Q:I have suffered for a number of years from anal/rectal pain and discomfort which also effected the perineum. During the past half year the trouble has spread elsewhere in my stomach and colon. Unable to get a satisfactory diagnosis, I studied a number of publications on "gut" subjects and have regretfully come to the conclusion that Crohn's disease may be the cause, despite my age - 71 and female. It is clear from what I have read that not much is known as to the cause of the disease, nor is there any known cure. Corticosteroids and sulphonamides appear to be the main drugs used to treat it. A new one, referred to as 5-ASA, is now being tried, but I have been unable to find out much about it. Can you help? C. R., London.......
A:Crohn's disease is ordinarily a disease of young adulthood between age 10 and 25, although it has been known to affect young children and older adults as well. Any part of the lining of the small intestine and/or colon becomes inflamed, causing diarrhoea (often with blood), weight loss, gastrointestinal bleeding, abdominal pain and frequent bowel movements. It can become a chronic condition.Although the cause is unknown, some nutritional researchers believe Crohn's disease has something to do with allergy or food intolerance, particularly to lactose rich foods like cream or milk.
Ulcerative colitis, on the other hand, is an inflammation of the bowel affecting only the rectum or the colon. This problem causes frequent bowel movements and diarrhoea accompanied by blood or mucus. Some researchers believe it occurs in families with intolerance to cow's milk, eczema, hay fever or polyarthritis. It can also be caused by drugs, particularly aspirin, and has often responded to a low salicylate diet. Foods high in salicylates include: most fruits and many vegetables, coffee, tea, fruit juices, alcoholic drinks and, of course, aspirin. Sometimes cutting out sugar and refined carbohydrates alone can help.
Crohn's patients can be particularly susceptible to zinc, and vitamins A, D, and B deficiencies. Our panel member Annemarie Colbin has found that many sufferers can tolerate fruits and vegetables so long as they are cooked.
The usual drug treatments include corticosteroids like prednisolone. The idea is to calm the inflammation. According to Peter Parish, who has written the excellent Medical Treatments The Benefits and Risks (Penguin), these drugs should only be taken for a few weeks and then gradually tapered off; prolonged use can overstimulate the adrenal glands, producing Cushing's Syndrome, hyperglycaemia, diabetes, muscle weakness, and skin atrophy or thinness. Drugs such as sulphasalazine, a salicylate/sulphonamide combination, are also used to treat attacks, often in combination with prednisolone. Sulphasalazines have two properties in the bowel as a sulphonamide anti bacterial drug, and as an anti inflammatory drug called 5-amino-salicylic acid (5-ASA).
According to Parish, one fifth of all patients develop side effects from sulphasalazine. These include anything from nausea and vomiting to reduced sperm count and damage to red or white blood cells, or to the liver, kidneys, pancreas, nerves or hearing. Consequently, drug companies have attempted to put together a drug free of the sulphonamide, which has always been necessary to prevent the 5-ASA portion from being absorbed before it has a chance to reach the colon.
Mesalazine is such a new product. The 5-ASA is coated with a resin which only releases the drug when it arrives at the colon. Among its harmful effects are diarrhoea, abdominal pain and a flare up of the colitis in other words, all the symptoms you're taking the drug to stop! That makes sense when you consider that mesalazine and many of these other colitis/Crohn's disease drugs are in the salicylate family. If your problem is caused by an allergy to salicylates, the drug is only making the problem worse. And either drug could be causing the mouth ulcers.
It may well be worth finding a practitioner who knows something about the dietary/allergy approach to managing these diseases before deciding to continue indefinitely on drugs with extremely powerful and potentially damaging effects.