Metastatic Crohn’s Disease and its Ayurvedic Management

Abstract

There are a lot of gastrointestinal or digestive system disorders a human can suffer from. There is no person who has never had gastrointestinal discomfort.  Crohn’s disease is one of them. Crohn’s disease is a disease which comes under the inflammatory bowel disease. It is a chronic transmural inflammatory disease of the gastrointestinal tract which has unknown aetiology. It can cause inflammation of the gastrointestinal tract from mouth to anus. Furthermore, there are various symptoms which manifest the disease. One of the main complications of Crohn’s Disease is Metastatic Crohn’s disease. It shows the presence of non-caseating granuloma of the skin at sites which are separated from the gastrointestinal tract by normal tissue. In the following text we shall take a look at some details of Metastatic Crohn’s disease. In addition to this we shall also discuss its allopathic and ayurvedic management of the same. Let’s discuss it !!

Introduction

Metastatic Crohn’s disease is an infrequent cutaneous manifestation of  Crohn’s disease. It can be defined as the presence of non caseating granulomatous lesions of the skin at sites anatomically different from the gastrointestinal tract.   Crohn’s disease comes under the inflammatory bowel disease. Which has unknown aetiology. It is inflammatory condition of the colon/last part of the small intestine and anal canal. In the past, it was known as ‘terminal ileitis’ and these days, it is called ‘regional ileitis’. Though it can occur or affect any part of the gastrointestinal tract. The disease may show a variety of symptoms. In Ayurveda, Crohn’s disease is generally correlated with vitiation of pitta dosha. Pitta dosha’s seats are navel, stomach and the small intestine. As the pitta dosha gets imbalanced, hence the signs of malabsorption, indigestion and others occur. Therefore, Crohn’s disease is related to an imbalance of pitta dosha.

Aetiology

1. Aetiology of metastatic crohn’s disease is unknown.
2. Immunological factors : cytotoxic T lymphocytes against colonic epithelial cells and presence of anticolon antibodies.
3. Ig G antibodies play a role in chronicity of Crohn’s disease.
4. There is a high amount of antibodies to milk proteins and controlled diet and milk free diet provide symptomatic relief.
5. Smoking : it increases the risk of Crohn’s disease.
6. Infective factors include RNA type of small virus.
7. It has hereditary predominance.

Pathology

It has been suggested that antigens or immune complexes stemming from the gastrointestinal tract in primary Crohn’s disease travel through the circulatory system and deposit in the skin, creating perivascular granulomatous features seen in microscopic examination of Metastatic Crohn’s disease lesions.

Autoimmune cross-sensitivity has also been attributed to a type IV hypersensitivity reaction wherein T cells cross-react with skin antigens, wrestling in an inflammatory response similar to that seen in the gastrointestinal tract of Crohn’s disease.   Crohn’s disease usually initiates in the terminal ileum as ulcers in the intestine.Severe inflammation and ulcerative mucosa.Skip lesions are a characteristic feature of Crohn’s disease.Enlarged mesenteric nodes.Mononuclear cell infiltration and lymphoid hyperplasia is a common finding.With time as the disease progresses, narrowing of the lumen occurs which results in intestinal obstruction.Snail track ulcers and serpiginous ulcers develop.Perianal abscess, fissure and fistula in ano develop.

Clinical features

1. Majority of the patients have a previous Crohn’s disease’s diagnosis.
2. It is most commonly seen in the second or third decade of life.
3. One third of the patients with metastatic crohn’s disease have classical gastrointestinal symptoms.
4. Twenty percent of patients suffering from metastatic crohn’s disease may present without long established symptoms of crohn’s disease.
5. Skin lesions of Metastatic Crohn’s Disease may present as plaques, ulcerations, papules and nodules which can spread to the legs, genitalia, arms and face.
6. It may present as a single lesion or occur at various sites.
7. It is usually painless or painful to touch.
8. The genitalia remains to be the most commonly involved area. Most commonly, cutaneous manifestations present as – penile, labile, scrotal swelling can be or cannot be present with erythema and genital ulceration may also be presented.

