Therapy for Crohn's disease has been discussed in practice guidelines published in 2009 7 . These guidelines set up a definition for the severity of a Crohn's disease flare. Mild to moderate disease is indicated when patients can tolerate oral intake without dehydration, high fever, abdominal pain, abdominal mass, or obstruction. Moderate to severe disease describes the disorder in patients who have failed to respond to therapy for mild or moderate disease or those with fevers, weight loss, abdominal pain, anemia, or nausea and vomiting without frank obstruction. Severe to fulminate disease is found in patients with persisting symptoms despite the introduction of steroids on an outpatient basis or those presenting with high fever, persistent vomiting, obstruction, rebound tenderness, cachexia, or an abscess. In addition, it is important to distinguish between differing behaviors of disease: inflammatory, fistulizing, or fibrostenotic because different therapies are best suited for different disease behaviors regardless of disease severity.
It’s important, however, to consider nutritional red flags that may arise during the management of autoimmune conditions. Typical drugs used in treatment, such as analgesics and nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying drugs, and biologic response modifiers, may cause side effects such as nausea and vomiting, stomach pains, mouth sores, and decreased appetite. And some drugs can interact with specific nutrients, such as folic acid and vitamin B12. In addition, alterations in energy and protein metabolism that lead to muscle loss and wasting may occur in some autoimmune diseases.
Data Synthesis Early studies of HPVG were based on plain abdominal radiography and a literature survey in 1978 found an associated mortality rate of 75%, primarily due to ischemic bowel disease. Modern abdominal CT has resulted in the detection of HPVG in more benign conditions, and a second literature survey in 2001 found a total mortality of only 39%. While the pathophysiology of HPVG is, as yet, unclear, changing abdominal imaging technology has altered the significance of this radiologic finding. Hepatic portal venous gas therefore predicts high risk of mortality (>50%) if detected by plain radiography or by CT in a patient with additional evidence of necrotic bowel. If detected by CT in patients after surgical or endoscopic manipulation, the clinician is advised that there is no evidence of increased risk. If HPVG is detected by CT in patients with active peptic ulcer disease, intestinal obstruction and/or dilatation, or mucosal diseases such as Crohn disease or ulcerative colitis, caution is warranted, as risk of death may approach 20% to 30%.