CROHN’S DISEASE

Crohn’s disease (CD) is a non-specific inflammatory bowel disease. It can affect any segment of the digestive system – from the mouth to the anus.

The most common site of inflammatory lesions is the last section of the ileum, then the small and large bowels and the large bowel alone. Other sites are rarely affected. About half of the patients have lesions, such as fissures, abscesses and fistulas, in the anal area. 

The exact cause of Crohn’s disease is not known. Three factors are listed as possible mechanisms behind the disease: individual predisposition (genetic component), gut flora and the immune response of the patient’s mucosa.

General non-specific symptoms include: weakness, fever, weight loss. Local symptoms depend on the site, size and intensity of lesions in the digestive system. 

The clinical presentation depends on the site of the lesions: 

If you experience recurring diarrhoea, abdominal pain, fever or unexplained or unintended weight loss, bleeding from your digestive tract or perianal lesions (abscesses, fissures, fistulas), see your general practitioner for diagnostic work-up.

Patients with diagnosed Crohn’s disease who are experiencing a flare-up should immediately see a doctor, who will decide if hospitalization is needed or if the treatment can continue in an outpatient setting. Some symptoms (e.g. bleeding or obstruction of the digestive tract) may lead to severe complications and require urgent medical help. 

The diagnosis is based on the evaluation of the results of physical examination, medical history and additional tests, out of which the results of colonoscopy and biopsy are the most important. Basic laboratory tests are needed as well. A computed tomography of the abdomen is a very useful diagnostic tool. In some cases, patients need enteroscopy or capsule endoscopy.

Anti-inflammatory and immunosuppressive medicines (which inhibit defective immune system response) are used to treat flare-ups.

In mild cases patient take oral aminosalicylates (mesalazine, sulfasalazine) and/or glicocorticosteroids (prednisone, methylprednisolone). In more severe cases the treatment involves IV administration of glicocorticosteroids, and if the symptoms fail to improve – immunosuppressants are added. Doctors can also prescribe new medicines, monoclonal antibodies, such as infliximab or adalimumab, and a more recent glicocorticosteroid, budesonide.

Crohn’s patients quite often undergo surgeries. These are mainly procedures for local complications (abscesses, fistulas), but also for stenosis, partial bowel obstruction or suspected cancer.

The treatment in Crohn’s disease is long-term: the goal is to prevent relapses and alleviate the symptoms when the disease flares up. Most likely Crohn’s disease cannot be entirely cured, but there are mild cases without flare-ups.

A rare and distant effect of inflammatory bowel diseases is colorectal cancer (ca. 1.5% of patients).

You should not discontinue the medications on your own, without talking to your doctor, even if the symptoms have long resolved. Long-term treatment during the remission is the most effective way of preventing relapses. Endoscopic monitoring is also important – patients who have had the disease for over 10 years should be monitored for colorectal cancer (colonoscopy every 2 years). Osteoporosis prevention is also important.

There is no special diet recommended for Crohn’s patients. The diet should be healthy, i.e. varied and rich in nutrients, vitamins and minerals. The most important thing is to avoid foods which cause or aggravate the symptoms, such as (but only in some patients): milk and milk products, wheat, yeast, corn, bananas, tomatoes, eggs and wine. During flare-ups patients should avoid high-residue foods, such as wholemeal bread, pulses, vegetables (in particular cabbage), or high fibre fruits and foods that can worsen diarrhoea.