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
  • Expand mention of the possible neurological complications of CD in the extraintestinal symptoms section. Add links to journal papers on this subject and discuss possible causes.
  • Reference trends in treatment - biologics versus antibiotics (European treatment/trends lean towards long term antibiotics), success rates, outcomes and long term treatment prognosis (given the nature of the new treatments).
  • Expand on the bacterial pathogenesis (offering an unbiased critical view on whether or not a cure for Crohn's disease may be out there as was the case with H. Pylori but simply overlooked/ignored by the medical community).
  • I believe Crohn's can only be diagnosed by colonoscopy, not stool test- review categories?
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[edit] Pic & Video of recent CT

I am a Crohn's patient and have uploaded the following still from a CT scan taken prior to surgery.

Image:CT_Scan_Bowel.JPG

Please feel free to add this the the Crohn's article should people feel it would be helpful.

Also I have video to YouTube of the same CT scan.. I don't know if this could be included but non the less I thought some of you looking at this page would find it very interesting... I am amazed at what these machines can do.

Video of my CT scan prior to Surgery

--Jsaveker 17:02, 10 July 2007 (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)

Crohn's Zone Support Forum was also removed. It was considered spam and thus not allowed. I wonder if this is a bad thing. I found the forum a valuable source of information and support since being diagnosed. I am not affiliated with the site. --Jsaveker 07:25, 9 July 2007 (UTC)

First, Samir I wasn't the one to delete the site you posted but I did delete the other one. But my understanding is personal websites like these are not allowed. If I am wrong, and they are not spam, please advice me with policy. I am still learning though I have been here quite a time but my learning curve do to meds for Crohn's slows me down with understanding. Sincerely, --CrohnieGalTalk 13:06, 9 July 2007 (UTC)


Links to be avoided Okies... I have taken the time to read External Linking Guidelines and can see two sides to the coin.

Links to sites that require payment or registration to view the relevant content. - Well as it happens in order to view most of the content at Crohn's Zone you must first register. This is not to charge you but rather to enable the site owners to moderate the user submitted conent.

Links to blogs and personal web pages, except those written by a recognized authority.

Again Crohn's Zone is not a personal web page but rather a support community. It is heavily moderated.

It seems to me it is easy to interpret these guidlines either way. After all it does say "links to be avoided" as opposed to "Links not allowed". Non the less I can now understand why CrohnyGal removed the link.

Best not include these links on the page as I do not believe everybody would be in agreement.

Non the less I know better for the future in case I want to add a link.

I do have some images from my last Virtual Colonoscopy that I could upload as they gave me the scan on CD - very cool how I can zoom and pan across the animated 3d image of my bowels... still pics won't do it justice.... What are peoples thoughts on including images like that... or are we only allowed to use images out of text books?

--Jsaveker 12:33, 10 July 2007 (UTC)

Thanks for the info Jsaveker about the external links. I don't know the answer about more pictures but I bet it is cool to see your virtual colonoscopy. I haven't had that one yet but the camera pics I had were awesome. Ask someone if you can upload it here. I would love to see it. --CrohnieGalTalk 12:53, 10 July 2007 (UTC)
Thanks, the picture is awesome. Can you make it smaller? If you can then I think you should go through the trouble and get it approved to be added to the article. Of course this is just my opinion but I think it would help the article and it shows really well with what Crohn's patient's go through. --CrohnieGalTalk 14:27, 10 July 2007 (UTC)

[edit] Suggestion to add short bowel syndrome and diet

Short bowel syndome is very much part of Crohn's. It usually occurs because of surgeries. As for diet, maybe separating it out of where it is at would make it easier to expand on. The information I have read is both inaccurate or not complete. What I mean is that diet is a difficult thing to figure out. What is good for one person might make another have a major flare or even a blockage. You can read more about this at [1]--Crohnie 13:31, 12 March 2007 (UTC)

Does anyone have any ideas about my suggestion above? Short bowel syndrome is very real to people who have had surgery, usually multiple surgeries. I would appreciate any input on this, thanks. --Crohnie 12:08, 26 April 2007 (UTC)

[edit] Diet and Lifestyle

These two are different and need to be separated into different sections. Diet is one of the most difficult things to figure because what someone else can tolerate another may not. Also, a list of 'no' foods can change with time. A lot of times a food get put on your list of not to eat, then down the road all of a sudden you can eat it without ill affects. The [2]has great examples about diet and how to handle it. Just for the record, I am not a doctor nor scientific, just a crohn's patient. Please feel free to correct any errors I may make. --Crohnie 12:55, 16 March 2007 (UTC)

[edit] Mortality

doi:10.1111/j.1365-2036.2007.03276.x shows that Crohn's patients are 50% more likely to die than their age-matched controls. JFW | T@lk 14:24, 1 April 2007 (UTC)

The link you provide doesn't work, please try again. --Crohnie 14:48, 1 April 2007 (UTC)
The link doesn't work DOI is corect - Here's a link to the abstract. I don't have access to the whole paper to read their methodology, but it does seem to indicate that there may be a higher mortality risk from Crohn's than previously believed. Spin2cool 18:08, 1 April 2007 (UTC)
Thanks, yes I agree but it also seems to say at the end that more studies need to be done for new current practices. Interesting though, --Crohnie 20:40, 1 April 2007 (UTC)
That data seems very weak Dabomb691 01:31, 24 October 2007 (UTC)

[edit] Was this article written mostly by a GI?

