see what a peer review would come up with. I'll try to add more later, but won't change any of the formatting until everyone adds their thoughts! InvictaHOG 17:03, 31 July 2006 (UTC)

[edit] Lead or Lede

Please try to avoid adding details to the lead. Eventually the entire article will wind up in the lead.

One thing that the lead is supposed to do is to tell what the words mean. It is not obvious to all readers what a "Crohn" is. Is it a body part? No, it's just a person's name. If you want to find out more, read the article. But, we don't want you to get three pages in before you figure out what a Crohn is.M dorothy 03:17, 1 August 2006 (UTC)

Burrill Bernard Crohn should be linked to. --WS 09:02, 1 August 2006 (UTC)

The link is present in the history sectionM dorothy 05:05, 2 August 2006 (UTC)

I don't think that adding the full name of the physician who is responsible for the eponym should raise the fear of a slippery slope of information moving into the lead. I don't personally think that the first sentence of the article should discuss where the name came from, however. I think that the most important things in the first paragraph are 1)What symptoms does Crohn's disease cause 2) What is Crohn's disease and 3) How serious is Crohn's disease. Right now, reading the first sentence, I bet most people would not know anything about Crohn's disease other than who named it. It's a minor point, I know, but I think that the first paragraph is the most important part of an article and that it should be as perfect as possible. I would like to rewrite the first sentence to attempt to capture the chronicity, severity, and nature of Crohn's disease but sense that I should allow some time for consensus to build as to what is most important here. I'll ask those who have spent a lot of time editing this article to let me know what you think. InvictaHOG 11:33, 1 August 2006 (UTC)

See Wikipedia: Lead Section. The initial task is to define the term "Crohn's".M dorothy 05:05, 2 August 2006 (UTC)

Actually, the initial task is to define or clearly describe the condition. I personally feel that a description is more helpful than explanation of the etiology of the name. I'm sure that a sentence could be found which captures both... InvictaHOG 15:25, 2 August 2006 (UTC)

No. We want to start by explaining what we are talking about, and not talking about. It is a "disease". It is named afer a man, not some characteristic of the disease. It is a type of IBD. It is like UC, but different. It's not the same as IBS. And, we have to explain the Crohn's illeitis and colitis refs into the article.M dorothy 05:09, 3 August 2006 (UTC)

How about this or a similar lead sentence "Crohn's disease is a common, chronic, episodic disease affecting the gastrointestinal tract which was named for Burrill Bernard Crohn, the physician who first described it as a distinct type of inflammatory bowel disease." It would be difficult to be more specific about the type of disease and how it may affect the rest of the body in this setting. However, I think that it covers a lot and summarizes the name as well as the disease. Let me know what you think! The rest of the lead article could easily be rewritten to accomodate it. InvictaHOG 03:18, 3 August 2006 (UTC)

Crohn's is not common: it is, indeed, a "rare" disease. Dr. Crohn was not in fact the first to characterize the disease, his name was just earlier in the alphabet. If we lead with him, the supporters of the earlier discoverers may demand equal space. There are at least 100 factoids that are more important than the ref to Dr. Crohn, but the lead is already long enough. The important point is just that the disease is named after a person, so the unfamiliar reader doesn't have to wonder what a "Crohn" is.

Was the concept of IBD actually developed prior to Dr. Crohn's time, or did that concept develop subsequently? If the concept of IBD, or UC, were around prior to the characterization of Crohn's, that would be a new fact worthy of mention, but not in the lead, please.

I agree that the common symptoms of the disease may belong in the lead, if we can be brief about it.M dorothy 05:09, 3 August 2006 (UTC)

Crohn's is a rare disease. I've also just read through Sleisenger's chapter, Yamada's chapter, Podolsky's review, and the 1986 Britannica article. None of the mention Crohn's name in the intro. Regardless, I do think it belongs in the lead to contextualize the name, but you need to define the symptoms and the like first. Mentioning in the latter part of the lead that the disease was named after Burrill Crohn is more than adequate. -- Samir धर्म 09:40, 3 August 2006 (UTC)

