What Is Crohn's? (Part 2)

One of the most difficult things about dealing with Crohn's is that noone knows what causes it. If pressed, people give a hand-wavy answer, saying that it is the result of environmental influences inducing autoimmunity in someone with a genetic predisposition. In fact, a few genes have been identified that appear to be linked to developing Crohn's (they are mostly genes involved in intracellular signaling that senses bacteria). Actually, one of the first was discovered right here by one of our researchers in the U of C GI Section. Holla!

Beyond this, environmental factors definitely play a role: the incidence of Crohn's is on the rise throughout the world, and it is increasing primarily in industrialized countries, specifically in urban centers. Interestingly, Crohn's has also been linked to the advent of refrigeration--crazy, huh? So basically we might be too hygienic for our own good (Note: it's okay to worry about your kids and germs, but it's okay for them to go outside and play and eat dirt from time to time, too--advice from an Immunologist, not a doctor).

Anyhow, while I won't argue that genetics and the environment are both playing a role in Crohn's, that information alone doesn't help us much. For instance, when you get pink eye, you can basically narrow down the causes why (i.e. bacteria) and treat them (i.e antibiotic eye drops). When you get Crohn's, since we don't know exactly what the cause is, all we can really do is treat the symptoms (with anti-inflammatories, immunosuppressants, surgery). Obviously this is good, but not perfect for the long run ('cuz, ya know, you need your immune system for doing other good things)...and that's why I really want us to be able to figure out the cause of Crohn's (even if it's exceedingly complicated, which it probably is), and then work on the cure.

An interesting side note about Crohn's incidence is that it appears to be less prevalent in Asian populations (though incidence in Asia is also on the rise). Is it the importation of western culture in Asia (i.e. the fast food nation effect)? The rise of ultra-clean societies (Hello, Singapore!)? I don't know. Discuss! Anyhow, the reason I bring this up is because I'm hoping that, at least genetically, Asians are less susceptible to Crohn's Disease (and anyone with information on this, I would appreciate if you could fill me in). If so, when Eileen and I eventually have children, hopefully her good genes will overpower my own and our kids will be healthy and disease-free (yes, I also plan on letting them eat dirt--although incidentally, I played outside in a lake almost every day growing up, so that can't be the whole story for me).

Can you tell that I have been thinking about this extensively? I guess that when faced with the downsides of a chronic disease, I have found two things have helped me quite a bit: planning and controlling the things that I actually have control over (incidentally, I didn't marry Eileen because I thought she had superior, Crohn's-free genes; it was just a perk), and having a sense of humor about it all.

And in case you were wondering, my pink eye is gone.