The doctors couldn't figure out what was wrong with Mike Leier.
Even at the world-renowned Mayo Clinic, the physicians were stumped by Leier's symptoms, which included severe stomach pain and blood in his stools. They told him he had a virus and sent him home.
But Leier kept getting sicker. He had to go to the bathroom dozens of times a day. He lost 25 pounds in a few weeks. His stomach pain became so intense that he could barely get out of bed to run his carpet-cleaning business.
"It got to the point where I couldn't take the pain anymore," the Fargo man says.
After Leier wound up in the emergency room for the second time, he met Dr. Ari Taheri. The Fargo gastroenterologist diagnosed him with Crohn's disease and wrote out a prescription.
"By the morning, I felt like I was almost at 100 percent," Leier says. "If it hadn't been for her, I think I would have been 6 feet under by now."
Crohn's disease, along with the similar disorder ulcerative colitis, are both forms of inflammatory bowel disease (IBD). Symptoms can include prolonged bouts of diarrhea (sometimes bloody), stomach pain, fever, fatigue, nausea, anemia and unexplained weight loss. If left untreated, the disorders can affect other systems of the body, leading to arthritis, swollen eyes, skin lesions and liver problems.
While the two diseases share similar symptoms and treatments, there are differences. Ulcerative colitis typically affects the colon only, while Crohn's can cause inflammation anywhere in the gastrointestinal tract - from the mouth to the rectum.
As many as 1.4 million Americans may have IBD, according to the Crohn's and Colitis Foundation of America.
The prevalence of these two disorders is higher in the Midwest and the Northwest than it is elsewhere in the country, according to a 2007 study published in Clinical Gastroenterology and Hepatology.
To illustrate, the rate of adult Crohn's disease is 213 per 100,000 people in the Midwest, as compared to 180 per 100,000 in the South, according to the study.
The exact cause of these diseases is unknown. Studies indicate it involves a complex interplay of factors: the inherited genes, the immune system and environmental triggers. Both diseases are believed to be autoimmune disorders, meaning the body mistakes normal bacteria, food and other material in the intestines for foreign substances, according to the CCFA. The body then launches an attack by sending white blood cells into the intestinal lining, where they produce chronic inflammation. The cells also generate harmful products that cause ulceration and injury to the bowel.
Family history, environment and ethnicity also play a role. If someone has a relative with the disease, his or her risk of developing the disease is 10 times greater than that of the general population.
It also seems to be much more common in developed countries, urban areas and northern climates, according to the CCFA. It's found principally in the United States and Europe.
One study concluded that family history, cigarette smoking and appendectomy can affect prevalence of these diseases. The study suggested second-hand smoke exposure in childhood increases the risk for Crohn's but not ulcerative colitis.
The study also showed that people who have appendectomies are less likely to develop IBD.
Inflammatory bowel disease also affects certain ethnic groups more frequently. American Jews of European descent are four to five times more likely to develop these diseases than the general population. Overall, Caucasians are more prone to it, although there's been a steady rise in both Crohn's and ulcerative colitis among African-Americans.
Can require surgery
Tessa Rasmussen was 26, outwardly healthy and training for a half marathon when she was diagnosed with Crohn's disease in March.
The Fargo woman had noticed she needed to use the restroom more often - sometimes as much as eight times a day. Then the pain started. "Every time I ate, within 15 to 45 minutes, I would be keeling over with intense pain," she recalls.
Rasmussen called the doctor's office and told them she felt pain after eating and had noticed bright red blood in her stools. Following a colonoscopy, Dr. Fadel Nammour, a gastroenterologist at Innovis Health in Fargo, diagnosed her with Crohn's.
While some patients with severe Crohn's need surgery, Rasmussen's case has been relatively mild. She's been able to take a generic oral medicine, sulfasalazine, which reduces irritation and swelling in her gastrointestinal tract. Recently, she was able to reduce her dosage from six pills a day to four.
In retrospect, Rasmussen says she experienced symptoms for more than a year. She had an unexplained weight gain of 15 pounds, and her stomach grew bloated. While training for the marathon, she took a lot of ibuprofen, which she believes exacerbated the irritation to her stomach. "It developed and progressed so slowly ... it just started to seem normal," she says.
Although Crohn's is a lifelong disease, marked by periods of remission and flare-ups, Rasmussen considers herself lucky.
"I have had no surgeries and am heading toward remission already," she says.
Others aren't so lucky. Rasmussen's third cousin, also 26, has been diagnosed with Crohn's, too. That cousin had to have her colon removed. Patients can develop fistulas - deep ulcers that turn into tracts and tunnel into surrounding tissues such as the bladder, vagina or skin - or blockages in the intestine.
Taheri has treated a patient who had become so anemic from IBD that she lost sight in one eye. Another patient developed such severe skin lesions that she couldn't walk.
"It is a horrendous disease," says Taheri.
"You can lose days from work. It disrupts your life."
After 12 years with Fargo's MeritCare (now Sanford Health), Taheri opened the independent Gastroenterology and Hepatology Clinic five years ago. About 80 percent of her patients have either Crohn's or ulcerative colitis.
Studies have shown that early diagnosis and early, aggressive treatment when symptoms first arise can improve a patient's quality of life significantly. That's one reason Taheri's practice includes an in-office infusion center, where patients can arrange to receive IV-infused medications such as Remicade on short notice. A decade ago, IBD patients had to make appointments to receive their medication at a chemotherapy center, and they sometimes had
to wait weeks to get in, Taheri says.
But one problem is getting people to get help in the first place. "Especially with younger people, they have other issues on their minds besides their bowels," Taheri says. "They blame it on food, on anxiety and nervousness and taking exams, and they postpone coming in. That's why we think public awareness is so very important."
Doctors will perform different medical tests to determine if the condition is inflammatory bowel disease. They'll examine a patient's medical history, collect stool specimens and give blood tests. The doctor may order a colonoscopy, in which a long, flexible, tubular instrument is used to view the entire inner lining of the colon.
These tests will help determine whether the patient has Crohn's
or ulcerative colitis. Ulcerative colitis is marked by inflammation and ulceration of the innermost lining of the large intestine. The inflammation usually begins in the rectum and lower colon but may also involve the entire colon.
Crohn's, on the other hand, can affect any area of the gastrointestinal tract, including the small intestine. It also affects the entire thickness of the bowel wall, rather than just the innermost lining.
Once diagnosed, the patient is typically prescribed medications, which will alleviate inflammation and symptoms.
Biologic therapies, like Remicade, constitute one of the most recent and effective developments in the treatment of IBD. These drugs are made from antibodies that bind with certain molecules to block a particular action, reducing inflammation and side effects in the process. Remicade is typically administered via IV over a three-hour period. In the same class, newer medications like Cimzia can be injected much more quickly and have fewer side effects. In very severe cases, surgery may be needed to remove part or all of the colon.
The good news: If patients receive prompt treatment, symptoms may disappear, and flare-ups may occur less frequently.
"If treated properly," Taheri says, "they can have a normal life."
This article contains information from the Grand Forks Herald. Readers can reach Forum reporter Tammy Swift at (701) 241-5525