Gastrointestinal signs and symptoms remain the same as Crohn’s disease, as follows

1. Dirrhoea
2. Abdominal pain
3. Nausea
4. Vomiting
5. Fever
6. It mimics appendicitis
7. Malnutrition
8. Weight loss
9. Hypocalcemia
10. Hypoproteinemia
11. Hypovitaminosis
12. Fatigue
13. Loss of appetite
14. Weakness
15. Mucus
16. Pain arond the anal part
17. Mouth sores
18. Blood may be present in stool but it is not so common.
19. Extra-intestinal manifestations can be ankylosing spondylitis, uveitis, arthritis,
20. Stomatitis, pericarditis, pericholangitis.
21. Cutaneous disorders associated with Crohn’s disease include pyoderma gangrenosum, erythema multiforme, epidermolysis bullosa and erythema nodosum.

Investigations

Firstly to diagnose Crohn’s disease, following investigations are necessary.

1. Barium enema : Ulceration looks like spikes known as raspberry thorns or rose thorns.
2. Sigmoidoscopy and colonoscopy : it may show mucosal inflammation and ulcers. Biopsy could be taken at the time of the procedure.
3. CT scan : it shows thickening of bowel and extraintestinal disease.

Extraintestinal manifestations of Metastatic Crohn’s Disease include

Ocular findings, musculoskeletal pathology and mucocutaneous manifestations. Most frequent extraintestinal manifestations are the mucocutaneous,which may be further classified as granulomatous skin disease, oral manifestation and other cutaneous changes secondary to cutaneous disorders and nutritional deficiencies.

Histopathological findings

1. The granulomas consist of Langerhans giant cells, lymphocytes, epithelioid histiocytes and occasional plasma cells.
2. Perivascular granulomatous inflammation surrounding the dermal vessels.
3. Necrobiosis consists of collagen degeneration accompanied by granulomatous inflammation.
4. Eosinophils may also be present.

Management

Treatment of Crohn’s disease is to be followed with Metastatic Crohn’s Disease

• There are few agents that have been used. It includes oral and topical steroids , oral antibiotics, azathioprine, sulfasalazine, 6-mercaptopurine infliximab and metronidazole. Infliximab appears to show nice results with respect to severe cases of Metastatic Crohn’s Disease.
• Hyperbaric oxygen has also been used in treatment of Metastatic Crohn’s Disease.
• Patients also respond to surgical debridement, especially in cases refractory to medical therapy.

Conservative and Medical management

1. A good intake of fluid.
2. Antibiotics
3. Analgesics
4. Nutritive supplements

Following are the drugs which help in improving the condition of Crohn’s Disease symptomatically

1. Antidiarrhoeal Drugs

loperamide-like medicines are used to slow down gut motility.

2. Sulfasalazine

it is the drug of choice. It is used as an antimicrobial agent. It reduces inflammation. It also causes immunosuppression. Side effects of the drug include folic acid deficiency, temporary fertility problems in men and skin rashes.

3. Corticosteroids

when sulfasalazine fails to reduce remission, corticosteroids are used. oral prednisolone 60 mg per day tapering in 4 weeks is used.

4. Immunosuppressive drugs

Azathioprine-like drugs are used

5. Multivitamin Supplements

deficiency due to malabsorption causes severe deficiencies of vitamins etc. Therefore supplements according to the deficiency are used.

6. Surgical management

The surgery is total proctocolectomy. The diseased part is excised and end-to end anastomosis is performed. Indications for surgery include failure of conservative treatment, bowel perforation, intestinal obstruction, abscess formation formation of fistula.

Ayurvedic Management

Treating Crohn’s disease will automatically cure the metastatic manifestation of Crohn’s disease. Ayurveda is known to treat the disease from its root. As the pitta dosha is the culprit in causing Crohn’s disease. Ayurveda has such a miraculous formulation that is treating the stubborn conditions of Crohn’s disease. Kutajghan vati and kutaj parpati are of much help. There are various other herbal formulations that are treating Crohn’s disease impeccably. Parpati kalpa, kutajghan vati etc are of use.

Herbal Remedies for Metastatic Crohn’s Disease by Planet Ayurveda

Planet Ayurveda is a famous GMP certified, US-FDA registered and ISO 9001:2015 certified Ayurvedic Company, which adhered to the aim of manufacturing quality Ayurvedic Formulations as mentioned in the various ancient texts of Ayurveda. Medicines are produced without additives and preservatives and other kinds of chemicals or flavour enhancers which causes many side effects on the human body. Products prepared at Planet Ayurveda are pure and devoid of any kind of adulteration. Following is the list of some formulations which are prepared by Planet Ayurveda for treating Metastatic Crohn’s Disease.