The reason I ask is a lot of what is written is not what people who actually have Crohn's happen. The cramp like pain in not cramp like, it hurts and it hurt really bad, enough to change someones life. Bleeding occurs in many Crohn's patients, not just red but depending on where the damage is occurring, it can be black to not being able to be seen by the naked eye. This is just an example. Is there anyone watching and active on the article? If so, I would really like to have a conversation about this article, piece by piece. I have Crohn's disease and I have tried real hard to stay away from this article because of this but I came and read some of the article and it is just too pigeon holed to explain the average Crohn's sufferer. Not all patient's have diarhea some actually have the dreaded constipation. Not all lose massive amounts of weight (I'm not one of those) they actually are heavy in their weight. Thanks,----CrohnieGalTalk/Contribs 14:49, 22 May 2007 (UTC)

Also there is comments about diet and sugar and so forth not being good for Crohn's. Diet is very personal, everyone is different on what they can or cannot eat and drink. I think this should be added to the articles. Also, short gut syndrome is missing from the article which occurs a lot to patients with Crohn's who have had multiple surgeries or a surgery with a lot removed. Thanks again, ----CrohnieGalTalk/Contribs 14:54, 22 May 2007 (UTC)

We can work on it together -- Samir 18:13, 22 May 2007 (UTC)
Sorry Samir for taking so very long to get back to you. After reading this article over and over again I am having trouble figuring out how to make it more people friendly without changing very important information. I know there is a way to but I am at a lost as to how to make this not so scientific, I guess that's what I am having problems with. Thanks, --CrohnieGalTalk 14:31, 10 July 2007 (UTC)

"Diet is very personal, everyone is different on what they can or cannot eat and drink." This is very true and something I can personally attest to. It should be added that everyone is very different and diet only helps SOME people. —Preceding unsigned comment added by 63.147.152.182 (talk) 08:19, 8 November 2007 (UTC)

Yes I agree, but I can't figure out how to put this kind of information into the article without it sounding like weasel words. I have hopes to be able to work on this article in the near future with my full attention. I would like to see this people friendly and even maybe it can tell people 'what' Crohn's is and 'how' it can change the lives of people who live with it and even the care givers should be mentioned. The care givers also have a lot to do when a Crohn's patient is flared or surgery is in the future or the only option is surgery, again.
Maybe we can even work in things like stress reactions to the disease and so forth. What I am saying, badly too I must say, is there should be more to this article than the genes and meds, maybe a more personal insight (I do not mean COI type) so that when reading the article you can understand Crohn's and what it feels and does to you. There are a lot of people with stomach problems that never heard of Crohn's or IBD at all. I was one of them until major surgery, just some thoughts. Please share any ideas!
My thoughts are more should be added like; short gut syndrome, diet difference between patients, adhesions and scar tissues issues, more depth about bleeding and vomitting etc. written in a way that is 'not' so scientific but still informative. Thanks, --CrohnieGalTalk 15:08, 8 November 2007 (UTC)

[edit] Some possible ideas

First the age of 15-30 is really not correct. I know of babies who have gotten it which is not unusual to people my age when I got diagnosed with surgery at 40ish then of course it attacks people even later than this.

Another subject that can be expanded on is diet. Diet is different for everyone. What I can eat might send another Crohn's patient to the emergency room. Of course these are just some ideas to chew on. Are there editors watching this article who is willing to work with me on this article? I do want to say that I do not get my feelings hurt if what I edit is changed or deleted. I also do not do edit wars so I pretty much consider myself a pacifist when it comes to all of this. I know edit wars and arguing seem to be the norm on some articles but I would love to be able to edit here in a friendly and constructive way. I hope there are editors reading this and agree. My goal is to make the article informative so that people know what Crohn's is and how it does change the person's life.

Also, how about a section about short bowel syndrome? I think this is needed in this article. Short Bowel Syndrome happens usually via surgeries. Sometimes a lot of surgeries, sometimes just one will cause it depending on if a large amount is removed. I was staying away from this article because I have Crohn's and thought my attitude would not help here. I now think that I can add to this article in a fair honest way without my own WP:POV. Right now to be honest, it reads like a doctor wrote it, which is ok but it makes it difficult for the common person to understand a lot of it. I really would love some feed back on all of this, esp. my becoming active here. Thank you all for your time and your hard work. ----CrohnieGalTalk/Contribs 11:10, 12 June 2007 (UTC)

- FWIW, The age of Crohn's onset is usually described as a bimodal distribution. The largest peak occurs between the ages of 15-30 and the much smaller peak is between the ages of 60-80. It is important to remember that this is a distribution, and that does mean that there will be some cases that fall outside of the peaks, including yours.
- Diet is a complex issue, for the reasons you described. Since so little is known about how diet interacts with the disease, there isn't much to say. Any info would be anecdotal, unless you can find some papers on the subject.
- Info on short bowel syndrome belongs on its own page (which already exists). It makes perfect sense, however, to link to that page from a sentence describing how treatment for Crohns can lead to SBS.
- Spin2cool 00:57, 13 June 2007 (UTC)
Thanks for taking the time to respond to me. I will check my links about diet and see if I have anything useful. I think I do but I am not sure at this point. Thanks again, ----CrohnieGalTalk/Contribs 12:37, 13 June 2007 (UTC)

