ABOUT CROHN'S DISEASE
Crohn’s Disease affects about 3.2 per 1000 in North America and Europe and cases are rapidly growing in Asia, and parts of South America. As a consequence, the increasing global burden regarding healthcare costs is significant. In addition, the disease substantially impacts the quality of life of those who are afflicted. Read more here about Crohn's and how we hope to help cure it.
What is Crohn's Disease?
Crohn’s disease is a debilitating inflammatory bowel disease (IBD) that causes inflammation anywhere along the digestive tract from the mouth to the anus. This inflammation can involve different areas of the digestive tract in different people, although the ileum (the last part of the small intestines) and colon are almost always involved. It often digs deep into the layers of bowel tissue and causes excruciating, debilitating pain and sometimes leads to life-threatening conditions. Most people suffer from abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. People may go through periods of remission where these symptoms quiet down for a while, only to reawaken in a severe flare. Others experience persistent and debilitating symptoms.
Typical Crohn's Symptoms:
Diarrhea or Constipation
Blood in stool
Mucus in stool
Is Crohn's an autoimmune disease?
No, it is not. For a disease to be considered autoimmune there must be autoantibodies. Only a few people with Crohn's show autoantibodies. And only a few of those have self-antigens, another requirement. It is now considered an immune-mediated disease involving deficiencies in the innate immune system.
According to the Lancet article by Dr. Marcel Behr, MD., Maziar Divangahi, PhD., Jean-Daniel Lalande, BSc., 'What's in a name? The (mis)labelling of Crohn's as an autoimmune disease', "Scientists constantly generate new factual information that they use to derive models of the processes they study. This knowledge often requires the generation of new terms. In medical science, disease labels help to guide research priorities by informing funding agencies of the kinds of investigators and types of studies that are likely to be successful for a specific disorder. In clinical medicine, disease names provide pertinent information that helps to explain why patients are sick, what they can expect, and how treatments are predicted to modify the outcome. For this reason, criteria have been defined to establish that a microorganism is the cause of an infectious disease (Koch's postulates) or that something is a carcinogen (Hill's causality criteria). Therefore, putative autoimmune diseases should be subject to a similar degree of scrutiny before we conclude that the disease process is caused by a self-directed host immune response."
You might want to watch this video and read this article regarding Crohn's and autoimmunity. Both resources are provided by Dr. Marcel A. Behr, MD, M.Sc., FRCPC, a clinician-scientist with appointments of Full Professor in the Department of Medicine, McGill University Health Centre, Montreal, Canada.
If it isn’t autoimmune, what causes it?
The jury is still out on the cause or causes. It is possible that there are multiple triggers in genetically susceptible individuals. The science is simply not there yet to determine what causes the disease. Compelling studies have pointed to viral or bacterial pathogens, fungi, food additives, diet, stress, or some sort of combination creating a perfect storm. More research is required to identify the culprits, hence the critical role of Propel a Cure to fund promising projects.
Is it genetic?
Yes, there is a genetic component. Scientists have found links between the disease and mutations in genes located on chromosomes 5 and 10. Not everyone who has these mutations will develop the disease, however. But mutations in one or all the ATG16L1, IL23R, IRGM, and NOD2 genes appear to increase the risk of developing Crohn's disease.
Why is it called Crohn's?
In 1932 a physician at Mt Sinai hospital in New York, Dr. Crohn, presented an article to the American Medical Association (AMA) about a condition he called Terminal Ileitis, describing Crohn’s disease symptoms, thus giving his name to the disease. However, long before this presentation, other physicians had described the same characteristics — First an Italian physician, Giovanni Battista Morgagni, then John Berg in 1898 and Antoni Lesniowski in 1904, and finally in 1913, Kennedy Dalziel.
More About Crohn's Disease
80% of those diagnosed with Crohn's Disease require major surgery.
It can occur at any age but usually strikes teenagers and young adults at the cusp of adulthood, between the ages of 12 to 30.
Patients can have long periods of remission, where they have no symptoms or only very mild symptoms, but then see their symptoms return in a flare.
Some will have just a few symptoms their entire lives.
Others will have chronic and severe cases where they experience never ending symptoms and pain.
Some have "Silent Crohn's" where there are no overt symptoms, but inflammation informed by elevated CRP levels and endoscopies show active disease. 37% will end up having surgery within two years.
Genes, microbes, and environment play a role.
Crohn's is growing in prevalence worldwide.
In 1999, IBD affected 0.9% of the population.
Today it affects 3.2 per 1000 in North America and Europe.
4 million worldwide.
In the last 15 years cases have grown 60% in the under 18 age group.
Under 10 is the fastest growing group.
Canada has seen a 50% increase in pediatric cases in the last 10 years.
Cost depends on severity.
The top 25% of total costs averaged $60,582 per year.
Cost of patients in the top 2% averaged more than $300,000 per year.
For mild to moderate cases the estimated direct medical costs have been estimated to be between $22,987 and $18,022-18,932 per patient with CD per year in the United States vs. $6956 for healthy controls.
And more than twice the out of pocket costs: $2213 vs $979, in Europe: € 2898-6960
Combining prevalence rates, the total economic burden of CD was $10.9-15.5 billion in the United States and €2.1-16.7 billion in Europe.
Hospitalizations accounted for 53-66% of direct medical costs, with an average cost-per-hospitalization of $37,459 in the United States.
Compared with adults without IBD, those with IBD are more likely to have certain chronic health conditions that include:
Cardiovascular disease (CVD)
Neurological conditions like Parkinson’s
Statistically, Crohn’s Disease research monies trail many other conditions. In 2018 $69 million was spent on Crohn’s research but $3,000 million for HIV, $83 million for ALS and $152 million for Osteoporosis. Propel a Cure believes this must change, and so we are funding cutting-edge research, using the latest technologies that will determine the cause, leading to a CURE.
Please join us to help make it happen!