Understanding Crohn’s Disease: Causes, Symptoms, and Management

Crohn’s disease is a chronic inflammatory disease. This was named after its discoverer (Burrill Bernard Crohn). Crohn’s disease can co-occur (discontinuously) in several places in the entire digestive tract (from the mouth to the anus), but preferably in the end area of ​​the small intestine (= terminal ileum, therefore ileitis terminals) and the beginning area of ​​the large intestine. The inflammation affects all layers of the wall of the intestine (not just the mucous membrane, as in ulcerative colitis ).

Crohn’s disease: causes and triggers

Despite intensive research, no apparent cause of Crohn’s disease has been found. The significant increase in cases of Crohn’s disease in recent years could be associated with significantly improved hygienic conditions. It is assumed that the immune system cannot distinguish itself from foreigners without immune stimulation by intestinal parasites (worms). As a result, the immune system attacks its structures (e.g., intestinal cells), leading to chronic inflammation.

It remains to be seen whether this assumption is correct. Familial aggregation indicates that genetic factors also play a particular role in Crohn’s disease. Specific pathogens  (bacteria and viruses) may have a role in triggering the autoimmune mechanism. The influence of psychological or physical stressful situations on the development of Crohn’s disease seems obvious.

Smoking also seems to be a risk factor that promotes the development of Crohn’s disease and also hurts its course.

 

Crohn’s disease: symptoms and signs

Although the entire digestive tract can be affected by Crohn’s disease, in most cases, the small and large intestines are affected. The inflammation of all wall layers leads to a thickening with a narrowing of the diameter of the intestine. Ulcers and fissures in the layers of the intestine also appear as signs of Crohn’s disease.

In particular, during an attack, patients often suffer from symptoms such as abdominal pain and fever combined with general fatigue.

Even if Crohn’s disease can occur without diarrhoea, this is usually a frequent accompaniment of the disease. Watery diarrhoea often occurs. However, blood in the stool is scarce. Pain characteristics and localization (usually in the lower right abdomen) can be very similar to appendicitis, so thorough clarification by a doctor is essential.

Crohn’s disease: diagnosis

In addition to the clinical indications (the experienced doctor pays attention to anal fistulas, which often appear as the first symptom), instrument-based examination methods are of great importance in the diagnosis of Crohn’s disease:

• With the colonoscopy, the typical changes are visible and can be localized.
• Taking a tissue sample simultaneously can verify the finding of Crohn’s disease under the microscope.
• An x-ray is taken after the contrast medium has been enema to get a general overview of the digestive tract. In this way, the individual foci of the disease can be better identified.
• The thickened intestinal walls are also made visible by ultrasound.
• In an acute episode, the blood laboratory values ​​show the typical signs of inflammation (many white and few red blood cells, high ESR).
• The stool must be examined to rule out a bacterial cause of the infection. If the value of the protein calprotectin in the stool is increased, there is inflammation in the intestine.

Differentiating from other chronic intestinal diseases, such as ulcerative colitis, diverticulitis, or appendicitis, is usually possible through a thorough medical history and patient examination. However, the calprotectin value also provides an essential indication since this is not increased in irritable bowel syndrome.

Circulatory disorders in the intestine can also cause an inflammatory change, especially in older patients. After tumour irradiation in the abdomen, the intestinal loops often appear thickened and inflamed.

 

Crohn’s disease: life expectancy and course

Crohn’s disease progresses in stages. Periods of high activity are followed by breaks when the condition is less symptomatic. The probability of a flare-up after one year is 30 per cent; after two years, it is already 40 per cent. In the clinic, the activity is determined using an activity index. With optimal therapy, the average life expectancy of Crohn’s disease patients is not less than that of healthy people.

Unfortunately, the likelihood of Crohn’s disease going away entirely is pretty slim. The regular recurrence of flare-ups often brings complications and often makes surgical intervention unavoidable. However, a cure is impossible (unlike ulcerative colitis).

Complications of Crohn’s disease

Because this autoimmune disease affects the entire body, signs of it include:

• on the skin (redness, ulcers)
• on the joints (arthritis, spinal inflammation)
• on the eye (inflammation inside the eye)
• on the liver (inflammation of the bile vessels)

Impaired absorption of nutrients and vitamins through the intestines and frequent diarrhoea can lead to weight loss and nutrient deficiencies. Calcium deficiency increases the risk of osteoporosis. Growth retardation can also occur in children.

In advanced disease, there is a risk that narrowing (stenosis) will form in the intestine, which can lead to complete intestinal obstruction. Perforations of the bowel are less common in Crohn’s disease. Fistulas, which are mainly found in the area of ​​the anus, are particularly unpleasant and painful. They create a connection between the large intestine and the anus (surrounding the sphincter muscle). If the fistula closes, an abscess can form.

 Colon cancer can develop after years of disease. However, this risk is lower in Crohn’s disease than in ulcerative colitis.

Crohn’s disease: treatment and therapy

Crohn’s disease therapy consists, on the one hand, of adhering to a special diet. If the colon is affected, aminosalicylates are used in conjunction with cortisone. When the small intestine is affected, cortisone acts in an acute attack. The dosage is adjusted depending on the strength of the thrust. In addition, antibiotics and immunosuppressants  (drugs that suppress the immune system) are also administered in severe cases of Crohn’s disease. Various dietary supplements can also be used to compensate for a nutrient deficiency.

Due to the relatively frequent complications (perforation, intestinal obstruction, fistulas), it is not uncommon for surgical treatment to be required. Since Crohn’s disease cannot be cured, a gentle operation is performed with the removal of only short sections of the intestine and subsequent connection of the ends of the intestine. It may also be necessary to close fistulas or remove abscesses. Chronic inflammation can also lead to the formation of constrictions in the intestine. Then, the treating gastroenterologist has to widen the narrowing with the help of a balloon.

To mitigate the negative influence of stress on the course of the disease and to better introduce those affected to life with the disease, psychological support can also be used.

 

preventive measures

Appropriate nutrition for Crohn’s disease and good medical (including psychological) care can positively affect the course of the disease. Still, it is not possible to prevent the disease. Immunomodulating measures (with intestinal parasites) are still in the testing phase but could play a key role in interfering with the mechanism of development of Crohn’s disease.