Definition, Causes, Symptoms, Diagnosis, and Treatment
Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract, leading to the formation of granulomas. It is a chronic condition characterized by systematic involvement of various organs, with severe cases requiring surgical intervention. Inflammation in Crohn’s disease affects the mucosal layer and submucosa, with inflammatory granulomas appearing in any part of the digestive tract, particularly the small intestine, especially the ileum. The damage to the intestines starts with inflammation of the crypts (cryptitis), leading to the formation of small ulcers underneath. The inflammation spreads to involve deeper layers of the intestinal walls, affecting the entire thickness of the intestinal wall and becoming transmural. It is characterized by wall thickening, disruption of lymphatic circulation, and sometimes fistula formation. Ulcers heal with the formation of rough scar tissue. During endoscopic examination, the inner lining of the intestines appears with a characteristic “cobblestone” appearance.
The multidisciplinary care team includes gastroenterologists, geneticists, and surgeons. The disease typically begins in adolescence and is less common in individuals under 35 years of age. The course of the disease is unpredictable, with periods of remission alternating with flare-ups. There is no gender difference in the incidence of this disease.
Risk factors include having relatives with the disease, with rates of incidence in this group being 10 times higher. Crohn’s disease is four times more common among smokers compared to those leading a healthy lifestyle. Additionally, women who regularly use oral contraceptives are more frequently affected by the disease.
Symptoms of Crohn’s Disease
Symptoms can be divided into intestinal and extraintestinal symptoms.
Intestinal symptoms include:
- Frequent watery diarrhea, sometimes to the extent of disrupting sleep.
- Abdominal pain of varying severity.
- Loss of appetite.
- Nausea and vomiting.
- Intestinal obstruction.
- Severe weight loss leading to malnutrition.
- Presence of blood in the stool or intestinal bleeding.
- Fever.
- Fatigue and reduced ability to work.
- Ulcers and fissures inside the abdominal cavity, especially those directed toward the vagina and bladder.
- Abscesses in tissues adjacent to the rectum (around the anus).
- Arthritis.
- Inflammation in different areas of the eye.
- Formation of lesions on the skin.
- Presence of red, hard nodules on blood vessels.
- Inflammation of the gallbladder and liver.
- Delayed growth in children if the disease begins at an early age.
Additionally, the recurrence of fistulas is considered an important symptom of the disease. In some cases, Crohn’s disease may be complicated by issues such as bacterial overgrowth in the intestines, peritonitis, anal fissures, colon cancer, or total exhaustion.
Causes of Crohn’s Disease
The causes of this disease have not been fully studied yet. Among the main risk factors that doctors point to are:
- Genetic predisposition, as confirmed by statistics.
- Presence of allergic reactions to various triggers.
- Smoking.
- Frequent alcohol consumption.
- Tendency to take medications in large quantities.
- Exposure to unfavorable environmental conditions.
The main role in the formation of the disease is attributed to an abnormal immune system reaction to the intestines’ own tissues. For reasons unknown, a large number of white blood cells migrate to the intestinal wall, where they become the starting point for inflammation.
Diagnosis of Crohn’s Disease
The accuracy of Crohn’s disease diagnosis has improved in recent decades due to advancements in the quality and analytical capabilities of medical devices.
The initial examination and clinical image analysis are conducted by a gastroenterologist. To confirm the diagnosis, diagnostic tests such as:
- Computed tomography imaging of abdominal cavity organs – detects granulomas, intestinal wall thickening, and small ulcers.
- Colonoscopy (visual examination of mucous membranes) – detects inflammations, erosions, ulcers, and scarring, and allows for tissue sample collection (biopsy).
- Barium X-ray imaging of the intestines with contrast – reveals changes in structure, narrowing, ulcerative defects, and granulomas.
- Capsule endoscopy – exploration of the digestive tract using a capsule that captures images of the inner walls along the route.
Laboratory diagnosis is essential and includes:
- Comprehensive blood analysis – shows signs of inflammation and anemia.
- Stool analysis.
- Occult blood stool test.
Treatment of Crohn’s Disease
Treatment is palliative and aims to reduce the appearance of disease symptoms.
Treatment is primarily conservative.
The basis of treatment is following the Bevisner Diet #4. The amount of fat is reduced, and toasted bread, secondary meats, fresh cheese, steamed or boiled and mashed chicken meat, whipped chicken eggs, mashed grains, boiled or steamed vegetables, mashed fruits, light tea, and fruit drinks are allowed.
Absolutely prohibited!! Baked goods, strong broths, fats and fried foods, sausages and canned foods, pickles and smoked products, full-fat milk, legumes, coarse grains, fresh vegetables and fruits, salty liquids.
Food should be warm, and it is recommended to consume 5-6 meals a day. Additionally, about 1.5 liters of fluids should be consumed, and bed rest should be observed.
Alcohol, coffee, strong tea, carbonated beverages, fast food, and smoking should be completely avoided.
- Medications are used during flare-ups, including anti-inflammatories, immunosuppressants, cytokine inhibitors, antibiotics, and, if necessary, corticosteroid hormones.
- Hemostatic agents, pain relievers, antiemetics, and laxatives are also prescribed, as well as vitamin and mineral supplements as needed.
Surgical Treatment
Surgical treatment for Crohn’s disease refers to emergency cases and planned surgeries:
- Reasons for emergency surgery include: lack of improvement in severe disease cases despite adequate treatment (including intravenous steroids) for 7 days, intestinal obstruction due to strictures, fissures, abscesses, perforation, and severe bleeding.
- Planned surgery reasons include: severe disease cases with no improvement with conservative treatment as the disease progresses, recurrent exacerbations negatively impacting quality of life, and the presence of severe deformity or cancer.
The affected area of the intestines is excised to restore the integrity of the digestive system.
Modern medical techniques cannot cure Crohn’s disease completely. However, proper nutrition management, preventive treatment, and a regular lifestyle can reduce the number of flare-ups and thus improve quality of life. It is important to quit smoking and avoid alcohol consumption as much as possible, as well as to avoid psychological stress. Experienced doctors at healthcare centers conduct a comprehensive diagnosis of the intestinal condition and select appropriate treatment and prepare a dietary plan.
Sources:
- Grigoryeva G.A. Ulcerative colitis and Crohn’s disease are a challenge of the 21st century. Published in the Bulletin of Smolensk State Medical Academy. No. 1. 2011.
- Gastroenterology. National Guidelines // Edited by Ivashkin V.T., Lapina T.L. – GEOTAR-Media. – 2008. – 754 p.
- Clinical recommendations on “Crohn’s