Crohn’s disease is chronic intestinal inflammation in the area of the gastrointestinal tract or digestive tract. This leads to typical flare-ups of complaints and symptoms, such as diarrhea, painful stomach cramps and severe weight loss. However, these symptoms are initially non-specific, so that Crohn’s disease is not always diagnosed first. Therefore, if chronic intestinal inflammation is suspected, the doctor should always carry out a colonoscopy, X-ray examination, laboratory tests and ultrasound in the diagnosis and treatment.
What is Crohn’s disease?
Alongside ulcerative colitis, Crohn’s disease (chronic intestinal inflammation) is one of the chronic inflammatory bowel diseases that often occurs in flare-ups. The frequency peak is between the ages of 16 and 35. Older people over the age of 60 can suffer from what is known as Crohn’s disease. There is a familial accumulation, overall the frequency of the disease is increasing. See lawfaqs for Definitions of Liver Fibrosis.
The symptoms are often unspecific (cramps, nausea, weight loss), courses without the trend -setting diarrhea are also possible. The formation of granulomas in the intestinal wall is characteristic. Unlike ulcerative colitis, Crohn’s disease can occur anywhere in the gastrointestinal tract, from the oral cavity to the rectum. There is often a discontinuous infestation, ie affected sections are interrupted by healthy intestines.
However, the attack on the last section of the small intestine, the terminal ileum, is typical. Complaints outside the gastrointestinal tract are common, usually joint pain and joint inflammation, painful skin changes or eye symptoms are present. The diagnosis is made via a colonoscopy with the removal of tissue samples.
Causes
There is a lot of speculation about the causes of Crohn’s disease (chronic intestinal inflammation), none of these theses has been proven so far. Only smoking has been identified as a risk factor. Crohn’s disease is currently classified as an autoimmune disease. This classification is by no means certain; it is based solely on the good response to immunosuppressive therapy. It is also suspected that those affected have a barrier disorder in the intestinal wall, so that bacteria can penetrate unhindered and provoke a partially overactive defense.
A genetic component is also discussed because of familial accumulation. It is unclear whether excessive hygiene, dietary conditions or infections with mycobacteria play a decisive role. Crohn’s disease was long thought to be a psychosomatic illness. This has now been refuted as the sole cause, although a psychosomatic influence can be assumed. The severity of the disease and the frequency of relapses are significantly increased in stressful times.
Symptoms, Ailments & Signs
Colonoscopy of the large intestine in Crohn’s disease © Juan Gärtner – Fotolia.com
Crohn’s disease is characterized by prolonged watery diarrhea and colicky pain in the upper right abdomen. There is usually no blood or mucus in the stool. The symptoms come on in stages. There can be long intervals between each flare-up. However, the symptoms can also increase during a flare-up if there are also allergies or intolerances to certain foods.
Such food allergies or food intolerances are more common in patients with chronic inflammatory bowel diseases such as Crohn’s disease. As a result of the numerous diarrhea, other symptoms can develop, which can be attributed to the high protein and fluid loss. Tiredness and exhaustion often occur.
There is also a loss of appetite, which in turn can lead to severe weight loss. Various deficiencies can develop due to malabsorption of nutrients in the gut. A vitamin B deficiency, which can be the cause of anemia, is typical. During an attack there is usually a general feeling of illness.
In addition to the symptoms of anemia, fever and an increase in white blood cells can also occur. Other organs can also be affected. For example, symptoms of hepatitis, kidney stones, joint pain, bone loss, eye inflammation or painful skin diseases are observed in around 40 percent of patients with Crohn’s disease. The high disease activity often causes psychological problems, which manifest themselves in depression, among other things.
Complications
Since Crohn’s disease permanently damages the tissue of the digestive tract through inflammation, fistulas occur. Depending on how they progress and whether they ensure an unintended mixing of substances in the body, they must be surgically removed. The same applies to developing ulcers.
In the worst case, these can degenerate and lead to tumor formation. The risk of tumor diseases in the area of the digestive tract is increased. An intestinal blockage occurs at least once in up to 30 percent of those affected and represents an acute emergency. Severe narrowing of individual sections of the intestine can also occur. Both involve operations.
Inflammatory abscesses in the various parts of the digestive tract – especially the intestines – also occur. They can also cause severe inflammation and lead to symptoms of poisoning if opened mechanically. In addition, the impaired absorption capacity of the intestine, in combination with the occurrence of diarrhea, often leads to deficiency symptoms and metabolic imbalances.
In addition to general exhaustion, this also leads to problems in the bone tissue (osteoporosis; also promoted by cortisone therapy of the disease) and other tissue weaknesses. Urinary stones are also common. In addition, a protein deficiency can set in, which is unfavorable for the entire cell preservation of the body.
Because people with Crohn’s disease should avoid certain foods, there is often an undersupply of certain nutrients, which must be compensated for with medication or the administration of dietary supplements.
When should you go to the doctor?
Schematic representation of the symptoms and signs of Crohn’s disease. Click to enlarge.
Diarrhea, pain in the stomach or intestines and unwanted heavy weight loss must be examined by a doctor. Before taking an analgesic drug, it is advisable to consult a doctor because of the possible risks and side effects. The episodic occurrence of symptoms is characteristic of the disease.
Between the phases, the affected person experiences a period of freedom from symptoms, which in some patients can last for several months or years. Nevertheless, a doctor’s visit is necessary so that extensive medical tests can clarify the cause and thus make a diagnosis. An increase in existing irregularities during an attack should be presented to a doctor as soon as possible, as they contribute to a severe impairment of the quality of life.
