functional medicine and nutritional genomics - American Association ...
functional medicine and nutritional genomics - American Association ...
functional medicine and nutritional genomics - American Association ...
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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS<br />
painful. Crohn's disease (CD) <strong>and</strong> ulcerative colitis<br />
(UC) are two forms of inflammatory bowel disease<br />
(IBD).<br />
As researchers try to underst<strong>and</strong> the long unknown<br />
etiology of CD, there does not appear to be one<br />
precise cause of CD. However, it is clear that CD is<br />
relapsing in nature <strong>and</strong> it affects all layers of the<br />
intestines from mouth to anus. In comparison, UC is<br />
generally limited to the large bowel <strong>and</strong> does not<br />
necessarily affect all layers of the intestine<br />
The anatomical location <strong>and</strong> behavior of CD can<br />
change over time. At diagnosis, the disease is located<br />
in the terminal ileum in 47%, the colon in 28%, the<br />
ileocolon in 21% <strong>and</strong> the upper GI tract in 3% of<br />
cases, respectively (7,8). ‚Patches‛ of asymmetrical<br />
intestinal inflammation <strong>and</strong> ulceration are seen in CD,<br />
interspersed between areas of healthy tissue (9). The<br />
inflammation <strong>and</strong> ulceration can potentially extend<br />
deeply into the intestinal wall, forming granulomatous<br />
lesions. The clinical presentation of patients diagnosed<br />
with CD is largely dependent on disease location. It<br />
can include some or all of the following symptoms:<br />
frequent diarrhea; lower right quadrant abdominal pain<br />
appearing soon after meals; bowel obstruction; fatigue;<br />
weight loss; low appetite; fever; stomatitis; passage of<br />
blood, mucus or both; <strong>and</strong> perianal fistulae or fissures.<br />
87<br />
2012<br />
Some patients also present with arthritis <strong>and</strong> erythema<br />
nodosum lesions on the extremities. Failure to thrive is<br />
observed in 75% of pediatric CD patients (10).<br />
Approximately 10-15% of patients with disease<br />
confined to the colon <strong>and</strong> rectum present with<br />
‚indeterminate colitis‛, in which the clinician is unable<br />
to definitively distinguish between ulcerative colitis <strong>and</strong><br />
Crohn's disease (9). In such cases, blood tests that<br />
detect autoantibodies for "perinuclear anti-neutrophil<br />
antibody" (pANCA) <strong>and</strong> "anti-Saccharomyces<br />
cerevisiae antibody" (ASCA) are used to assist with a<br />
differential diagnosis (9). Frequently, those with UC<br />
present with the pANCA blood antibodies, while those<br />
with CD present with the ASCA antibodies. Although<br />
not every individual with UC <strong>and</strong> CD fits ‚neatly‛ into<br />
this profile, this approach is often helpful in<br />
distinguishing the two types of IBD (9).<br />
In 1932, a group of three scientists, Ginzburg,<br />
Oppenheimer <strong>and</strong> Dr. Burrill B. Crohn, published a<br />
paper describing the features of an inflammatory bowel<br />
disease that was ultimately named Crohn’s disease in<br />
honor of Dr. Crohn (9). Several categories of CD<br />
have been described, defined by the portion of the<br />
digestive tract involved <strong>and</strong> the presenting<br />
symptomatology (Table 1).<br />
Table 1. Subcategories <strong>and</strong> Symptoms of Crohn's Disease (9)<br />
SUBCATEGORY AREAS AFFECTED<br />
Crohn's (Granulomatous) Colitis<br />
Affects the colon only. Symptoms include diarrhea,<br />
rectal bleeding, <strong>and</strong> disease around the anus<br />
(abscess, fistulas, ulcers). Skin lesions <strong>and</strong> joint<br />
pains are more common in this form of Crohn's<br />
than in others.<br />
Gastroduodenal Crohn's Disease Affects the stomach <strong>and</strong> duodenum. Symptoms<br />
include loss of appetite, weight loss, <strong>and</strong> nausea.<br />
Vomiting may indicate that narrowed segments of<br />
the bowel are obstructed.<br />
Ileitis Affects the ileum. Symptoms same as ileocolitis.<br />
Complications may include fistulas or inflammatory<br />
abscess in right lower quadrant of abdomen.<br />
Ileocolitis The most common form of CD, affecting the<br />
ileum <strong>and</strong> colon. Symptoms include diarrhea <strong>and</strong><br />
cramping or pain in the right lower part or middle<br />
of the abdomen. Often accompanied by significant<br />
weight loss.<br />
Jejunoileitis Produces patchy areas of inflammation in the<br />
jejunum. Symptoms include abdominal pain