Crohn’s disease

Crohn’s disease is a chronic condition that causes inflammation, swelling, and pain in at least part of the digestive tract. The most affected part is the end of the small intestine, the so-called ileum.

Some people who suffer from Crohn’s disease experience long periods of remission, sometimes for years, during which they are symptom-free.

It is not possible to predict when remission will occur or when symptoms will return.
Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases.


How does Crohn’s disease affect the intestine?

In the initial stages, Crohn’s disease causes small ulcers (erosions) that form at shallow depths in the inner surface of the intestine.
These erosions are called aphthous ulcers. Over time, the erosions become deeper and larger, then become true ulcers or ulcers (which are deeper than the erosions) and cause scars and stiffening of the intestine. As the disease progresses, the intestine becomes narrower and narrower until it comes to occlusion.

Causes of Crohn’s disease

The exact cause of Crohn’s disease is unknown. It used to be thought that the causes could be diet and stress, but now doctors know that these factors can exacerbate the disease, but not cause it.

Factors provoking Crohn’s disease

Immune system
It’s possible that a virus or bacterium can trigger Crohn’s disease. When the immune system tries to fight invading microorganisms, an abnormal immune response causes the immune system to attack the cells of its own digestive tract.

Crohn’s disease is more common in people in whom at least one family member has this condition.
This circumstance suggests that one or more genes may make people more susceptible to Crohn’s disease. However, most people who develop Crohn’s disease do not have a genetic predisposition to this disease.

What are the symptoms of Crohn’s disease?

When the condition breaks out, the inflammation can cause one or more of the following symptoms:

Diarrhea is the most common symptom and can vary from mild to severe. The stool may also contain mucus, pus or blood.

Violent urge
to defecate 
Often you have the feeling that you cannot reach the toilet in time. Also, there is often the feeling of having to go to the toilet, even if there is no bowel movement.

Intestinal pain
Pain occurs in about 7 out of 10 cases.
The area of pain depends on which section of the intestine is affected.
The last section of the small intestine (ileum) is the most commonly affected area.
The most common pain zone is the lower right abdomen.
When Crohn’s disease develops, it is often confused with appendicitis (appendicitis).
The severity of pain can vary from person to person.
In addition, a sudden change or worsening of the pain may indicate a complication.

Unexplained weight loss is another common symptom.

Ulcers (ulcers)
An ulcer is an area of the intestinal lining that can bleed.
Then you can notice blood in the stool.
Ulcers in the mouth and oral cavity are common.

General feeling of malaise, which includes loss of appetite, fever and fatigue.

If a lot of blood is lost, anemia may occur.

rhagades may form.
These are skin injuries on the anus. There may be skin changes in the form of small formations resembling warts around the anus.

The symptoms can vary and depend on which section or sections of the intestine affect them, for example:

  • There is no diarrhea if the disease is limited to the small intestine.
  • A persistent abdominal pain without further symptoms can be caused by a small ulcer in Crohn’s disease in the small intestine.
  • In general, an exacerbation can cause severe discomfort.
  • If a large part of the intestine is affected, the food cannot be absorbed well and vitamin and nutrient deficiencies can occur.

Other symptoms
In some people, other parts of the body may be affected in addition to the intestine. These are: inflammation and pain in some joints (arthritis), rashes; Inflammation of the eye (uveitis) and inflammation of the liver.
These disorders can cause various symptoms.
It is not clear why such problems occur. The immune system can also trigger inflammation in other areas of the body in the case of existing intestinal inflammation.
These disorders tend to disappear once the intestinal symptoms are resolved, but this is not always the case.
Crohn’s disease does not make you lean or fat.

What are possible complications of Crohn’s disease?

One can notice complications, especially if exacerbations are frequent or severe.
Here are the complications that often require surgical treatment:

Intestinal stenosis is the narrowing of a section of the intestine.
It arises from scarred tissue that forms in the inflamed parts of the intestine.
Narrowing can cause difficulty in the passage of digested food.
This causes pain and vomiting.

