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  Crohn's Disease  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea. Ulcerative colitis and Crohn's disease are known as the inflammatory bowel diseases (IBD). When the intestinal immune system does not function properly, many white blood cells accumulate in the inner lining (mucosa) of the gut. The white cells then release chemicals that lead to tissue injury in the form of inflammation. This inflammation of the mucosa can cause diarrhea, which is the most common symptom of IBD, with or without intestinal complications.

The precise cause of IBD remains unknown. These diseases are believed to be caused by a combination of genetic and non-genetic, or environmental factors (such as infections) that interact with the body's immune system. Based on a study of 3,545 people who received live measles vaccine as children, their rate of developing Crohn's was 3 times higher compared to an unvaccinated group.

The two primary sites for Crohn's disease are the ileum, which is the last portion of the small bowel (ileitis, regional enteritis), and the colon (Crohn's colitis). The condition begins as small, microscopic nests of inflammation which persist and smolder. The lining of the bowel can then become ulcerated and the bowel wall thickened. Eventually, the bowel may become narrowed or obstructed and surgery may be needed.

The diagnosis is suggested by signs and symptoms. Additional testing to help make the diagnosis may include barium x-rays of the upper and lower GI tract, flexible sigmoidoscopy, and sometimes colonoscopy. The last two tests permit a direct examination of the colon with a lighted tube inserted through the anus. During these tests, biopsies may be obtained to help make a diagnosis. Laboratory tests are also helpful and include evaluation of the blood and stool.

Because Crohn's disease often mimics other conditions and symptoms may vary widely, the correct diagnosis of Crohn's disease may take some time.
 

 
 

Signs, symptoms & indicators of Crohn's Disease:
 
 
Symptoms - Bowel Movements  Significant/frequent blood in stools
  Regular/occasional/frequent painful urge to defecate
  (Very) frequent stools or normal stool frequency
  Having very watery/having loose stools
  Mucous in stools

Counter-indicators:
  Having normal stool texture or having hard stools
  Occasional painful urge to defecate
  (Very/tendency to) infrequent stools

Symptoms - Food - General

  Weak appetite

Symptoms - Gas-Int - General

  (Right/left) lower abdominal ache
  Severe left/severe/severe right lower abdominal pain

Symptoms - Metabolic

  Frequent/occasional unexplained fevers
  Having a high/having a moderate/having a slight fever

Symptoms - Reproductive - General

  Genital sores
 Medical illnesses such as Crohn's Disease can on occasion cause genital lesions.

  Painful perineum
 Metastatic Crohn's disease is the term used for granulomatous lesions of Crohn's disease involving sites other than the gastrointestinal tract. On rare occasion, this may involve the perineal area.
 
 

Conditions that suggest Crohn's Disease:
 
 
Autoimmune  Ankylosing Spondylitis
 Bowel inflammation is somehow tied to the development of ankylosing spondylitis and this is the reason why people with Crohn's disease or ulcerative colitis are at increased risk of the illness.


Counter-indicators:
  Gluten Sensitivity / Celiac Disease
  Ulcerative Colitis

Circulation

  Anemia (Iron deficiency)

Diet

  Dehydration

Digestion

  Increased Intestinal Permeability / Leaky Gut
  Heartburn / GERD
 Crohn's disease is a chronic ailment that causes inflammation and injury in the colon and other parts of the gastrointestinal tract, including the esophagus.

Infections

  Helicobacter Pylori Infection
 Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn's disease. Researchers recently reported that "after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn's disease] was achieved in all patients", regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.

"What this shows is that by eradicating H. Pylori infection... we achieved a remission of Crohn's disease," Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn's disease. But it does raise the issue of "whether regimens aimed at eradicating H. Pylori in infected patients with Crohn's disease may also achieve remission of Crohn's disease."

Inflammation

  Episcleritis

Lab Values

  Elevated Homocysteine Levels
 See the link between Elevated Homocysteine and Ulcerative Colitis.

Nutrients

  Folic Acid Requirement
 All inflammatory bowel disease patients are prone to low serum folate levels.