I concur on the common part - I didn't think that it qualifies as rare, but it appears that it does indeed. Just seems like everyone has it! As to why Crohn's name is attached to the disease - I think that the submitted lead sentence candidate adequately describes his contribution - he first characterized the pathology of Crohn's as distinct from that of other forms of IBD (as far as my understanding goes, I haven't read his original article, to be honest). The submitted lead sentence (with rare in place of common!) seems to characterize the disease broadly and to address what a "Crohn" is. Would it work as a compromise or are there other proposals? InvictaHOG 11:38, 3 August 2006 (UTC)

Dr. Crohn was the third to characterize the disease. The desase was named after him because "C" came earlier in the alphabet. I still think the lead is long enough. What do you propose to delete?M dorothy 01:53, 7 August 2006 (UTC)

I have put together a lead section which actually cuts down significantly on the length while I hope increasing some of the things I felt was missing. To explain, I don't think that the different categories of Crohn's is important to have in the lead, especially since they are in the first paragraph after the lead. All of the categories were not included and, frankly, I'm not sure how helpful the categories actually are in clinical practice other than shorthand to describe where the disease is. Especially since the idea of fistulizing Crohn's is not developed - I would love to learn if there are any data about these categories and outcome measures, etc. An additional discussion I excised dealt with the idea that diet and bacteria are not thought to play a role in the development of CD. There are a lot of things which could be discussed as not causing CD. Are these two more important that others for a reason that I am not aware of? I didn't think that they added much. Things that I felt could be added (and were) was a little more of the epidemiology. I included age, but was surprised to find that the article as a whole did not discuss whether there were sex differences (at least to my eye!). I also added the most common synonyms. Anyway, give it a read and give me some feedback! InvictaHOG 03:44, 7 August 2006 (UTC)

The refs to Crohn's ileitis and colitis are obligatory, since those terms link into the article. These were added in response to specific criticism of an earlier version.

The refs to IBS and ulcerative colitis are important to help the reader that doesn't know much about the subject to know whether they are reading the right article. The confusion with IBS is real among the typical readers.

The fact that Crohn's is not caused by diet is important to negative a common misconception.

[edit] Proposed lead paragraph

Crohn's disease (also known as regional enteritis or CD) is a rare, chronic, incurable, episodic disease affecting the gastrointestinal tract which was named for Burrill Bernard Crohn, one of the physicians who first described it as a distinct type of inflammatory bowel disease. Crohn's disease can affect the entire gastrointestinal tract from mouth to anus. Because it is a systemic disease, it can also cause complications outside of the gastrointestinal tract.^[2]^[3] The main gastrointestinal symptoms are abdominal pain and diarrhea, which may be bloody. Symptoms outside the gastrointestinal tract include skin diseases, arthritis, and ulcers in the mouth.

Crohn's disease is a type of inflammatory bowel disease (IBD). IBD occurs when the immune system contributes to damage of the gastrointestinal tract by causing inflammation. Crohn's disease can be difficult to distinguish from other forms of IBD such as ulcerative colitis. Because of the name, IBD can be confused with irritable bowel syndrome (IBS), an annoying but much less serious condition.

Crohn's disease is a rare disease, affecting fewer than one person in 10,000 in Europe and North America. The disease is believed to be even less common in the rest of the world. Crohn's disease often develops in the teenage years, though individuals in their 60s and 70s are also at increased risk.

Although the cause of Crohn's disease is not known, it is widely believed to be an autoimmune disease. There is a genetic component to susceptibility, and the disease may be triggered in a susceptible person by environmental factors. Unlike the other major type of IBD, ulcerative colitis, there is no known medical or surgical cure for Crohn's disease.^[4] Many medical treatments are however available for Crohn's disease with a goal of keeping the disease in remission.^[5]

InvictaHOG 03:44, 7 August 2006 (UTC)

Historically, did the concept of IBD exist before the characterization of Crohn's disease, or were several diseases subsequently linked together to form this category?

Although the disease is "incurable", it often goes away after a single attack.