An intestinal perforation is a small hole that forms in the intestinal wall. The intestinal contents can leak and cause an infection or abscess inside the abdominal cavity.
Perforation can be severe and dangerous.

A fistula is a phenomenon in which inflammation leads to the formation of a channel that connects two independent parts of the body.
For example, a fistula can form between part of the small intestine and part of the large intestine.
Fistulas can also form between a section of the intestine and other organs, such as the bladder or uterus.
The intestinal contents can then pass into these other organs.
Sometimes a perianal fistula develops, which runs from the anus or rectum to the skin around the anus.
At the same level, rhagades or perianal abscesses may develop.

People with Crohn’s disease have a slightly higher risk than the general population of developing colon cancer.

Other complications of Crohn’s
About 4% of patients have non-intestinal complaints, such as:

  • Erythema nodosum
  • Ulcers or aphthae in the mouth
  • Acute arthropathy affecting the large joints (for example, wrist, hip and knee)
  • Sacroiliitis
  • Ankylosing spondylitis
  • Episcleritis
  • Pyoderma gangrenosum
  • Anterior uveitis
  • Conjunctivitis (conjunctivitis)
  • Iritis
  • Fatty liver
  • Primary sclerosing cholangitis
  • Kidney stones
  • Osteoporosis. The increased risk of reducing bone density is due to poor food absorption that occurs in some people with severe Crohn’s disease.
  • Growth retardation. In children with Crohn’s disease, growth retardation has been observed due to malabsorption of nutrients.

How is Crohn’s disease diagnosed?

The doctor asks about the symptoms and performs a physical examination. An X-ray can be taken and laboratory tests can be carried out to find out if you have Crohn’s disease.

The studies for Crohn’s disease include:

Barium contrast X-ray of the small intestine and large intestine.

Colonoscopy. In this examination, the doctor uses a thin and illuminated tube to look inside the colon.

Biopsy. The doctor takes a tissue sample and sends it to a laboratory for examination.
The biopsy is used to clarify whether someone has Crohn’s disease or another condition such as cancer.

Stool examination. This is an examination that looks for signs of infection in a stool sample.

Blood tests cannot be used to diagnose Crohn’s disease.

What is the therapy for Crohn’s disease?

Crohn’s disease is a condition that can become serious and potentially significantly affect quality of life. It is therefore important to learn how to deal with it.

Treatment options include: medication, surgery, and/or dietary supplements. The doctor’s goal is to keep inflammation under control, correct nutritional problems, and relieve symptoms.

Medication for Crohn’s disease

Anti-inflammatory medications – the doctor will presumably start with mesalazine and sulfasalazine, which help control inflammation. Some doctors prescribe 5-ASA (5-amminosalicylic acid), such as pentasa, if sulfasalazine is not tolerated or improved.

Cortisone or steroids – Corticosteroids are medications that contain cortisone. In the initial stages of Crohn’s disease, doctors often prescribe prednisone. The side effects of corticosteroids also include an increased risk of infection.

Immunosuppressive drugs
These drugs decrease the patient’s immune response. The doctor may prescribe mercaptopurine (purinethol) or azathioprine. Immunosuppressants block the immune response that would cause inflammation. Side effects include nausea, vomiting and a lack of resistance to infections.

Biologic medicines (infliximab and adalimumab, monoclonal antibodies and TNF-alpha blockers)
infliximab (Remicade). Remicade blocks the inflammatory reaction of the organism. This medication is indicated in patients with moderate or severe symptoms who have not responded to previous therapies. It is also indicated in the treatment of open fistulas.

A fistula, stenosis or preventive surgery can lead to bacterial proliferation. Doctors usually treat this disorder by prescribing the following antibiotics: ampicillin, sulfonamides, cephalosporin, tetracycline or metronidazole.