Organ Health

  Poor Small Intestine Health

Symptoms - Gas-Int - Conditions

Counter-indicators:
  Absence fo Crohn's disease
 
 

Risk factors for Crohn's Disease:
 
 
Autoimmune  Gluten Sensitivity / Celiac Disease
  Autoimmune Tendency

Childhood

  Vaccinations
 Based on a study of 3,545 people who received live measles vaccine as children, their rate of developing ulcerative colitis was 2.5 times higher (3 times higher for Crohn's) compared to an unvaccinated group.

Circulation

  Hypercoagulation (Thickened Blood)

Environment / Toxicity

  Fungus / Mycotoxin Exposure
 Some scientists have directly implicated yeast and fungal mycotoxins in the cause of Crohn’s disease. Former World Health Organization expert Dr. A.V. Costantini has found that people with Crohn’s often have aflatoxin, a mycotoxin made by Aspergillus molds, in their blood. Also, disease activity in patients with Crohn’s was lower while they followed a yeast-free diet, specifically avoiding baker’s and brewer’s yeasts. [Scand J Gastro. 1992; 27: pp.196-200]

Hormones

  Low Adrenal Function / Adrenal Insufficiency

Infections

  Dysbiosis, Bacterial
 During the early 1980s, exaggerated immunologic responses to components of the normal fecal flora were proposed as possible mechanisms behind inflammatory bowel disease. Little progress has been made in confirming or disproving this theory, although bacterial overgrowth of the jejunum has been found in 30% of patients hospitalized for Crohn's disease, in which it contributes to diarrhea and malabsorption. The demonstration of increased intestinal permeability in patients with active Crohn's disease and in healthy first degree relatives suggests the existence of a preexisting abnormality, such as dysbiosis, that allows an exaggerated immune response to normal gut contents to occur.

Elimination diets can induce remission in Crohn's disease as effectively as prednisone. The primary bacteriologic effect of elemental diets is to lower the concentration of Lactobacilli in the stool drastically without altering levels of other bacteria.

  Mycoplasma Infection
  Yeast / Candida

Lab Values - Chemistries

  Trace/significant amounts of occult blood or history of occult blood

Symptoms - Food - Intake

  (High) dairy product consumption
 Johne's disease is an infection that cows pass on to humans as irritable bowel syndrome. Johne's disease has no cure and costs dairy producers over $1.5 billion each year [Source: USDA]. The bacterium, Mycobacterium avium paratuberculosis (MAP) causing Johne's is not killed by pasteurization and is passed onto consumers in milk, cheese and ice cream. Forty million Americans have irritable bowels and over 500,000 have gone on to develop Crohn's disease.

"Mycobacterium paratuberculosis RNA was found in 100% of Crohn's disease patients, compared with 0% of controls." [Mishina, Proceedings National Academy of Sciences USA: 93: September, 1996]

The bacterium (MAP) does not cause tuberculosis in humans, but there is growing evidence linking it to Crohn's disease. British tests, released in January 2000, showed that Mycobacterium paratuberculosis can survive pasteurization, prompting the USDA to re-examine 1999 tests that showed pasteurization kills it.

Symptoms - Gas-Int - Conditions

Counter-indicators:
  Colitis

Symptoms - Metabolic

  Recent unexplained weight loss

Symptoms - Nails

  Some/possible clubbing of digits or clubbing of toes and fingers

Counter-indicators:
  Absence of clubbing
 
 

Crohn's Disease suggests the following may be present:
 
 
Autoimmune  Autoimmune Tendency
  Gluten Sensitivity / Celiac Disease

Emergency Care

  A Potentially Urgent Medical Need

Infections

  Helicobacter Pylori Infection
 Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn's disease. Researchers recently reported that "after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn's disease] was achieved in all patients", regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.

"What this shows is that by eradicating H. Pylori infection... we achieved a remission of Crohn's disease," Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn's disease. But it does raise the issue of "whether regimens aimed at eradicating H. Pylori in infected patients with Crohn's disease may also achieve remission of Crohn's disease."

  Dysbiosis, Bacterial
 During the early 1980s, exaggerated immunologic responses to components of the normal fecal flora were proposed as possible mechanisms behind inflammatory bowel disease. Little progress has been made in confirming or disproving this theory, although bacterial overgrowth of the jejunum has been found in 30% of patients hospitalized for Crohn's disease, in which it contributes to diarrhea and malabsorption. The demonstration of increased intestinal permeability in patients with active Crohn's disease and in healthy first degree relatives suggests the existence of a preexisting abnormality, such as dysbiosis, that allows an exaggerated immune response to normal gut contents to occur.