[edit] Pregnancy and birth

doi:10.1111/j.1572-0241.2007.01216.x - thiopurines are associated with prematurity, but this may still be a marker of disease severity rather than actually being due to the meds. JFW | T@lk 12:08, 24 June 2007 (UTC)

[edit] CCFA Links

I reverted several links to the CCFA site and an advertising/PR blurb from the CCFA (made by an IP that traces back to the CCFA). This is not an appropriate forum for advertising, and the CCFA site is already linked in the appropriate section. If you wish to add more information about the CCFA and their mission, I suggest that you create a wikipedia page for the organization. Spin2cool 18:38, 1 August 2007 (UTC)

[edit] Anti-yeast antibodies

This page lacks discussion of the potential aggrevating role of ASCA in Crohn's disease or the discussion of lectin binding deficiencies that have been found in ASCA+ patients. This is one criteria missing from the table, Crohn's disease is associated with ASCA and ulcerative colitis has rather low levels. If you pubmed Crohn's and ASCA you will get 127 hits, with Crohn's and yeast 207 hits. This is obvious an area where the article is deficient relative to the literature.Pdeitiker 22:18, 23 August 2007 (UTC)

Absolutely. I've always wanted to add serology to the article -- Samir 05:58, 24 August 2007 (UTC)

[edit] The lead

I think the lead is too long and it's supposed to tell the reader what the disease is. I personally think that it's too in-depth and even too medical for the common reader to understand what Crohn's is. The comment that it attacks young people to older people is also incorrect these days. Please read and see what it is trying to say, though I don't think I am saying it too well. Also, many do not lose a large amount of weight. --CrohnieGalTalk 12:06, 24 August 2007 (UTC)

I would also love to see the article written so people understand it. I for one don't understand a lot of what is said. --CrohnieGalTalk 12:07, 24 August 2007 (UTC)
I've wanted to do that for a while. I wish I had more time. -- Samir 04:10, 25 August 2007 (UTC)
Thank you for you quick response to me. I will try to find time to do it too. Real life events have taken a lot of my time lately but I will try to get to this and make it reader friendly as soon as I can. Were you able to see the info in the last magazine that was sent out to me? Of course you know you have to sign up to CCFA to get to the articles. If you have problems please let me know and I will email it to you or you are welcomed to email me, if you would like. You being a GI, I know this magazine will be great interest to you. I plan on hopefully soon to be able to put some of this new info into the article, time allowing of course. Also, the CCFA site has a lot of good new promising things happening. --CrohnieGalTalk 11:49, 25 August 2007 (UTC)

[edit] Worked lead a little bit, but I have to CD rash

I have been dealing with a nasty rash, would pictures be appropriate? I am using Benedryl for the itchiness, 150 mg, and a steroid cream and an antibiotic cream. The rash has been on going since Feb of this year. The dermatologist also had me on a antibiotic, though right now I can't remember the name of it. Would putting this info into the article about rashes be appropriate? I know the name of both of the creams as I a still using them multiple times a day. The antibiotic name I can probably get off my insurance list of medications. This rash is annoying, itchy and at times very painful but it is not PG. The dermatologist said that this rash is a common rash for Crohn's patients and that stress can be a big trigger to set it off. (I got it originally when my husband had a heart attack.) If you want, you can respond here, my talk page or even email me. I would really like to work with you on this article. --CrohnieGalTalk 12:23, 25 August 2007 (UTC)


[edit] Nightshade

I removed text that proposed nightshade as a causative agent for multiple reasons. The first is that it was uncited. The second is that it appeared to be a self-promotion for a book. If you'd like to re-add the info, please provide appropriate citations to peer-reviewed research that links nightshade to CD. Spin2cool 02:11, 4 September 2007 (UTC)

[edit] Bacterial Link

The bacterial link to Crohn's Disease is already covered, farther down in the section. Most of what you added was redundant. That said, some of it was also inaccurate. The current state of knowledge seems to be that invasive bacteria take advantage of defective microbial clearance. Thus, the bacteria are not causative of Crohns, but rather opportunistic pathogens.

It's also misleading to link any one bacterial species to CD, as several studies have implicated different species, including Enteroadherent and invasive E. coli and MAP. In the most recent and most comprehensive bacterial survey of Crohn's patients, specific strains of E. coli were found to be linked to the disease, but neither MAP nor other suspected pathogenic bacteria were found Nature article Spin2cool 02:11, 4 September 2007 (UTC)

