Essay - Crohn's Disease & Inflammatory Bowel Disease Literature Review Introduction the...

Crohn's Disease & Inflammatory Bowel Disease

LITERATURE REVIEW

INTRODUCTION

***** work of Reissman and Lee entitled: "Introduction to Crohn's *****: Clinical, Economic, ***** Societal Impact" relates that Crohn's disease is a "chronic disorder that causes inflammation of the gastrointestinal tract, most commonly affecting ***** small intestine and colon." (2008) This disease is one most prevalent in the developed world and is said to be principally in North America ***** Western Europe as well as be*****g more ***** found in urban instead of rural areas and occurring "***** often in northern compared to southern locales." (Reissman and Lee, 2008) In Crohn's disease, the flare-ups occur throughout the life of the patient with the patient experiencing symp*****ms ***** may be both mild and even long period free ***** symptoms whereas o*****rs have symptoms that are both persistent and severe.

SYMPTOMS

Mild symptoms are experienced by the majority of patients ***** stated by Reissman and Lee to respond well to treatment leaving the majority of patients to "cope well with the disease."(Reissman and Lee, *****) For the minority of patients with Crohns disease this ***** can be one that is both "burdensome and debilitating" and one that carries ***** it "***** prospect of years ***** medical care, hospitalization and surgery." (Reissman and Lee, 2008) The quality of life of the patient is greatly impacted for these patients as well as many disruptions being caused ***** family and marital relationships. Symptoms of Crohn's disease interfere with work, social activities ***** sexual activities including affecting school and work attendance as well as the patient ***** able to acquire insurance.

ETIOLOGY

Reissman ***** ***** state ***** precise etiology of Crohn's ***** is unknown however, it is known that Crohn's disease "involves immune system dysfunction. An imbalance in local mucosal production of pro-inflamma*****ry cytokines over anti-inflammatory cytokines is theorized as the ***** cause. (2008) ***** pathogenesis of Crohn's disease is multifactorial and involves several infectious agents combined ***** environmental exposures "***** activate an immune response in a genetically susceptible person." (2008) It has long been held that bacteria ***** some involvement in ***** pathogenesis of Crohn's ***** while there has not been a singular bacterium identified definitely.

GENETICS

***** is suggestion of a genetic component due to clustering of Crohn's disease *****d a positive family history has been found in 10 to 15% of patients with Crohn's disease. Reissman and Lee (2008) report a recent breakthrough ***** a team of investigators "who identified the first CD susceptibility gene, NOD2/CARD15. The gene mutation limits the immune system's ability to recognize bacteria as harmful and occurs twice as frequently in CD ***** as in the *****ral population. A recent genome-wide association study identified interleukin (IL)-23R as an inflammatory bowel disease gene. Ongoing and future research may target the IL-23 signaling pathway in the treatment of *****." (Reissman and Lee, 2008)

*****

There is a variation in the presentation ***** ***** disease in individual patients, which makes ***** accurate diagnosis of Crohn's ***** difficult. Crohn's disease is stated to: "...most