By Josette Keelor -- Daily Staff Writer

For some, a diagnosis of Crohn's disease can be overwhelming.

When Sam Lindamood, of Strasburg, was diagnosed with the disease, at the age of 26, he was unsure of what to do.

"It sort of ended life for me," he said recently, remembering how he thought that he had only a few years to live. Now, 21 years later, Lindamood said he's taking life one day at a time.

"I've had setback after setback, but I just keep pulling through," he said, noting three surgeries that he had through the late '80s and early '90s.

"I have the energy of a weak kitten," he said, and "pain that doesn't go away," which he said is related to Crohn's disease.

Over the last 21 years, though, the medical field has made many advances in its knowledge of Crohn's and ways to treat it. The disease, named for Dr. Burrill B. Crohn, the doctor who researched it during the 1930s, affects the digestive or gastrointestinal tract, most commonly impacting the small intestine or the colon. Ulcerative colitis, which affects only the colon, and Crohn's disease are both inflammatory bowel diseases and affect as many as a million Americans, according to the Crohn's and Colitis Foundation of America's Web site, www.ccfa.org.

Dr. Peter Lee, of the Pediatric Digestive Diseases Center at Inova Fairfax Hospital for Children, said at a recent seminar, "When the Body Battles Itself: Overcoming Crohn's and Colitis," that 25 percent of patients with Crohn's disease are under the age of 18. The seminar was held in Manassas.

"People have been looking for causes [of Crohn's disease]," said Dr. Nicholas Snow, a gastroenterologist at Winchester Gastroenterology. He said the disease was first described in medical notes in the 1930s.

"There's nothing definitive ... it may be a spectrum of diseases," he said. "The responses can be different in different people."

Like Lindamood, many people diagnosed with Crohn's disease are in their teens to 20s, Snow said, but others might not be diagnosed until their 60s. Those are the two peak age groups, he said.

"It's relatively common," Snow said.

"It's been probably increasing in frequency over the years," Snow said, adding that it is more common in Western cultures. He said he can't pinpoint what it is about Western culture that heightens the risk of people contracting Crohn's disease. Though the disease can run in families, family history is not necessarily an indication of who is most at risk.

"It can [run in families]; if you have a first-degree relative or a twin, your risk is increased," said Snow.

Snow said the disease can present itself in various symptoms, including diarrhea, pain or even with mouth sores, though Snow said the latter is unusual.

Other symptoms might include weight loss, urinary tract infections or even signs mimicking appendicitis or diverticulitis, Dr. Darren Baroni, a gastroenterologist at Gastroenterology Associates, P.C. in Manassas, said during the seminar.

In children, symptoms of Crohn's might be a delay or failure in growth, Lee said. When the small intestine is involved in a health issue, he said, it will affect how much weight a child will gain and how tall he or she will grow. He added that 50 percent of children with Crohn's will have slowing of growth in height and weight even before other symptoms present themselves. Of those, 25 percent might not achieve full height potential, due to malnutrition, nonabsorbtion of vitamins and minerals, lack of appetite, overactive metabolism, bone density issues or inflammation, the latter of which affects bone development and a delay in puberty.

"We can get it into remission, but we can't cure it," Snow said. "There's no bacteria that we know of [that causes Crohn's]."

All of this makes it difficult to treat depending on the patient's symptoms and reactions to medication, he said.

Though there is no cure for the disease, Snow said that it can be treated in various ways, such as surgery, antibiotics and dietary changes.

Immunomodulators also can be used.

One of the harmful aspects of Crohn's disease is that it tricks the body into thinking that bacteria normally found in the intestines is the enemy, sending white blood cells to attack. This causes chronic inflammation in the colon and small intestine. By suppressing immune function, immunomodulators can help ease inflammation, although they also weaken the body's defense against viruses and illnesses, such as the common cold, Lee said.

Surgery and drugs, including antibiotics and steroids, also are used in treating Crohn's disease.

"In the 1990s, was the first spectrum drug for Crohn's disease developed and approved," said Snow.

"They have so many advances now," Lindamood said, explaining that though he is on a strict diet now, he did not know when he was first diagnosed that a change in diet might help him.

Lindamood said that his surgeries, in addition to the disease, affect what he eats.

"I've been living off of eggs, soup and sandwiches from Arby's," he said, explaining that Arby's sandwiches do not contain harmful preservatives that he is not allowed to include in his diet. Vegetables, he said, are one of the main foods that he cannot eat, because, since having surgery to remove his colon, his body cannot process the hulls in food.

Snow said a high fiber diet should be avoided by most people with Crohn's disease.

According to ccfa.org, although there is no evidence that anything in a patient's diet history causes or contributes to Crohn's disease or ulcerative colitis, once people develop inflammatory bowel disease, paying attention to what they eat "may go a long way toward reducing symptoms and promoting healing."

"There's really not a lot of data," Baroni said. "There's really no magic foods to avoid or take."

Diet change, though helpful to treating patients with Crohn's disease, may create other problems, said Snow. People with a low fiber diet have increased risk of osteoarthritis. There is also the risk of anemia and inflammation of the eyes, because people with Crohn's might not absorb needed vitamins and minerals, such as iron and vitamin B-12. Snow suggested that people at risk of not getting enough nutrients take supplements.

Keeping a food diary, the Crohn's Web site suggests, will not only help patients identify troublesome foods, but also keep track of needed nutrients.

Baroni recommends the rule of threes — if symptoms flair up after eating a specific food on three separate occasions, it is likely that food is causing the problems and should be avoided.

In general, the CCFA's Web site says, people with Crohn's disease lead full, active and productive lives.

For more information about Crohn's disease and ulcerative colitis, visit the Web at www.ccfa.org.

* Contact Josette Keelor at jkeelor@nvdaily.com