The statement that "neither MAP nor other suspected pathogenic bacteria were found" is factually inaccurate [3][4]. The confusion comes from the fact that different studies have looked in different areas for MAP bacteria, MAP is difficult to culture and requires different staining techniques to see it, there are 2 forms of MAP, and many older less precise studies were done which pop up from time to time. MAP is an obligate pathogen that seems to live in the lymph like tissues of warm blooded animals. Furthermore anti-MAP treatment regimes have been used with great success[5]. One reason MAP is so often implicated is that patients can go into permanent remission form use of anti-MAP drugs but not all antibacterial drugs work against MAP. You may have been reading studies older than a few decades ago before effective anti-MAP treatments were available. Another reason MAP is so often implicated is because the symptoms are often indistinguishable from intestinal TB[6][7][8]. If only 20% of patients went into long term or permanent remission from anti-MAP treatment then other possible explanation would be necessary, or a better treatment design would be necessary. However; anti-MAP treatments when done properly can give greater than 90% remission from those that are able to comply with treatment and more than 80% overall long term remission. Some interesting links follow [9][10][11]. —Preceding unsigned comment added by Halej (talk • contribs) 03:58, 9 June 2008 (UTC)

The nature link seems to be broken as well. —Preceding unsigned comment added by Halej (talk • contribs) 03:59, 9 June 2008 (UTC)

[edit] Pregnancy

A write-up on CD and pregnancy would be helpful, especially since CD can affect the vulva and perineum. The article on caesarian notes that CD may be an indication for C-sections. Perhaps more could be included here.--Westendgirl 06:00, 7 September 2007 (UTC)

I added information about pregnancy today at [12]. Maybe it's time to set up a title about Crohn's and pregnancy. I know there is a lot of information pro and con about this esp. about the use of medications etc. --CrohnieGalTalk 20:18, 7 January 2008 (UTC)

[edit] The object of external links is to add....

External links are to add information for the reader to locate things. [13] is a great community but not for Wikipedia of course not unless it is part of the article. WP:EL says to keep external links down as much as possible so we don't have the reader leaving Wikipedia. Sorry, but other policies also apply as far as I know and the External links area is quite long. --CrohnieGalTalk 20:52, 24 September 2007 (UTC)

[edit] Incidence and patterns

A small series from Wales shows that incidence of CD continues to rise slowly, but also that the disease pattern continues to favour the colon over the small bowel. doi:10.1111/j.1365-2036.2007.03576.x JFW | T@lk 21:15, 22 November 2007 (UTC)

[edit] IL23R

doi:10.1111/j.1572-0241.2007.01661.x and doi:10.1111/j.1572-0241.2007.01660.x - IL23R and ATG16L1 linked... JFW | T@lk 15:28, 2 December 2007 (UTC)

doi:10.1111/j.1572-0241.2007.01525.x - whoa, the evidence is piling up. JFW | T@lk 19:01, 2 December 2007 (UTC)

[edit] Disability

About 5% of Crohn's patients are completely unable to work. Those with a low QOL and frequent relapses are the most likely to land in this category doi:10.1111/j.1572-0241.2007.01561.x JFW | T@lk 23:32, 12 December 2007 (UTC)

I am one of those who can not work do mostly to blockages and chronic pain issues. Trying to get help though is almost impossible without the help of a doctor and an attorney. I plan on doing this a week form today so maybe I'll have some info to update. --CrohnieGalTalk 20:12, 7 January 2008 (UTC)

[edit] Bowel Resection Photos

I had 20 centimetres of my small bowel resected last Friday, as well as a bit of the large bowel and the appendix (not shown), and I was wondering if the article needed some stronger images to show how bad the disease can get in patients who have surgery as their last option like I did.


http://i163.photobucket.com/albums/t297/kowbrainz/bowel2.png

http://i163.photobucket.com/albums/t297/kowbrainz/bowel1.png

Basically any part which isn't a lush pink colour like new strawberry bubblegum is inflamed to some extent, whether it be the bloody red bits, the yellow or the black parts. The metal tool indicates a fistula which was present in the side of the bowel.

If the images are considered too strong for general audiences, then that's fine. If not, then feel free to upload them again to Wikipedia by all means.

Thanks,

Nathan —Preceding unsigned comment added by 124.169.87.225 (talk) 09:00, 14 December 2007 (UTC)

I personally think the photos are appropriate for the article. I didn't get to see what I had sectioned out but your pictures sure hit home with me. You have to go through the acceptance to release the photos for use. I did that, with help from my mentor, of my rash. I hope you are doing better now. I just got out of the hospital so maybe when I get my records I will be able to see what the tests showed too. Better health to you and happy editing. --CrohnieGalTalk 13:36, 14 December 2007 (UTC)

[edit] Question

What is this template for? eDigestive system - Gastroenterology (primarily K20-K93, 530-579) What use is this template? --CrohnieGalTalk 18:49, 7 January 2008 (UTC)

Good question... The {{Gastroenterology}} template was made by WikiProject Medicine, it looks like, (it's their template for GI-related illness articles to cross-reference between them) and I'd ask them about it. I've found their templates useful on other articles. Note that all but the top line is hidden until you click on "show", so it may not look useful until you do that. — CJewell (talk to me) 01:39, 17 January 2008 (UTC)
I'll move it under "See Also", however, it doesn't contain external links... — CJewell (talk to me) 01:41, 17 January 2008 (UTC)
A couple of things; first I think there are way too many charts. Second, I did like you suggested and checked what was linked. I checked only one article that was linked and it was to a band, which I don’t understand any connection unless it’s to show that a member of the band is dealing with Crohn’s. If that’s the case, I didn’t read the article, and then we could put in the body of the article this kind of thing. It just doesn't seem useful at all for this article. On the bottom of the article it lists other articles so IMHO; this seems like duplicating. Personally I think it should be removed.
Another idea is adding to the article about people who have CD and still can move on into there profession might be useful. When someone with Crohn’s sees a list or something of people who continue with their profession is uplifting. This is just a thought… --CrohnieGalTalk 16:34, 17 January 2008 (UTC)

