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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 37 clear, but many experts theorize that a disruption triggers an inappropriate immune system attack on bacteria in the gut, which then leads to the many signs, symptoms, and potentially dangerous complications that characterize this disease. Our Virome One particularly interesting line of inquiry has identified that along with our resident bacteria, fungi, and yeasts, our colon is also host to a multitude of viruses. This "virome" is the subject of much investigation. The residual DNA found in the stool samples of people with Crohn's disease appears to belong to types of viruses that have not yet been identified. For some people with Crohn's disease, these intestinal viruses may invade and kill off colonies of their health-promoting bacteria; this may be what knocks things out of balance and triggers an autoimmune attack. Gut Disruptions Many commonplace activities can disrupt our internal environment. Antibiotics, diarrhea, and even jet lag have all been seen to alter the healthy biodiversity in the colon. Scientists who specialize in studying the human gut microbiome are investigating whether changes in that environment precede Crohn's disease flares; this would allow treatment to anticipate the attack, rather than always trying to catch up. The inflammation from Crohn's disease involves the unrestrained activity of certain types of T-helper cells, along with several strongly pro-inflammatory cytokines. In addition, many people with inflammatory bowel disease have an abnormal epithelial barrier within the digestive tract, which allows for inflammatory cells to invade deep mucosal layers. The result is deep lesions called granulomas that can extend through all layers of the intestinal wall, thickening the bowel with excessive scar tissue. And, unlike ulcerative colitis (which usually involves one large, continuous lesion), Crohn's disease granulomas can appear throughout the digestive tract in disconnected, patchy skip-lesions. SIGNS AND SYMPTOMS Abdominal pain is the leading symptom of Crohn's disease. Fever and bloody diarrhea may be present during flares. Weight loss follows, as the ability to eat healthily is impaired. When it occurs in children, failure to grow and delayed puberty are possible signs. This condition runs in cycles of flare and remission, but even during quiescent periods, dehydration, diarrhea, and fatigue are ongoing issues for people who live with Crohn's disease. The most common first lesion in Crohn's disease is at the distal end of the ileus, so cramping pain that focuses in the lower right quadrant of the abdomen is the most typical early sign. Unfortunately, this can also look like ulcerative colitis, appendicitis, celiac disease, diverticular disease, giardia, irritable bowel syndrome, Clostridium difficile infection, and a host of other conditions, and each of which requires a different treatment strategy. Consequently, the testing for Crohn's disease tends to be intrusive, lengthy, and nerve-wracking. COMPLICATIONS The complications related to Crohn's disease are potentially very serious. Here are a few: Stenosis Most Crohn's disease patients experience some level of stenosis, or narrowing of the digestive tract. Early in the disease, this is probably from a combination of inflammation and pain-related spasms. Later in the process, however, the accumulation of fibrotic scar tissue can form permanent strictures that limit the passage of material through the GI tract. "My pain was mostly in the lower right quadrant. It felt like acid was being poured in an open cut while a knife was twisting." Meredith Kusmer Jerome