The second paragraph appears to be making a definitive statement that all forms of IBD are autoimmune diseases. There is no consensus on this. This statement is probably too strong even with respect to Crohn's, where some people claim it is a bacterial infectionM dorothy 04:17, 7 August 2006 (UTC)

The concept of IBD existed - the pathology of Crohn's (and apparently its treatment effects) were not distinguished. Incurable can be moved out of the first sentence (as below). The second paragraph was attempting to highlight the role of inflammation in the disease - it states that the immune response contributes to the damage, which is certainly true no matter the initial trigger. I'm sure the language can be improved to make it more clear, though! InvictaHOG 05:38, 7 August 2006 (UTC)

These articles are weak on history. If Crohn was working against a backdrop in which IBD and UC were already known, this is significant, and should be discussed in the history section. Please provide foot notes, however.M dorothy 02:31, 8 August 2006 (UTC)

I agree that a lot of the medical pages are weak on history - a lot of the historical summaries are not available on-line and, though fascinating, are less well-known than the pathology, epidemiology, etc. of the disease. That said, this article does discuss the early work on IBD and, in fact, lists three people who contributed to the early understanding of IBD. This information is referenced with the abstract freely available through pubmed. InvictaHOG 02:41, 8 August 2006 (UTC)

[edit] Samir's version

I like InvictaHOG's version a lot. I would tweak as such:
Crohn's disease (also known as regional enteritis or CD) is a rare, chronic, episodic disease which can affect any part of the gastrointestinal tract from mouth to anus. Because it is a systemic disease, it can also cause complications outside of the gastrointestinal tract.^[2]^[6] The main gastrointestinal symptoms are abdominal pain and diarrhea, which may be bloody. Symptoms outside the gastrointestinal tract include skin rashes, arthritis, and ulcers in the mouth.

Although the cause of Crohn's disease is not known, it is widely believed to be an autoimmune disease. There is a genetic component to susceptibility, and the disease may be triggered in a susceptible person by environmental factors. Unlike the other major type of IBD, ulcerative colitis, there is no known medical or surgical cure for Crohn's disease.^[7] Many medical treatments are however available for Crohn's disease with a goal of keeping the disease in remission.^[5]

The disease was named for Burrill Bernard Crohn, an American gastroenterologist who, in 1932, first described a series of patients with inflammation of the terminal ileum, which we now know is one of the most common areas affected in patients with Crohn's disease.^[8]

BTW: The classic teaching is that Crohn, Ginzburg and Oppenheimer's work was novel in that they described terminal ileitis that did not respond to anti-TB therapy (i.e. streptomycin) but responded to steroids instead.

-- Samir धर्म 05:29, 7 August 2006 (UTC)

I like the changes made to the proposed version. The last paragraph is a single sentence, but could easily be changed, such as "The disease was named for Burrill Bernard Crohn, an American gastroenterologist.In 1932, he and two other physicians described a group of patients with inflammation of the terminal ileum, which we now know is one of the most common areas affected in patients with Crohn's disease.^[9]" InvictaHOG 05:40, 7 August 2006 (UTC)

[edit] SCD etc

This article, while informative, still reads like a page from a national Crohn's group with the heavy bias from the medical experts. Diet certainly makes a major difference. Also disappointing to see no mention of the SCD - it saved my life after I was diagnosed with CD and I can attest to the theory that sugars play an important part in this disease. There also needs to be a mention of the research showing that it is a depressed immune system that is an aggrevating factor (see reference to BBC article above). I believe all these things carry equal weight and should not be dismissed just because a bunch of doctors think they should be stuffing Asacol into people and that "diet makes no difference" - after all, none of these self-professed experts can say what causes CD, let alone cure it. Their opinions are no more valid than those who have the disease and have found out by experiment what cures them or alleviates the symptoms.

What makes me angry is that I could have saved myself 6 months worth of misery, hospital visits, and useless drug taking if I'd been told other than "diet makes little or no difference". I'd like to see others spared this by being given all of the information, not just the medically politically correct information. —The preceding unsigned comment was added by David Digi (talk • contribs) .

I agree that SCD should be mentioned in the article, as there is some basic science evidence to its effectiveness as put together by Elaine Gottschall. Please feel free to add it in. But, you are only one person, and I am happy that the diet worked for you. I can tell you of ~~hundreds~~ dozens of my patients who threw Breaking the Vicious Cycle into the garbage in tears when it didn't work for them -- Samir धर्म 10:44, 29 August 2006 (UTC)
I agree with you that many people might have thrown Elaine Gottschall's book in the bin mainly because it requires a strict diet that most people won't stick to, but equally importantly because, I believe, like many other things the earlier you catch them the easier they are to shake. Someone with an scarred and ulcerated colon caused by 6 years of CD, for example, will probably not overcome the disease while someone like me, who had the disease for 6 months, will be able to turn it around completely. I also believe multiple attacks are beneficial; diet change plus anti-inflammatories like Asacol are probably the quickest way to achieve lasting results. What is needed are some proper studies to determine the effectiveness of these approaches. Unfortunately these are very slow at coming into existance. Perhaps with more and more people getting these things we might see some progress? DocDigi 11:30, 29 August 2006 (UTC)

