Crohn’s disease (MC) – colloquially called Crohn’s disease – (synonyms: colitis granulomatosa; colitis regionalis; Crohn’s disease; enteritis regionalis; enteritis regionalis Crohn; enterocolitis regionalis; ileitis regionalis Crohn; ileitis terminalis; sclerosing chronic enteritis; terminal ileal inflammation; inflammatory bowel diseases; ICD-10-GM K50.-: Crohn’s disease [enteritis regionalis] [Crohn’s disease]) is a chronic inflammatory bowel disease (IBD). It can affect the entire gastrointestinal tract (gastrointestinal tract; from the oral cavity to the anus). A characteristic feature is the discontinuous pattern of spread, i.e. segmental (sectional) involvement of the intestinal mucosa of the terminal ileum (last part of the small intestine that merges into the colon) and colon (large intestine). This means that several intestinal sections may be affected, which are separated from each other by healthy sections. The site of predilection (preferred body region) is the terminal ileum in 87% of cases and the colon in 69% of cases. Less frequently affected are the esophagus (about 0.5%), stomach (about 6%), duodenum (about 4.5%), anterior segments of the small intestine (about 3%), and rectum (about 21% of cases). Sex ratio: men and women are equally affected. Frequency peak: The disease occurs predominantly between the 15th and 35th year of life. 19% of all Crohn’s disease sufferers are under 20 years of age, and in some cases the disease begins in infancy. The prevalence (disease incidence) is 100-200 per 100,000 inhabitants. The incidence (frequency of new cases) is about 5-10 cases per 100,000 inhabitants per year (in Germany). In industrialized countries, the number of diseases is steadily increasing. In total, about 320,000 Germans suffer from Crohn’s disease and ulcerative colitis, two chronic inflammatory bowel diseases. Course and prognosis: The disease progresses in episodes. If the disease symptoms persist for longer than 6 months, the course is described as chronically active. So-called activity indices (e.g. CDAI = Crohn’s Disease Activity Index) are used to assess the course of the disease. The prognosis is unfavorable the younger the affected person is at the onset of the disease, if there is perianal (“around the anus (anus)”) involvement, if the first episode is severe and accompanied by weight loss > 5%, and/or if steroid use (corticosteroids, e.g., cortisone) is required. Crohn’s disease is relapsing (recurrent). The recurrence rate is 30% after one year and 70% after two years. Within 15 years of disease, surgery is required in 70% of cases, due to complications. Since repeated surgical procedures are often required, they should be minimally invasive and bowel-preserving techniques should be preferred. The recurrence rate is independent of the surgical procedure. Limited resection, in which the most severely diseased portions of the bowel are removed, and alternatively stricturoplasty, i.e., extension of a stricture on the small bowel, are preferred. Stricturoplasty preserves the small intestine and avoids short bowel syndrome (malabsorption /poor absorption of micro- and macronutrients). A cure for the disease is not yet possible. After a disease course of more than ten years, Crohn’s disease patients have an increased risk of developing colon carcinoma (colorectal cancer). The risk of developing small bowel carcinoma (cancer of the small intestine) is higher than that of colon carcinoma (cancer of the large intestine). A population-based cohort study found a reciprocal association between Crohn’s disease and neoplastic lesions of the cervix uteri (dysplasia/precancerous tumor (precancer); cervical carcinoma/malignant neoplasm in the cervix uteri (uterine cervix)). Patients with Crohn’s disease also have a 26 percent increased incidence of Parkinson’s disease. Patients with inflammatory bowel disease (IBD) have an increased risk of celiac disease (RR, 3.96; 95% CI, 2.23-7.02). Note: Children and adolescents are at increased risk for psychosocial problems and psychiatric illness.
