Über die Autorin bzw. den Autor

Dr. Joan Gomez currently serves as a consultant to the staff of Chelsea and Westminster Hospital in London, England. She is a member of several key medical associations and has been involved in clinical work and research on the relationship between psychiatry and physical medicine. She is the author of four previous books: Coping with Thyroid Problems; How to Cope with Bulimia; Living with Diabetes; and How to Cope with Anemia.

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Positive Options FOR CROHN'S DISEASE

Hunter House Inc., Publishers

Contents

Introduction What Crohn's Disease Is and Why It Matters..................................1Chapter 1. The Digestive System: How It Works...........................................7Chapter 2. Are You at Risk? The Background to Crohn's Disease...........................18Chapter 3. Signs and Symptoms: How Crohn's Disease Manifests Itself.....................30Chapter 4. Children and Adolescents.....................................................40Chapter 5. Patients over Sixty..........................................................48Chapter 6. Effects outside the Digestive System.........................................54Chapter 7. Proper Diagnosis: The Full Range of Tests....................................64Chapter 8. Treatment Options: Medicines.................................................76Chapter 9. Treatment Options: Surgery...................................................91Chapter 10. Ileostomy and Colostomy......................................................105Chapter 11. Diet in Prevention and Treatment.............................................119Chapter 12. Eating Well..................................................................132Chapter 13. Constructing Your Personal Diet..............................................151Chapter 14. Feeling and Coping: The Psychological Aspects................................158Chapter 15. The Research Continues.......................................................167Resources................................................................................171Index....................................................................................175

Chapter One

Imagine a life without eating and drinking-it wouldn't be much fun at all. You would miss out on a recurrent pleasure, a comfort in distress, and the focus of much of our social life, from a formal banquet or a candlelit supper for two to pizza with the family. Yet, for happy eating, you need a digestive system in good working order. It has to perform the everyday chemical magic of turning pizza and apple pie, or whatever you choose, into blood, brain, and bone-all manufactured to your own individual specifications.

To accomplish this miracle, the different parts of the digestive system must coordinate their separate tasks. The timing is crucial: the food must pass down the alimentary tract (the pathway through the digestive system) at exactly the right rate for the processing of each of the varied ingredients of your meal-proteins, carbohydrates, and fats-to be completed. All of this would be pointless without the next stage, the absorption of the processed nutrients into the bloodstream, so that your body can use them. The main area for absorption is the small intestine, the part most seriously affected by Crohn's. The final task of the digestive system is the disposal of the waste matter-down the toilet.

Crohn's disease upsets all of this-absorption in particular, but also the basic work of digestion and elimination-including the time frame. To understand Crohn's it helps to know the main parts of the digestive system and what they do. Besides, it is a fascinating story.

THE ALIMENTARY TRACT

The system operates under computer control. The computer is your brain, and it keeps in touch with every part through the nervous system. The two ends of the alimentary tract, the mouth and the anus, work in response to your conscious decisions-to eat and to go to the toilet. All the rest comes under the influence of the autonomic (automatic) nervous system, and most of the activity is reflex, like a knee jerk. That is, given a particular stimulus, in this case tapping the front of your knee, your knee jerks automatically. You don't have to give it a thought.

Similarly, but in a much more complex way, the arrival of a steak or a piece of chicken in your stomach stimulates a reflex reaction in the stomach glands. They produce just the right amount of the digestive enzyme pepsin to digest the type and amount of protein. Imagine how tiresome it would be if you had to weigh and analyze what you ate, and then had to sit down with pencil and paper to work out which digestive enzymes you would need and the quantities. Instead, the whole system runs on a series of reflexes.

Although Burrill Crohn in the 1930s believed Crohn's could affect only the last few inches of the ileum, the terminal part, by the 1960s other doctors had found that the telltale patches of inflammation could show up anywhere in the alimentary tract. The effects-including your symptoms-differ according to the site of the trouble.

The Mouth

This is the entry point for food, where tasting and savoring help you to decide whether to go ahead and enjoy or spit it out. One job of the mouth is to smash and crunch up the food: this allows the digestive juices to reach all parts of it and also makes it easier to swallow. The other important task depends on the salivary glands, the saliva factories, which output about a quart per day. This slippery fluid lubricates each mouthful, making for easy transit down the esophagus (gullet) to the stomach. Saliva also contributes to oral hygiene by preventing crumbs of food sticking to the lining of the mouth and by washing away the germs that abound in the mouth.

Saliva has another useful role. It contains ptyalin, an enzyme that digests starch. You can test this out for yourself by chewing a piece of bread extra thoroughly. You will find it begins to taste sweet as the starch is digested into sugar. Our grandparents had a point when they advised us to chew every mouthful 32 times, making a mush with the saliva well mixed in and giving it time to work on the starch. An excellent start to digestion.

The salivary glands go into production when they receive information from the brain about the imminent arrival of food. My cat Emma dribbles in anticipation when she sees me open a can of cat food. Our human reflexes are similar, and we speak of something delicious as "mouth-watering." The actual presence of food in the mouth also promotes the flow of saliva. Another stimulus to the flow of saliva is when the stomach has been irritated and you feel nauseous. The extra saliva helps to flush out the harmful material, or at least dilutes it.

The Esophagus

This flexible, collapsible tube connects the mouth with the stomach. It is lined, like the whole of the alimentary tract, by moist, delicate mucous membrane. Mucous glands down its length provide it with a protective covering. Food does not just fall down from the mouth to the stomach, but is massaged along by the muscles in the wall of the esophagus. This is called peristalsis and is a feature of the whole alimentary tract. It makes it possible for circus performers to drink a glass of water while standing on their heads. You can feel the peristalsis working if you accidentally swallow a cherry pit or swallow a mouthful of food without chewing it.

The "law of the gut" is that throughout the alimentary tract, and most obviously in the esophagus and the intestines, peristalsis moves the contents continuously onward in the direction of the anus.

Lorna Lorna had coped with her typical Crohn's...