As soon as there is data and verifiable sources, information should be expanded in the article. However, anecdotal evidence, even from a contributor, simply cannot be relied upon in an encyclopedic article. I agree that the article reads poorly and that the lists need to be converted into readable prose. InvictaHOG 18:16, 29 August 2006 (UTC)

Yes, we should make the prose brilliant. But the content's great in my opinion -- Samir धर्म 02:02, 30 August 2006 (UTC)

Oh, absolutely! The content is superb and I really wish that lists weren't so frowned upon at FAC because they are quite well done. I shouldn't have said that it reads poorly - I simply meant that there is still some jargon (despite a great effort which removed a ton!) and that it needs more prose. InvictaHOG 09:03, 30 August 2006 (UTC)

"Bias towards medical experts"?! 'Alternative' medicine supported only by a few flimsy testimonials and authors out to make a buck should not be included as factual information. Until a treatment is shown to be effective in a properly-controlled, peer-reviewed clinical trial, there is no justification for including it. ~~Samir~~ OP, I suggest that you read the Seven Signs of Junk Science and try to come to a better understanding of what biomedical scientists and clinicians do. (Sign #2: The discoverer says that a powerful establishment is trying to suppress his or her work).

Spin2cool 19:01, 29 August 2006 (UTC)

We should all try to avoid confontational stances. The scientific method knows no credentials. If SCD is indeed an effective therapy for CD, we will eventually know. Until that time, we must recognize and acknowledge that there is little data to support it, despite anecdotal evidence to the contrary. InvictaHOG 20:10, 29 August 2006 (UTC)

I'm the first to want to ensure that there are only cited therapies in this article. I eliminated a whole heap of uncited stuff when I first edited it. Evidence comes in many forms, the best of which is a double blinded placebo ctl'd RCT. Unfortunately, this is rarely achieved for dietary therapy. Thus, we rely on the best evidence we have. There are reviewed citations on SCD: PMID 15497569, PMID 2862371, PMID 14361377 (celiac paper, but cites Crohn's data as well). There's basic science supportive evidence as well. I agree that the evidence supporting SCD is poor (but it exists). A whole heap of patients are using the diet. I think it warrants a one-line mention (i.e. The specific carbohydrate diet has also been suggested as dietary therapy for Crohn's disease). -- Samir धर्म 02:02, 30 August 2006 (UTC)

My apologies, Samir. I didn't notice that the OP was unsigned and mistook your signature for his. Corrected above. Spin2cool 02:42, 30 August 2006 (UTC)

[edit] section added by Langrl2

This heading and section were added by Langrl2 and moved here for discussion.

Recent Research

Recent research indicates that cytokines, a group of chemicals that are produced by various cells in the body, may be responsible for generating the response of chronic pain associated with Crohn's Disease. Medications that affect the release of cytokines or block the action of cytokines may reduce the response of chronic pain. Various anti-cytokine medications are now being used to treat painful disease states such as Rheumatoid Arthritis, and Crohn's Disease. In addition, research using the anti-cytokine medication, Thalidomide, is being evaluated for its effect in treating chronic pain associated with Arachnoiditis.

I've notified the user and asked him/her to join the discussion. BaseballBaby 15:08, 21 September 2006 (UTC)

[edit] Community Forums

Crohn's Disease Forum keeps being deleted from the appropriate section. There is no good reason for this to be happening.

WP:EL -- Samir धर्म 04:52, 20 October 2006 (UTC)

[edit] Listy

The article's currently a little too listy. LuciferMorgan 22:51, 8 November 2006 (UTC)

Yes, it's unfortunate. We will have to work on that before FAC. InvictaHOG 19:44, 9 November 2006 (UTC)

So, I went ahead and did it. There's still quite a bit of work to do. I've updated the to do list. InvictaHOG 01:37, 10 November 2006 (UTC)

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