[edit] External link

I added the Crohn's Colitis Foundation of America and I plan to add more later.--CrohnieGalTalk 18:53, 7 January 2008 (UTC)

[edit] Serology

I was recently found to have Crohn's and I have noticed that this article doesn't seem to have any information about the highly accurate serologic blood tests now being used. That was the very first test my doctor initiated. He found I had the positive serologic markers for the disease (Prometheus IBD Serology; that are 98% accurate), severe anemia of a megaloblastic nature (an astounding feat for a person with beta thalassemia, to go from very small red blood cells to gigantic), elevated liver, and a normal sedimentation rate. My colonoscopy and barium swallow both came back normal only for the wireless capsule endoscopy to reveal extensive damage in the small intestine. My symptoms were loose bowel movements at a rate of one every hour for about a year, blood in my stool, tingling sensation of the fingers, sores in my mouth, fatigue, dramatic increase in nummular dermatitis, and inflammation of the eye. And he believes it to be related to my mother's multiple sclerosis. 71.219.78.10 (talk) 07:02, 11 January 2008 (UTC)

Glad you got the diagnosis; hopefully along with that you'll get some relief of your symptoms with treatment. Thanks for asking about serology. Those tests are actually complicated, because their value is in part determined by your doctor's a priori estimate of your odds of having Crohn's. (See positive predictive value for more info.) Serology can be useful, but it still can't make the diagnosis just yet (at least that's what I was taught in med school this week - what timing!?). Anyway, this probably means that it's even more important to get a good serology section in this article. If I ever get my life/free time back, I'll help out. Antelan talk 07:33, 11 January 2008 (UTC)
First let me say I am glad you got diagnosed. It took me over a year and emergency exploratory surgery for my Crohn's to be seen and I had all the tests. I didn't have the camera back in '00-'01 as the camera was not available for me at that time. In a way since I had totally dead tissue which the surgery ended up removing half my small bowel, cecum valve and over 12” of small intestines. The camera would have gotten stuck in me putting me in surgery anyways to remove the camera. Keep in mind that not all tests, including the blood work shows the problems. I had my blood taken many times, had around 4 scopes, 5 barium enemas, many cat scans and so on. None of the tests showed the damage. When I asked my surgeon about taking all these tests and nothing showing up he told me that a colonoscopy was about 75% successful at showing the problems. All the other tests were even lower in percentage. I believe he said that bloods and barium tests were at about 50% accuracy. So, I'm really thrilled it helped up but if you research Crohn's you will see that everyone is different with everything from what you can eat to even how helpful the available tests are. Frustrating? You bet! I have had three surgeries since my '01 surgery and I have another one knocking on the door for me that I am delaying for as long as possible. I would like to see this article more informative and more 'people friendly' than it is now, which is what I am trying to do. If you can help add more to this article so that anyone can come to this article and understand better what CD is. To me it's too medical and is better understood by professionals or people with a good scientific background, which I am not! :) --CrohnieGalTalk 20:48, 21 January 2008 (UTC)

The prometheus test is appropriate only if it is known that the the patient has inflammatory bowel disease. Then it can help distinguish Crohn's and UC. It is not 96% accurate, however. I think the last numbers was around 80% accurate. It does not prove or disprove the presence of Crohn's or UC. Kd4ttc (talk) 21:14, 9 March 2008 (UTC)

[edit] "Proprioceptive Therapy" - should this not be deleted ?

"An Alternative Therapy.... claimed to reverse the anterior rotation of the hips, which in turn, is purported to decompress the intestines and colon..... Since 1950, there is not a single peer-reviewed publication demonstrating any effect of this therapy in Crohn's Disease".

==>This sort of nonsense is surely offensive, and even potentially mis-leading to Crohn's patients, and I suggest that it be deleted. At a minimum, it is totally irrelevant to disease treatment today. io-io (talk) 01:12, 22 January 2008 (UTC)

The section was originally added by someone promoting the theories of a doctor in Italy:[14]
I will remove it. --A. B. (talk) 21:31, 23 January 2008 (UTC)
Thank Youio-io (talk) 17:46, 24 January 2008 (UTC)

[edit] Natalizumab's side effect profile regarding individuals with MS - relevant here?