Elimination diets can induce remission in Crohn's disease as effectively as prednisone. The primary bacteriologic effect of elemental diets is to lower the concentration of Lactobacilli in the stool drastically without altering levels of other bacteria.

Musculo-Skeletal

  Osteoporosis / Risk
 Getting enough calcium and protecting against bone loss is a challenge for those with Crohn's Disease.

Any digestive disorder carries the threat of nutritional deficiency, and Crohn's is particularly tricky. First, the chronic diarrhea and other symptoms of the disease can make it tough to get adequate nutrition from even the healthiest diet. Then, Crohn's patients are often on corticosteroids for long periods of time to relieve the intestinal inflammation. These medications further deplete the system of calcium. These factors explain why, next to the intestinal aspects of the disease, degenerative bone disorders top the list of Crohn's disease complications.
 
 

Crohn's Disease can lead to:
 
 
Diet  Dehydration

Inflammation

  Episcleritis

Nutrients

  Folic Acid Requirement
 All inflammatory bowel disease patients are prone to low serum folate levels.

Organ Health

  Poor Small Intestine Health

Risks

  Increased Risk of Colon Cancer
 Inflammatory bowel disease increases the risk of colon cancer.
 
 

Recommendations for Crohn's Disease:
 
 
Amino Acid / ProteinNot recommended:
  Glutamine
 Although glutamine is known to play a role in small intestine function, in Crohn's disease at least two studies have shown it to be mildly harnful. [J Parenter Enteral Nutr 24:196, 2000]

Animal-based

  Probiotics / Fermented Foods
 Use of a good probiotic product can help keep the bacterial flora in balance and reduce inflammation. Caution is advised with active inflammation, as bacteria may penetrate the gut wall and enter the blood stream.

  Urine Therapy
  Cetyl-myristoleate

Botanical

  Aloe Vera
  Robert's Formula
 See the link between Crohn's and Slippery Elm.

  Slippery Elm (Ulmus rubra)
 Slippery elm's soothing mucilage effect has been used for disorders of the gastrointestinal tract. It is part of the herbal combination called "Robert's Formula", which is widely prized by naturopathic physicians for such intestinal inflammations as gastritis, Crohn's disease, and ulcerative colitis. For digestive disorders, taking 500-1,000mg of powder tid is often recommended. It may be used in lozenge form as well.

  Chlorella / Algae Products

Diet

  Dairy Products Avoidance
 Mycobacterium paratuberculosis (Para-T) RNA (a bacteria causing Johne’s disease in cows) was found in 100% of Crohn's disease patients, compared with 0% of controls.

This bacteria becomes cultured in milk, and is not destroyed by normal pasteurization. Para-T crosses the species barrier to infect and cause disease in humans. Occasionally, the milk-borne bacteria will begin to grow in the human host, and irritable bowel syndrome and Crohn's disease results. The USDA estimates that 30% of America's dairy herds contain cows infected with Para-T.

  Therapeutic Fasting
 Fasting is an important element of treatment if a sustained remission is to be expected.

  Gluten-free Diet
 See the link between Crohn's and Sugar Avoidance / Reduction.

  Sugars Avoidance / Reduction
 Elaine Gottschall, author of Breaking the Vicious Cycle, has proposed that gut dysbiosis is a major cause of Crohn's disease, with small and large bowel fermentation being a key component. She has used a Specific Carbohydrate Diet (SCD) restricted in disaccharide sugars and devoid of cereal grains to alter gut flora. When digestion of carbohydrates such as starches and some sugars is impaired, these items are poorly absorbed. Yeast and bacteria can then overgrow in response to these newly available nutrients, increasing toxic by-products and mucus production, resulting in further injury to the small intestine and malabsorption. Digestion is worsened - thus "the vicious cycle". The purpose of the SCD is to deprive the microbial world in the small intestine of food it needs to overpopulate and irritate.


Not recommended:
  Increased Fruit/Vegetable Consumption
 In one trial, patients (rather than doctors) were asked which foods aggravated Crohn’s disease symptoms. Those without an ileostomy said that raw fruit and tomatoes were among the most problematic foods, though responses varied from person to person, and other reports have come up with different lists. People with Crohn’s disease wishing to identify and avoid potential problem foods should consult a doctor.