1. Pitta Balance
2. Sanjivani Vati
3. Swarn Vasant Malti Ras
4. Belgiri Powder
5. Neem Capsules
6. Mahamanjishthadi Kwath

Product Description

1. Pitta Balance

As the vitiated dosha is pitta in Crohn’s disease, balancing pitta dosha becomes mandatory to cure Crohn’s disease and its cutaneous manifestation that is Metastatic Croh’s Disease. It is a herbo-mineral formulation which contains various things that balance pitta dosha. Its ingredients include JaharMohra, Kaharawa, Akik, Mukta and Giloy Satva  (Tinospora cordifolia). As it balances the root cause of the disease, it is indicated in Metastatic Crohn’s disease.

Dosage: one capsule twice a day with plain water after meals.

2. Sanjivani Vati

It contains various herbs including vidanga (Embelia ribes), pippali (Piper longum), Haritaki (Terminalia chebula), amalaki (Emblica officinalis), vacha (Acorus calamus), Giloy(Tinospora cordifolia), shuddha bhallataka (Semecarpus anacardium), shuddha vatsanabha (Aconitum ferox), adrak (Zingiber officinale). All the ingredients are helpful in maintaining the wellness of the digestive system. Moreover it is useful in digestion related disorders and enhances absorption of food. Therefore it manages crohn’s disease and metastatic crohn’s disease.

Dosage : one tablet twice a day to be chewed after meals with lukewarm water.

3. Swarn Vasant Malti Ras

It is a herbo-mineral formulation which is blended with the goodness of various herbs and minerals. The product is constituted of shuddha parada (purified mercury),  Mukta bhasma (calx of pearl),  Swarna bhasma (gold calx), Shuddha hingula (an ore of sulphur and mercury), shuddha gandhak (purified sulphur), trikatu (dried ginger, Black pepper and long pepper), tamra bhasma (copper calx) and loha bhasma (iron calx). Furthermore it contains juice extract of datura (Datura metel), kutki (Picrorhiza kurroa), nimbu swaras (Lemon juice), Kantkari (Solanum xanthocarpum). With so many ingredients it is such a formulation combating weakness caused by Metastatic Crohn’s Disease and Crohn’s disease. It is beneficial in infectious conditions and also nourishes the body and increases absorption of nutrients in the body. It boosts immunity that results in overall wellness. Therefore it is useful in the aforesaid disease.

Dosage : one tablet to be chewed daily.

4. Belgiri Powder

It contains bilva (Aegle marmelos). It has appetiser and digestive properties. It soothes the intestines.Therefore comforting the intestines. It has anti-inflammatory activity. Therefore it relieves pain and inflammation.it is also used in worm infestation as it has anthelmintic properties. It relieves symptoms of Crohn’s disease and Metastatic condition as well.

Dosage : Half tablespoon twice a day with lukewarm water after meals..

5. Neem Capsules

The capsules contain neem (Azadsirachtra indica). Due to its bitter taste it is beneficial in balancing pitta dosha. Which results in overall alleviating signs and symptoms of Crohn’s disease and its metastatic manifestation. Furthermore, it is a magnificent herb for the skin ailments. Therefore it is useful in cutaneous features of metastatic crohn’s disease.

Dosage : One capsule twice a day after meals with plain water.

6. Mahamanjishthadi Kwath

It is a formulation with a number of herbs which overall benefits human health. It contains Bharangi (Clerodendrum serratum), Manjistha (Rubia cordifolia),  Akarkara (Anacyclus pyrethrum), Nagarmotha (Cyperus rotundus), Giloy (Tinospora cordifolia), Daruhaldi (Berberis aristata), Sonth (Zingiber officinale), Triphala, Murva (Marsdenia cucumerina) and many more. It is herb to treat various skin disorders and digestion related issues. reIt is a perfect blend to treat Crohns and its associated condition.

Dosage : Two tablespoons twice a day after meals after mixing with lukewarm water.

Conclusion

Metastatic Crohn’s Disease is a rare cutaneous manifestation of Crohn’s Disease. Therefore it has become essential to treat Crohn’s disease in its early stage. As we have seen, the treatment protocol for Crohn’s disease and its metastatic manifestation on skin, Ayurvedic management is successfully treating both the conditions of Crohn’s disease and Metastatic Crohn’s disease. It becomes important to stop Crohn’s disease at earliest to prevent complications like metastatic advancement. Therefore, choosing Ayurveda is beneficial as it provides proper care to the condition. As it stops the worsening of the condition by balancing the vitiated pitta dosha, the main culprit of the overall ailment. Thus live a healthy and disease free life by choosing Ayurveda.