Should the side effect profile of natalizumab as it relates to treating multiple sclerosis be included in this article? Io-io has inserted it into this article (As of late December 2007, more than 21,000 MS patients were receiving natalizumab mono-therapy without a single incidence of PML occurring.). It is my opinion that this, at best, belongs in an article about natalizumab. Placing it on this page strikes me as promotional, especially since it is out of place, discussing individuals with MS, not individuals with Crohn's. What do others here think? Antelan talk 02:14, 22 January 2008 (UTC)

I have debated this with Antelan. The problem was that before I added this, there were 5 lines on natalizumab as the newest therapy, and a further 5 lines why it was russian roulette to use. It reads more like media sensationalism than a reference encyclopedia.
It would be unbalanced to describe that the Drug is "linked" (rather spuriously now) to the PML issue, which is totally independent of the underlying disease, Crohns or MS, without giving this actual in-practice update. If that update had been different, say several cases of PML, then it would never even have been approved for Crohn's (which it just was, last week). Also the "link" to PML was found in MS first, and in combination-therapy only (when used with other immuno-suppressive drugs) - the actual practice (to date, in MS) has been in mono-therapy as is required by the FDA.
The other imbalance is that near the top of the page there are biological drugs mentioned (Remicade and Humira), and these have proven in practice to be at least as dangerous as natalizumab, in fact with dozens of fatalities - however there is no mention of that, nor any citations provided as to their clinical results or practice.
However I see that there are links here to 2 other pages: "Main articles: Treatment of Crohn's disease and Biological therapy for inflammatory bowel disease" - and perhaps most of the natalizumab safety material should be moved there, as both pages are anyway well out-of-date in this respect.
io-io (talk) 23:07, 22 January 2008 (UTC)
Sorry I know I am late to respond. I think some of this article can be moved over to the other articles mentioned, but I have to read them in total to know for sure. I just know that medication comments in this article seem to be scattered about which I commented on in another thread here. I hope the two of you come back here to edit, I sure could use some help. I've been trying to make the article so that people who do not know what Crohn's is understand from reading the article and so far it's not there. I have asked others to read the article and they still didn't know what Crohn's is other than painful if not in remission and that there is no cure for it. Thanks, --CrohnieGalTalk 14:39, 12 February 2008 (UTC)

The PML issue should be briefly mentioned in the Crohn's article. Cases of PML have been a definate chill in the Crohn's treatment community. Also, it may be that it is a pediatric problem and may relate to concomitant use of azathioprine. Leaving it only in the natalizumab article would bury it. However, it doesn't need a full story here. A line along the lines of "natalizumab has been rarely associated with a deadly neurodegerative disease (see discussion at natalizumab)" would serve to alert the interested reader while keeping the main discussion at natalizumab. Stephen Holland, M.D. (Gastroenterologist) Kd4ttc (talk) 21:11, 9 March 2008 (UTC)

I agree with the 2 points raised - the PML issue is not specific to N, and the description should be very brief..... io-io (talk) 23:20, 11 March 2008 (UTC)

[edit] History section

Should it talk about Dr. Crohn and his collegues and then explain the others? It seems backwards in reading it. Thoughts? --CrohnieGalTalk 14:28, 12 February 2008 (UTC)

Looks like it is written in chrono order, which makes sense to me. The whole section could definitely be expanded, and the referencing is less stringent - CCFA could be a source as could other official governing bodies' websites. WLU (talk) 16:41, 15 February 2008 (UTC)

[edit] Brand names of drugs

WLU, why do you object to using brand names in the article?

I realize that there are objections to commercial promotion.

But giving both generic and brand names makes it easier for the reader to understand the article. That outweighs any other consideration that I can think of.

For some drugs, like Adriamycin, the brand names are incorporated into standard treatments, like CA (cyclophosphamide, Adriamycin). You can't understand what doctors are talking about if you don't know the brand names.

Even the NEJM has started to give brand names now.

I'm not aware of any WP policy against it. On the contrary, we use brand names all the time.

Can someone come up with a good objection? Or should we add the brand names back? Nbauman (talk) 17:22, 14 February 2008 (UTC)

Note that I've moved all the medication to the Medication section, out of the lead, and replaced it with a generic summary of treatment. Adding the specific drugs to the lead doesn't seem necessary, and we would have to include all other types of treatment to balance things out - which would make the lead much longer.
I think that the use of brand names is not necessary, as the name will be mentioned in the lead of the specific drug's page, and the drugs themselves are wikilinked. I see the brand names as a type of spam, but I'd like some guidance on this as well, though MEDMOS doesn't seem to say anything. I would object to adding the brand names back, but I've brought this up at Wikipedia talk:Manual of Style (medicine-related articles)#Drug names in non-main articles and with Jfdwolff as well, though I'll point him to TALK:MEDMOS to centralize the discussion. WLU (talk) 16:54, 15 February 2008 (UTC)

One can use the notation "Brand name ( nonproprietary | Manufacturer )" to include both. For example, Imuran (Azathioprine|Prometheus Labs) would be a full description of a drug. Kd4ttc (talk) 21:19, 9 March 2008 (UTC)

[edit] Changes to lead

WLU has made major changes to the lead, for example deleting all references to drug treatment and moving it to the bottom.

I think that drug treatment is important information that people reading this entry want to know, and the names of major drugs belong in the lead.