Drug

  LDN - Low Dose Naltrexone
 As of September 2002, Dr. Bihari was following eight patients with Crohn's Disease on LDN. In all eight cases, within 14-21 days the signs and symptoms of disease activity stopped. All eight had remained stable since anywhere from 2 months to 36 months.

Dr. Jill Smith’s original article, "Low-Dose Naltrexone Therapy Improves Active Crohn’s Disease," in the American Journal of Gastroenterology (2007;pp.102:1–9), officially presents LDN to the world of scientific medicine. Smith, Professor of Gastroenterology at Pennsylvania State University's College of Medicine, found that two-thirds of the patients in her pilot study went into remission and fully 89% of the group responded to treatment to some degree. She concluded that “LDN therapy appears effective and safe in subjects with active Crohn’s disease.”

The Promise Of Low Dose Naltrexone Therapy: Potential Benefits in Cancer, Autoimmune, Neurological and Infectious Disorders. By Elaine Moore, co-author SammyJo Wilkinson Foreword by Dr. Yash Agrawal, MD, PhD.

This is perhaps the first, and so far only book on LDN, and as such represents a milestone in the effort to bring LDN into mainstream use. Written by Elaine Moore, a high level science writer with a portfolio of previous accomplishments, her LDN book is perhaps somewhat technical and may be difficult for the untrained non-professional to follow. It delves into the sophisticated jargon of the medical research world. For example, in Chapter 5 on LDN and Cancer, there is a discussion of Zagon's work on Cyclin dependent kinases, P53 and protein 21 and how this relates to inhibition of cancer by LDN.

However, in addition to the esoteric technical sections of the book, there are also chapters devoted to the lay reader interested in learning how LDN can help them on a practical level. A listing of dispensing practitioners was included which I found contained my own office address and phone number.

The book is highly recommended for other health care practitioners who wish to get quickly up to speed in this new area of medicine which is destined to become the medical paradigm of the 21st century, casting a giant shadow over the rest of mainstream medicine.[ Comments on the LDN book by Jeffrey Dach MD]

  Conventional Drugs / Information
 Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients. For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC. Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions). Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers. The research published in issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.

Centocor, Inc., Schering-Plough Corporation, and Mitsubishi Tanabe Pharma Corporation have announced that an estimated one million patients have now been treated with REMICADE® (infliximab), the leading anti-tumor necrosis factor (TNF)-alpha therapy worldwide. In fact, REMICADE has been used to treat more patients worldwide than all other anti-TNF-alpha agents combined. REMICADE was the first anti-TNF-alpha treatment approved by the U.S. Food and Drug Administration (FDA), when it was indicated for the treatment of acute moderate to severe Crohn's disease in 1998. The indication for Crohn's disease was quickly followed by additional indications, such as rheumatoid arthritis.

REMICADE has been studied in more than 37 clinical trials, evaluating its use in a wide variety of diseases of the immune system and is approved for use in 88 countries.

Extract

  Plant Sterols / Sterolins (Phytosterols)
 Although clinical studies have not been conducted using sterols and sterolins, based on existing research for other conditions, it is foreseeable that taking sterols and sterolins in cases of IBD will result in controlling the immune onslaught taking place on the mucosal surface. Sterols and sterolins will decrease the release of the inflammatory factors, get the good T cells to secrete the good factors, and induce a state of balance in the immune response. By so doing, it will allow repair mechanisms to kick in and recovery from such chronic conditions to take place.

Habits

  Tobacco Avoidance
 A study of 474 smokers with Crohn's disease found that patients who stopped smoking for more than 1 year had similar rates of flare-ups as patients who never smoked, and both groups had fewer problems than current smokers. Quitters, for example, had a 65% lower risk of flare-up than patients who were still smoking [Gastroenterology, April 2001]. Furthermore, smoking significantly increases the likelihood for Crohn's disease symptoms after surgery, particularly in women and heavy smokers.

Lab Tests/Rule-Outs

  Test for Helicobacter Pylori Infection
 Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn's disease. Researchers recently reported that "after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn's disease] was achieved in all patients", regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.

"What this shows is that by eradicating H. Pylori infection... we achieved a remission of Crohn's disease," Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn's disease. But it does raise the issue of "whether regimens aimed at eradicating H. Pylori in infected patients with Crohn's disease may also achieve remission of Crohn's disease."