In the event of exhaustion, tiredness, loss of appetite or internal weakness, a doctor should be consulted. If the organism shows intolerance reactions when eating or if inflammation occurs, a doctor’s visit is advisable. Joint pain, eye problems, kidney stones or hepatitis can be caused by Crohn’s disease. Therefore, a doctor is needed to order further examinations. Irritability, inner restlessness and psychological abnormalities are also signs of an existing health disorder. A doctor’s visit is recommended as soon as the symptoms persist for several days or weeks.
Treatment & Therapy
In the acute phase of Crohn’s disease, the intestine is relieved by parenteral nutrition. The use of cortisone is medicinal in the first place.
This can be used either systemically or, in the case of deep infestation, as an enema or rectal foam. Alleviation of the symptoms is the rule, often even a reduction in the symptoms of the disease can be achieved. Salazosulfapyridine and mesalazine can also be used, but their effectiveness is relatively low.
Antibiotic therapy can be useful in the event of complications. Antibodies against TNF-alpha (tumour necrosis factor) belong to a very young group of active substances, which to date have shown promising effects even in severe cases.
Immunosuppressants and TNF-alpha blockers are used for remission therapy (i.e. to prevent new flare-ups). A maintenance dose of cortisone is often unavoidable.
Surgical therapy should be as economical as possible and usually limited to the treatment of complications. Indications are, for example, narrowing of the intestine (stenoses) to the point of intestinal obstruction, breaking through the intestinal wall (perforation), tunnel formation between intestinal loops, to other organs or to the skin surface (fistulas), inflammatory melting (conglomerate tumor) and abscesses.
Psychological, stress management and body perception therapy is also recommended.
Outlook & Forecast
Crohn’s disease has very individual prognosis, but is always a lifelong affliction for all those affected. With increasing age, many people find that symptoms and flare-ups become less frequent. About a third of those affected experience Crohn’s disease as an intermittent disease with no symptoms in between. This freedom from symptoms can sometimes last for months. However, in about one fifth of all those affected, chronic intestinal inflammation manifests itself as a permanent condition without phases of improvement.
It has been shown that about half of people with Crohn’s disease experience at least one severe flare within a year. Within two years it is up to 70 percent. Important factors regarding a possible flare-up are diet and lifestyle. Cigarettes and alcohol usually make inflammation worse. A specific diet is currently not recommended. Deficiency symptoms can occur due to the weak intestine and should be compensated for a better prognosis.
Necessary operations worsen the quality of life for some of those affected. About a third of those affected develop inflammation in other parts of the body, such as the eyes or bones.
Lifelong therapy and possible stress on the body from operations and the frequent inflammations slightly reduce the life expectancy of Crohn’s disease patients.
Prevention
Crohn’s disease is one of the chronic inflammatory bowel diseases. Unlike ulcerative colitis, Crohn’s disease can inflame the lining of the entire digestive system, from the mouth to the anus.
Since no cause for Crohn’s disease has been identified to date, specific prevention is not possible. Only risk factors can be avoided (especially smoking).
Complications can be avoided or delayed by early diagnosis and subsequent adequate therapy. The prevention of deficiency symptoms as a result of impaired absorption from the intestine (e.g. lack of fat-soluble vitamins, osteoporosis due to calcium deficiency, massive weight loss due to fat loss via the intestine) is one of the building blocks in the therapy of Crohn’s disease.
Aftercare
In Crohn’s disease, follow-up examinations and treatment are extremely important parts of the disease process. They essentially contribute to dealing with the disease and living with it. Due to the chronic course, the disease can spread and affect other regions of the gastrointestinal tract. Follow-up examinations can be used to localize areas of inflammation at an early stage.
The follow-up examinations also serve to prevent colon cancer. An endoscopy of the intestine can thus detect changes and diseases in the large intestine and at the end of the small intestine. In this way, the attending physician always keeps an eye on the patient’s risk of developing colon cancer. Patients with Crohn’s disease are usually included in appropriate therapy programs.
This includes ongoing advice on nutrition and a healthy lifestyle. A balanced, healthy and individually tailored diet can be helpful in the long term. Sporting activities and dealing with stressful situations also play a decisive role in coping with everyday life for patients with Crohn’s disease.
The aim of the follow-up treatment is to achieve a remission phase that lasts as long as possible, in which the patient is doing well as far as possible. Talking to a psychotherapist about the illness is also helpful. The exchange with other Crohn’s disease patients in the context of self-help would also be advantageous.
You can do that yourself
Adhering to the treatment plan prescribed by the doctor is extremely important in the treatment of Crohn’s disease. To avoid complications, the dosage of the medication must not be changed arbitrarily, even if the symptoms improve.
Stress can worsen the symptoms, so there should be room for regular breaks in everyday life. Learning relaxation techniques and exercising while taking your own performance into account can also contribute to an increase in well-being. Smoking has a negative effect on the course of the disease and should be avoided.
Eating habits play a major role: it is advisable to keep a food diary to identify incompatible foods – these must be consistently eliminated from the menu. Occasionally, a change in the way of preparation helps to improve tolerance: raw vegetables, for example, trigger symptoms much more often than cooked ones. Particular attention should be paid to adequate nutrient intake, as these are difficult to absorb from food due to chronic intestinal inflammation. Some vitamins and minerals, including calcium and vitamin D, which are important for bone health, may need to be taken in the form of an appropriate dietary supplement after consultation with the doctor treating you.
Detailed information about the disease and the limitations and opportunities associated with it can help to accept the disease more easily – exchange in a self-help group often contributes to this.