Comments? Nbauman (talk) 21:03, 15 February 2008 (UTC)

Actually, the only changes I had made to the lead was to remove the specific discussion of 'medical treatment' (which was actually 'drug treatment' and didn't mention lifestyle, hookworm or surgical options). Just before posting this message I made some wording tweaks, added a wikilink and a citation template.
There's now an internal wikilink to the treatment section below. The lead should reflect the rest of the page; there should be an overview, not a detailed summary of one aspect. A discussion of all the specific drugs to treat Crohn's disease is a bit odd to me in the lead, and to do something similar with the rest of the page we would have to summarize all the tests to diagnoses Crohn's, all the symptoms, everything related to the causes, and put in something about the epidemiology. Also, citations in the lead are (or should be) unusual as the information and citations should be in the body of the page, not the lead. If people want to know the treatment options, there is now a main link to the Treatment of Crohn's disease page, which will give far more information, and in greater detail, than the CD main page ever would or should.
If Nbauman or anyone else thinks that my reading of Wikipedia:Lead section is off, or thinks there is a better way, I am happy to discuss. WLU (talk) 21:38, 15 February 2008 (UTC)
I think the main Crohn's disease page should have a useful summary of major treatments. It's not an acceptable alternative to link to the Treatment of Crohn's disease. Even if it were true in principle, the Treatment of Crohn's disease page has a long way to go before it will be a useful, or usable, page.
Take for example natalizumab. Treatment of Crohn's disease classifies natalizumab under "Research on medications in progress", along with drugs that are in Phase II or less. It places natalizumab below "Helminthic therapy," which according to the link is in proof-of-concept stage. Furthermore, it doesn't cite the Cochrane Collaboration study, which is the most reliable source of meta-analyses and evidence-based medicine that I know. (Even the NEJM has reviews by doctors with financial interests in the drugs they write about; Cochrane doesn't.)
Natalizumab is approved by the U.S. FDA, and evaluated as an effective therapy by the Cochrane Collaboration. An article that gives less emphasis to an approved, effective therapy than it gives to experimental helminthic therapy violates WP:WEIGHT.
My point is that an entry like Crohn's disease has to stand by itself, with a summary of all the most important information that an ordinary reader would want, including a summary of current treatments. Wikilinks are supplementary. It's not a valid argument to delete things and say that the reader can follow the links to that material in other articles in Wikipedia, when those other articles are in such a bad state that most people wouldn't be able to find that important information, or the information isn't in there at all, and when the more detailed articles might not be as up to date. Wikipedia is not a maze.
When I write an article, I don't write for my own benefit, I write for the benefit of my readers, the kind of people on this talk page. I'd like to know what they think. Nbauman (talk) 23:11, 15 February 2008 (UTC)
The Crohn's disease page has a treatment section in Crohn's disease#Treatment. The link to the main article on treatment in the lead is there because it is the most useful of all links to put in that spot. The section on treatment has a link to the main article, and a brief summary of the treatments available. The article does not give more weight to helminthic therapy - helminthic therapy is its own section because it is the only section on treatment using microorganisms (I assume, I didn't write it). In my mind, natalizumab is one treatment among many, and shouldn't be given too much weight (as in its own section or an extended discussion) because it's recommended as a second line treatment, not first.
If you have an issue with the main treatment page, feel free to edit it; it's easy enough to reorder. But really that discussion belongs on talk:Treatment for Crohn's disease, not this one. You don't have to convince me of this, I don't particularly care about the order of that page. And I haven't deleted anything, I moved something out of the lead, into the appropriate section.
Unless I missed something in my rewrite of the Natalizumab page, it's not worth putting in the lead. Am I missing something of its importance? You seem to consider it very important, but from what I've read on that page it is a slightly more useful medication than some of the extant ones, but with considerable risk of potentially lethal side effects. WLU (talk) 23:40, 15 February 2008 (UTC)
If Nbauman told you that natalizumab was approved for Crohns, then why suggest it has "considerable risk of potentially lethal side effects"? It is also a new class of Drug (both Remicade and Humira target anti-TNF alpha), and should be an option instead of surgery and obvious downsides to that....io-io (talk) 23:20, 11 March 2008 (UTC)
That reading was based on my initial assessment of the drug over three weeks ago; now I realize that the risk of lethal side effects are currently considered minimal and primarily in conjunction with other drugs. And my initial point was, natalizumab is one treatment among many. I see no reason to single it out in the lead with a sentence or part of a sentence when on this very long page, it occupies only one section and does not appear to have revolutionized treatment for Crohn's disease. If it has, and this is documented in medically reliable sources, then this should be easy to demonstrate and the page should reflect this change. You seem to think I have some sort of medical expertise - far from it. I'm not a specialist, I'm frequently wrong about factual information (less so about wiki-specific topics), and if this is demonstrated by a reliable source, I edit accordingly. But I'm not the boss of wikipedia. If I'm horrifically mangling pages with malicious intent, perhaps WP:ANI is the place to go. WLU (talk) 10:40, 12 March 2008 (UTC)
You can see what Kd4ttc wrote 9th March on N and PML by scrolling up the page.....io-io (talk) 23:43, 13 March 2008 (UTC)

[edit] Infobox caption

The reason I tried a different wording in the infobox is because on my browser everything in the third line of text is cut off. Is it a direct quote? Can the picture be adjusted? Am I unique in this problem? WLU (talk) 22:04, 15 February 2008 (UTC)

What's your operating system and browser version? Maybe who knows Wikipedia markup better than we do can fix it. Nbauman (talk) 22:34, 15 February 2008 (UTC)

[edit] Colon Ca example misleading

The colon ca shown is an adeno ca arising in uninflammed colon. Ca in Crohn's often develops from flat lesions. The Ca shown here is atypical for colon ca associated with Crohn's. It is a nice pic of an advanced adenoma, early colon ca, though. Kd4ttc (talk) 05:50, 18 February 2008 (UTC)

