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Crohn’s disease is a chronic inflammatory disease of the digestive system, which belongs to the group of inflammatory bowel diseases (IBD). Because we do not know the exact etiology of its occurrence, we classify it as an autoimmune disease.  

It is an inflammation that can affect any part of the digestive tract, from the mouth to the anus. It most often affects the final part of the small intestine and the large intestine. It is a chronic condition, which means that it can accompany the patient throughout his life and is characterized by flare-ups and remissions.  

Who can get it?

All of us can potentially be affected by Crohn’s disease. The usual ages are people between 15 and 35 years old, however, it also affects older people. The frequency of occurrence in the general population is 0.2%. However, if there is a family history of the disease, the risk of developing it may be slightly higher. One in five people with Crohn’s disease has a family member with a history of the disease.
 

Causes and risk factors. What causes Crohn’s disease?

The exact cause of the disease is unknown, but it is believed to be due to a combination of factors such as: 

• Genetic predisposition.

• Immune disorders.

• Environmental factors, Western diet.

• Gut microbiome.

• Infections.

• Smoking is a significant risk factor for the development of the disease, resulting in the most severe form of manifestation. 

How does Crohn’s disease manifest itself and with what symptoms?

The symptoms of the disease vary depending on the location and severity of the inflammation. The disease can be expressed by the digestive tract but also by a number of other anatomical organs such as joints (ankylosing spondylitis, sacroiliacitis), skin, mouth, liver, eyes, blood, vessels, urinary tract, etc. A characteristic of the disease is that several times the manifestations and symptoms of the remaining organs precede the intestinal manifestations. Some of the most common symptoms include:   

• Abdominal pain and cramps.

• Diarrhea (sometimes with blood or even mucus).

• Weight loss.

• Fatigue and weakness.

• Vomiting or nausea.

• Aphthae of oral cavity.

• Increased body temperature.

• Pain in the joints.

• Skin problems.

• Inflammation in the eyes.

• Fistulas and abscesses in the anus region.

How is Crohn’s disease diagnosed?

The diagnosis of the disease can be delayed, as the symptoms may resemble other diseases. After taking your history and symptoms, the doctor will proceed with a series of tests such as: 

• Blood tests

• Stool tests

• Colonoscopy and maybe gastroscopy

• Taking biopsies of the colon and small intestine through which the diagnosis will be made

• Magnetic enterography and capsule endoscopy for complete control of the small intestine bowel

What is the treatment for Crohn’s disease?

The first contact between the doctor and the patient is particularly important and should take place in a calm environment and without any time pressure. Initially, the doctor should explain and inform the patient and the family environment in detail about the nature, severity, possible course of the disease and possible complications. The following is information about the available treatments and their side effects. At present, there is no treatment in the sense of a complete cure. The primary goal is to treat the disease immediately and rapidly at its first appearance or during an exacerbation. Cortisone can be administered, orally or intravenously, in order to control the inflammation. At the same time, the appropriate medication must be selected immediately, through which the remission of the disease will be maintained over time.

Treatment includes anti-inflammatory, immunosuppressive or biological drugs. Treatment is now individualized. The doctor must evaluate several parameters such as age, location, severity, presence of extraintestinal manifestations, fistulas and/or abscesses. Some patients may undergo surgery to treat fistulas, abscesses or, more rarely, to remove parts of the intestine that are seriously affected by inflammation. Lifestyle changes, such as diet and exercise, are also required. Diet plays an important role in the management of disease as well as immediate smoking cessation! 

Psychological support: dealing with the emotional impact

Symptoms, treatment and uncertainty about the future often create anxiety, depression and a sense of isolation. The doctor-patient relationship in inflammatory bowel diseases is important and there must be a relationship of trust. It is helpful for patients to seek support from family and friendly environment, specialist counselors or psychological support groups. Psychotherapy can also help manage the emotional impact of the disease.