Crohn’s disease is an inflammatory disease of the gastrointestinal tract that can affect any part of the digestive system, from the oral cavity to the end of the colon, and is often difficult to distinguish from ulcerous colitis (inflammation of the colon with ulcerations).
Most commonly, the affected part of the gastrointestinal tract in Crohn’s disease is the terminal part of the small intestine (ileum) and large intestine (colon), although changes can occur on any part of the digestive organ. An intestinal wall can bleed and even lead to perforation of the intestinal wall with leakage of intestinal contents into the abdominal cavity causing numerous complications.
Various clinical studies have shown that the genetic factor plays a very important role in the onset of this disease. There is a high degree of concordance in the disease of monozygotic twins.
Numerous infective, bacterial and viral agents have been suggested as the cause, but without definitive evidence. M. paratuberculosis causes, in ruminants, Johne’s disease, a chronic inflammatory disease of the ileum, similar to Crohn’s disease.
The predisposing factors of Crohn’s disease include diets containing a lot of refined sugars and the use of contraceptives. Smoking is also one of the possible synergistic triggers for this disease.
Signs and symptoms
Periods of exacerbation and improvement change, besides the ileocecum, the descending colon and other segments can be affected also, so the symptoms mainly depend on the localization. However, three are dominant: diarrhea, abdominal pain, weight loss.
The acute phase goes with fever, loss of appetite, nausea; often the clinical picture is nonspecific and atypical. Palpable mass can be found in the ileocecum, the involvement of the entire small intestine is prognostically unfavorable. Colonic involvement is mainly manifested by diarrhea, rarely by hematochezia, and extra-intestinal symptoms are more common than in the small intestine.
Perianal involvement is manifested by fissures, ulcerated hemorrhoids, and ulcers. Abscesses, rarely, anovaginal fistulas and strictures are also seen, either as an underlying disease or a complication.
Extra-intestinal complications are, in fact, systemic disease outbreaks, which include: osteoporosis, arthritis, ankylosing spondylitis, erythema nodosum, changes in the eyes – episcleritis, uveitis, aphthous stomatitis, fatty liver, cholangitis, renal calculus, nutritional deficits, and anemia are frequent due to malabsorption defects, loss of appetite and chronic diseases.
Diagnosis should be considered in all diarrhea patients, with or without blood, and abdominal pain. Atypical manifestations, fever of unexplained origin without intestinal symptoms, or extra-intestinal manifestations, such as arthritis or liver disease, are possible.
As Crohn’s disease can also affect the small intestine, it should be considered in all forms of malabsorption syndromes, intermittent intestinal obstruction, and abdominal fistulas.
Blood tests are nonspecific. They may show moderate anemia (normochromic, normocytic or hypochromic), increased sedimentation, leukocytosis and thrombocytosis, hypoproteinemia. Diarrhea can lead to electrolyte disruption and malabsorption in Crohn’s disease to steatorrhea.
The prevalence of the disease is determined by an X-ray examination of the small intestine with barium and lower gastrointestinal series. These may show changes in mucosal appearance, deep ulceration, and a pathognomonic “ribbon or wire sign.” Changes often affect the ileum and colon continuously. In chronic cases, strictures may occur. Intestinal lesions are usually discontinuous.
For the treatment of mild to moderate cases of the disease, anti-inflammatory drugs are mostly used. Corticosteroids (budesonide and prednisone) are used briefly to relieve the symptoms of Crohn’s disease since they suppress the immune system and cause various other side effects.
Immunomodulators such as ciclosporin A and azathioprine help to maintain remission and can also help treat fistulas. Antibiotics are most commonly used when it is necessary to treat abscesses or other bacterial infections that occur as a result of Crohn’s disease.
Surgical methods of treatment for patients are mostly suggested in the case of the need to remove damaged bowel sections to avoid more serious complications, blockages or ruptures. Surgical methods are also resorted to in case the medicines do not show good results.
Surgery can bring remarkable improvement, and there is a possibility that the next attack will not occur for many years. However, absorption of vitamins, fats, and other important micronutrients may be reduced after the removal of a portion of the intestine.
When conventional treatments do not work, biological drugs can also be used, but only if the doctor has approved this type of therapy. During the onset of the disease, it is necessary to rest. In order to alleviate the symptoms, it is necessary to follow all the instructions given by your doctor.
Dietary supplements that you can use include supplements of vitamins A, C, E, B12, K, folic acid, minerals – calcium, magnesium, zinc and selenium, amino acid glutamine, essential fatty acids, and probiotics.
Disease activation is often associated with emotional or physical stress, but in some cases, it is not entirely clear why the disease has returned.