It's pretty difficult to get pictures for pages like this one that are GFDL-compatible. Though calling for a better one isn't a bad idea. If you're certain of the issues with the picture, feel free to adjust the caption to reflect this. WLU (talk) 12:45, 18 February 2008 (UTC)
I understand. Luckily, I don't see much Ca in my IBD patients, sending the occasional patient at the dysplasia stage. Rather than confuse the public on this fine point let's just keep an eye out for something we can use. Kd4ttc (talk) 17:52, 18 February 2008 (UTC)
It's a pretty obscure topic (someone with two very specific comorbidities), so good luck. You could try the Commons perhaps. I'm surprised to see it at all, it's the rare doctor who would ask "by the way, can I throw a picture of your colon cancer on wikipedia?" That's ballsy. WLU (talk) 18:00, 18 February 2008 (UTC)
If I get a pic I'll post it. More likely now is to see dysplasia in a dysplasia associated raised mass, known to us obscure IBD people as a DARM. I've got a few pics up on wikipedia. I'm proud of my polypectomy resection seen there. With no patient ID it works well, and I encourage other docs to put their pics here. I guess Ballsy is as Ballsy does. Kd4ttc (talk) 17:50, 22 February 2008 (UTC)

[edit] SCD diet

A claim popped up here about the SCD diet. No one in clinical medicine uses it. The reference that was added was malformed. The SCD diet does come up on a lot of lists for IBD treatment, so mentioning it is reasonable. The reference and discussion would be better if it were on the SCD diet page, which this article links to. Kd4ttc (talk) 17:46, 22 February 2008 (UTC)

Fixed the reference and added pubmed number. There's no abstract, so I can't tell what the article is actually about. If the citation says there is no evidence it works, why is it here? This is the second time this has been spammed to the page. If there's no evidence it is useful for CD, I agree it should be removed. WLU (talk) 18:00, 22 February 2008 (UTC)

[edit] Autoimmune Disease & "Classification"

Looked odd that this was barely mentioned, its listed even if Wiki's own list as a confirmed Autoimmune Disease (rather than suspected). I know its not in MeSH as such. Many autoimmune sufferers have another disease plus Crohns, is it not beyond doubt? I editted. Also under "Classification" it actually attempts to categorize (would that be a better word in text) the different kinds as they present....io_editor (talk) 03:02, 2 April 2008 (UTC)

[edit] Famous people with IBD

I deleted an edit about a famous person with Crohn's disease because of how it was written and lack of any citations. Saying that though, I think a section of famous people could be included and actually did some quick research, though I think more can be located. "here" is a list of famous people, now would a section about this be appropriate or would a category be more appropriate? Thanks for any inputs, --CrohnieGalTalk 15:12, 12 May 2008 (UTC)

Awhile back on the MedMOS, many were arguing that we should try to keep "famous people with X" out of these articles. The idea is that it doesn't really tell you anything about the disease. For some diseases, we have "list of people with X" in their own separate articles. Antelantalk 15:14, 12 May 2008 (UTC)
Thanks, good point that I didn't think about other than my own perspective. I see putting them in as proof that even people with chronic disabling diseases can still go on to see their dreams come true. --CrohnieGalTalk 15:25, 12 May 2008 (UTC)
Hey, I hadn't considered that perspective. Good point to you, too! Antelantalk 15:26, 12 May 2008 (UTC)
Three edit conflicts in a row, what are the chances?
Ya, agreeing with Antelan's original point - Wikipedia:Manual_of_Style_(medicine-related_articles)#Notable_cases has guidance. Lack of citations is a very good reason to delete, and insist on deletion without good sources per WP:BLP. You could always start the suggested 'list of' page, but they're usually spam/trivia magnets and I see them as only useful when you've a wager riding on who has x condition. There's lots of precedent for 'list of' pages, so if anyone wants to create one, as long as its sourced there's no reason not to. I wouldn't do it myself, but that's 'cause I hate lists in general.
I will note that your (Crohnie's) reason is not really the reason wikipedia exists, but one can, through careful wording, create a page or section that fulfills your purpose while being in keeping with wikipedia's purpose. But always wikipedia's policies and guidelines must come first. I don't know however, if the foundation's webpage would be sufficiently reliable and that's possibly a question for WP:BLPN. I don't do much work on BLP so I can't unfortunately help. Obviously however, WP:NPOV requires neutral reporting, so it would have to reflect that the people have CD and not 'and look what they've done'; the only real detail I could see that could be included as an extra is how the disease has actually affected their personal or professional lives. WLU (talk) 15:32, 12 May 2008 (UTC)
Thanks guys, it gives me a way to research this without my own POV becoming an issue, which I always try to keep out but it's honestly hard to do.  ;) I think that if it does become part of the article then the last part of what WLU says about how the disease affects the personal and professional lives would be the way to attempt it. I will have to think about this some more and do some more research on this area as I am aware that some of them had major battles with the CD to over come to be able to continue their roads to success and/or remission/control of the disease. Thanks to both of you for your input. --CrohnieGalTalk 17:43, 12 May 2008 (UTC)