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Regional Enteritis

Regional enteritis is also known as Crohn’s disease, being a medical condition in which the gastrointestinal tract suffers from chronic inflammation. The inflammation is commonly found at the level of the small and the large intestine but, in general, it can affect any part of the GI tract. The condition was named after the person who discovered it – Burrill Crohn – in 1932. Doctor Crohn was a gastroenterologist and he identified this condition in a series of patients who had chronic inflammation at the level of the small intestine (most common form of regional enteritis, even today).

Regional enteritis is more common in the countries of Europe and in North America, affecting approximately 3.2 in 1000 people. It is less commonly encountered in the regions of Asia or Africa. Each year, thousands of deaths are caused by the complications of this condition – it is believed that the life expectancy of those diagnosed with regional enteritis is slightly reduced. The onset of regional enteritis is often seen in the puberty period and there are no gender differences when it comes to the number of patients diagnosed with this condition. Despite extensive research, Crohn’s disease cannot be cured; however, the available treatments allows for the symptoms to be kept under control.

Regional Enteritis Symptoms

These are the most common symptoms that are encountered in patients diagnosed with regional enteritis:

Pain in the abdomen
Accelerated bowel movements (diarrhea)
Blood may be present in the stool (not in all patients)
- Less common in the chronic inflammation of the colon
- Symptom comes and goes
- Bright or dark red in color
- Severe cases – intense bleeding
Inflammation at the level of the ileum – the stools are characterized by a high volume and a water-like consistency
Inflammation at the level of the colon – the stools are characterized by a reduced volume and a high frequency; the consistency of the feces can range from watery to solid
Severe cases
- More than 20 bowel movements per day
- Also bowel movements at night
Flatulence and bloating accompany the other symptoms
Vomiting and nausea are also encountered in those who suffer from intestinal stenosis
Inflammation of the bile ducts
Perianal discomfort
- Itchiness
- Pain around the anus
- Fistula or abscess in the anal area
- Anal fissures
- Perianal skin tags
- Fecal incontinence
Aphthous ulcers at the level of the mouth
Rare cases – involvement of the esophagus or the stomach
- Difficult swallowing (dysphagia)
- Pain in the upper part of the abdomen
- Vomiting and nausea
Systemic symptoms
- Growth failure in children
- Fever
  - Low-running fever is common, due to the chronic inflammation
  - High-running fever appears in case of complications (abscess, for example)
- Weight loss – due to the reduced food intake
  - Patients often notice they feel better when they do not eat (reduced appetite)
- In case of severe cases, with chronic inflammation of the small intestine
  - Malabsorption – carbs, lipids
  - The malabsorption contributes to the accelerated weight loss

Other symptoms

Uveitis (the interior portion of the eye is inflamed)
- Blurry vision
- Pain in the eye
- Photophobia (increased sensitivity to light)
Episcleritis
- The white part of the eye is inflamed
- Can lead to loss of vision, if no treatment measures are taken
High susceptibility for stones at the level of the gall bladder
- Often encountered in patients diagnosed with ileitis (chronic inflammation of the ileum)
Rheumatologic conditions (in association with regional enteritis)
- Seronegative spondyloarthropathy
  - Inflammation of the joints (arthritis)
    - Affecting the joints that are responsible for the bearing of the weight (knees, hips, shoulders, wrists, elbows)
    - Affecting the small joints of the hands or feet
    - Arthritis of the spine – ankylosing spondylitis, sacroiliitis
  - Inflammation of the muscle insertions (enthesitis)
Modifications at the level of the skin
- Erythema nodosum (nodules that are tender and red in color, appearing most commonly on the shins)
- Pyoderma gangrenosum (ulcerating nodules that are extremely painful)
Increased risk for blood clots
- Deep vein thrombosis
- Pulmonary embolism
Autoimmune hemolytic anemia symptoms
Finger deformity
- Clubbing (end of the fingers present an abnormal shape)
Increased risk for osteoporosis
- Bones are thinner – increased risk for fractures
Iron deficiency due to the chronic blood loss
Neurological symptoms
- Seizures
- Cerebrovascular stroke
- Myopathy
- Peripheral neuropathy
- Headache
Depression and anxiety
Bacterial overgrowth at the level of the intestines
Modifications at the level of the oral cavity
- Cheilitis granulomatosa
- Geographic tongue
- Migratory stomatitis

Causes

These are the causes incriminated for the appearance of regional enteritis:

Environmental factors
- Consumption of animal proteins and dairy products
- Contraceptives usage
Genetic predisposition
- Inherited risk for developing regional enteritis
- Genetic mutation
Smoking
- Increased risk for flare-ups
Impaired innate immunity
- Due to the reduced immunity, the colon responses to the bacterial overgrowth through the chronic inflammation
- Impaired ability to attack the bacteria that appears at the level of the colon
- Modern hygiene – might have affected the strength of the immune system
Different microorganisms (especially in individuals with weakened immunity)
- Mycobacterium paratuberculosis
- E. coli
- Blastocystis
- Yersinia
- Listeria
Other potential causes
- Isotretinoin
- Stress
- Toothpaste ingredients.

Diagnosis

These are the most common methods used for the diagnosis of regional enteritis:

Colonoscopy – especially recommended in patients who are suspected of colitis (chronic inflammation of the colon)
Capsule endoscopy – indicated in patients who present symptoms of ileitis (inflammation of the ileum, part of the small intestine)
Imaging investigations – CT or MRI (better visualization of the structures affected by the chronic inflammation; can be used to determine whether there are other parts or organs of the body affected as well)
Endoscopic biopsy – can be useful for the identification of the chronic inflammation and the confirmation of the diagnosis.

Other tests

Gastroscopy
Barium X-ray
Barium enema
CBC (complete blood count)
Testing for antibodies (detection of previous infections).

Treatment

These are all the treatments and measures that can be taken in order to improve the symptomatology of regional enteritis:

Change of the diet
- Increased fiber intake
- Elimination of fatty or refined foods from the diet
- No more dairy or wheat-based products in the diet
Increased hydration
Quitting smoking (reduced risk for flare-ups)
Reduction of portion size
Physical exercise to reduce the chronic fatigue
Getting enough sleep is also recommended
Keeping a food diary – recommended so as to identify the foods that might aggravate the existing inflammation
Medication
- Antibiotics for acute infections
- Anti-inflammatory medication – pain relief and reduction of inflammation (symptomatic treatment).
- Corticosteroids
  - Cannot be administered for prolonged periods of time, as they can have negative consequences over a person’s health
  - Recommended choice – prednisone
  - Hydrocortisone – recommended only in severe cases of regional enteritis
- Aminosalicylates
  - Also require the administration of immunosuppressive medication
  - Recommended choice – aminosalicylic acid
- Immunomodulators
  - Azathioprine
  - Methotrexate
  - Infliximab
  - Adalimumab
  - Certolizumab
- Iron supplements
  - Recommended in patients who present iron-deficiency anemia, due to the chronic blood loss
  - Parenteral iron is recommended to be administered, due to the better absorption and the reduced risk of GI effects
Blood transfusions
- For anemic patients recommended as well (so as to compensate for the blood loss)
- Often performed in those who also suffer from heart disease
Surgical intervention
- In case of bowel obstruction (total or partial)
- Other potential reasons for surgery – fistula, abscess
- Can be recommended in case the symptoms are not alleviated by medication
- Intestinal transplant surgery (high risk of infection or rejection of the transplant)
Other solutions
- Acupuncture
- Homeopathy

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