  Test for Food Allergies
 Finding out which foods may be triggering the inflammatory reaction is an important part of treating this disease. Often wheat, corn, dairy, and eggs are involved as in ulcerative colitis.

  Hydrochloric Acid (Trial)
  Test CBC (Complete Blood Count)
  Test for Occult Blood

Mineral

  Zinc
 Tissue damaged by Crohn's disease has an enhanced recovery rate with adequate zinc.

  Calcium
 One study took a look at a drug called etidronate to see if it would help protect the bones of people with Crohn's disease. The bad news: It didn't. The good news: The vitamin D and calcium supplements that were taken in the control group were highly effective all on their own.

  MSM (Methyl Sulfonyl Methane)

Miscellaneous

  Reading List
 Please see the link between Crohn's and LDN.

Nutrient

  Superoxide Dismutase
 A study from France demonstrated the use of an antioxidant called superoxide dismutase and desferoxamine (an iron chelating drug) which allowed 82% of severe Crohn's patients to go into remission.

  Essential Fatty Acids
 A study by Japanese researcher Kuroki found that, compared with control subjects, Crohn's patients had lower concentrations of Omega-3 essential fats and higher concentrations of the monounsaturated fatty acids Omega-7 and Omega-9. These results indicate EFA deficiency. Among the fatty acids that correlated with the Crohn's disease activity index, EPA and total Omega-3 polyunsaturated fatty acids showed the most significant negative correlations. The less of these fatty acids present, the worse the disease. [Digestive Diseases and Sciences; 1997; 42(6): pp.1137-1141, Fatty Acid Patterns in Patients with Chronic Intestinal Disease, Metabolism 1996; 45(1): pp.12-23]

Fish oil, the only current means of getting EPA without equal amounts of DHA, may delay relapses in Crohn's disease due to its anti-inflammatory effect. Dr Belluzzi, MD tried a new way of delivering the fish oil to the intestine by putting it in a capsule that would not dissolve in the stomach for at least 30 minutes. As a result, the overall dose of fish oil could be reduced by a third and the unpleasant taste of the oil was avoided. 78 Crohn's patients took part in a trial for one year; 39 were given the fish oil and the other 39 were given a placebo in an identical capsule.

At the end of the year the doctors checked which patients were still in remission and which had experienced a flare-up of symptoms. 59% of the patients who took the fish oil were still in remission, compared with only 26% of those who were given the placebo.

About 10% of the patients who were given the fish oil dropped out of the trial because of increased diarrhea, but Dr Belluzzi believes that the coated fish oil capsules could offer an effective way to prolong remission for Crohn's patients. The patients involved in the trial had some evidence of mild inflammation before starting the trial and that the fish oil may have helped by treating this rather than by preventing inflammation from actually starting. He estimates that about 30-40% of Crohn's patients are likely to have a mild level of inflammation similar to those people involved in the trial.

Vitamins

  Vitamin E
 Dr. Antonio J. DeLiz treated an advanced case of Crohn's disease with remarkable results using 16,000IU of vitamin E daily. Dr. Wilfred Shute, too, was able to bring relief to several individuals with Crohn’s disease who telephoned or wrote him after a particular lecture in Australia.

  Vitamin D
 See the link between Autoimmune Tendency and Vitamin D.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Colitis:  Inflammation of the colon.

Colon:  The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Diarrhea:  Excessive discharge of contents of bowel.

Enteritis:  Sometimes Enteritis regionalis: Localized inflammation of the intestine.

Esophagus:  Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Helicobacter Pylori:  H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Irritable Bowel Syndrome:  (IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.

Jejunum:  The lower end of the small intestine.

Mucosa:  Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).

RNA:  A ribonucleic acid found in plant and animal cells; a complex protein chemical. Important in the coding of genetic information with DNA carrying information from the nucleus of the cell into the cytoplasm.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Spondylitis:  Inflammation of one or more vertebrae.

Tuberculosis:  Also known as TB, Consumption or "The White Plague", tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, usually affecting the lungs but possibly also the brain, kidneys and bones. Patients may at first be symptom-free or experience a flu-like illness. In the secondary stage, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. There might also be chest pain and shortness of breath.

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.

USDA:  United States Department of Agriculture

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.

Yeast:  A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.