Antidiarrheal drugs (medications for diarrhea)
As the inflammation subsides, diarrhea usually becomes less of a problem.
Nevertheless, sometimes the patient may need medication for abdominal pain and diarrhea.
The most commonly prescribed drugs are: loperamide and codeine.

Surgery for Crohn’s disease

If neither the change of diet and lifestyle, nor the drug treatment relieve the symptoms, the doctor may order surgical intervention.
During the procedure, the surgeon removes parts of the damaged digestive tract and then connects the healthy sections together. In addition, the closure of a fistula and the drainage of an abscess can be done. A common procedure for Crohn’s disease is plastic dilation of the intestinal walls by widening a segment of the intestine that has become too narrow.
As a rule, the benefits of surgery for Crohn’s disease are temporary.
The disease recurs often, often close to the restored tissue or elsewhere in the digestive tract.

Does smoking make Crohn’s disease worse?
Studies have shown that smokers with Crohn’s disease may have more severe symptoms and complications.
Surgical intervention is more common in patients who smoke.

Is pregnancy safe in a woman with Crohn’s disease?
Women with Crohn’s disease can become pregnant and give birth. Most children born to women with Crohn’s disease do not develop the disease.

Natural remedies for Crohn’s disease

Food, diet and nutrition
So far, no special diet has been identified as a prevention or treatment for Crohn’s disease, but you should definitely avoid foods that can worsen the symptoms, which is often the case, for example, with milk.
Those who suffer from Crohn’s disease often feel a certain loss of appetite, which can affect their diet.
In addition, Crohn’s disease is associated with diarrhea and malabsorption of the required nutrients. Foods don’t cause Crohn’s disease, but foods like whole grains, spices, alcohol, and dairy can make diarrhea and abdominal cramps worse.

Lemon can help as it is good for the entire digestive tract and joints. You should therefore drink a glass of squeezed lemon juice every morning.

Absorption of vitamin B12 occurs in the ileum. So if this section is inflamed, a vitamin B12 supplement is needed.
Some patients report that taking vitamin B12 eliminates the abdominal pain.

There are different types of probiotics (living microorganisms) with different properties.
Not all probiotics are effective, on the contrary, some could be harmful in certain cases.
Depending on the patient’s complaints, the gastroenterologist must choose microorganisms suitable for the specific case

Can Stress Make Crohn’s Disease Worse?
There is no scientific evidence about the influence of stress on Crohn’s disease.
However, individuals with Crohn’s disease suffer from increased stress because they live with a chronic condition.
Some people with Crohn’s report a flare-up when they go through a stressful situation or have a stressful experience.
For people who see a link between stress and worsening symptoms, relaxation techniques such as meditation, yoga, Reiki, or shiatsu are available to help them feel better.

Crohn’s disease and colon cancer
If Crohn’s disease affects more than half of the surface of the colon (colon), there is a small increase in the risk of developing cancer.

How long does Crohn’s disease (life expectancy) last?

The prognosis varies, but a definitive cure is very difficult. It depends on the affected areas of the intestine and the frequency and severity of exacerbations.

The prospects if Crohn’s disease is not treated are:

  • About 3 in 20 people with Crohn’s disease experience severe and/or frequent exacerbations.
  • Some people experience only one or two flare-ups of inflammation in their lives and have no symptoms for the rest of their lives.
  • Many patients experience a recurrence from time to time, but may be symptom-free for a long time.

Sometimes an exacerbation is severe and dangerous and a small number of sufferers die due to a complication, such as intestinal perforation.

Up to 8 out of 10 people with Crohn’s disease will need surgery at some point in their lives due to complications.
About half of patients with Crohn’s disease undergo surgery within the first 10 years after the onset of the disease.
The most common reason is the elimination of stenosis that has formed.

Some people need multiple surgeries during their lifetime.
Those who suffer from Crohn’s disease should expect 2 to 4 operations in a lifetime.
Meanwhile, the number of operations has decreased, possibly because more modern treatment methods and new drugs are available.

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