Crohn’s disease is a chronic inflammation of the intestines in the gastrointestinal tract or digestive tract. It causes typical episodes of discomfort and symptoms, such as diarrhea, painful stomach cramps, and severe weight loss. However, these symptoms are initially unpsecific, so Crohn’s disease is not always diagnosed first. Therefore, if chronic inflammatory bowel disease is suspected, the physician should always perform colonoscopy, X-ray examination, laboratory tests and ultrasound in the diagnosis and treatment.
What is Crohn’s disease?
Inflammatory bowel disease and the affected regions in ulcerative colitis and Crohn’s disease compared. Crohn’s disease (chronic inflammatory bowel disease), along with ulcerative colitis, is one of the chronic inflammatory bowel diseases that often occurs in episodes. The peak incidence is between the ages of 16 and 35. In older people over 60 years of age, a so-called age-related Crohn’s disease may occur. There is a familial accumulation, and the overall frequency of the disease is increasing. The symptoms are often unspecific (cramps, nausea, weight loss); courses without the characteristic diarrhea are also possible. A characteristic feature is the formation of granulomas in the intestinal wall. In contrast to ulcerative colitis, Crohn’s disease can occur throughout the gastrointestinal tract, from the oral cavity to the rectum. There is often discontinuous involvement, i.e. affected sections are interrupted by healthy bowel. However, infestation of the last section of the small intestine, the terminal ileum, is typical. Complaints outside the gastrointestinal tract are common, usually joint pain and inflammation, painful skin changes or eye symptoms are present. Diagnosis is made by colonoscopy with removal of tissue samples.
Causes
There is much speculation about the causes of Crohn’s disease (chronic inflammation of the bowel); none of the theories has yet been proven. Only smoking has been identified as a risk factor. Currently, Crohn’s disease is classified as an autoimmune disease. This classification is by no means certain, only the good response to immunosuppressive therapy is the basis for this. It is also suspected that those affected have a barrier disorder of the intestinal wall, so that bacteria can penetrate unhindered and provoke a partially excessive defense. A genetic component is also being discussed because of the familial accumulation. It is unclear whether excessive hygiene, nutritional circumstances or infections with mycobacteria play a decisive role. For a long time, Crohn’s disease was thought to be a psychosomatic disease. This has now been disproved as the sole cause, although a psychosomatic influence can be assumed. For example, disease severity and relapse frequency are significantly increased during times of stress.
Symptoms, complaints, and signs
Crohn’s disease is characterized by prolonged watery diarrhea and colicky pain in the right upper abdomen. There is usually no blood or mucus mixed in with the stool. The symptoms occur in episodes. There may be long intervals between episodes. However, the symptoms can also intensify during an episode if allergies or intolerances to certain foods are also present. Such food allergies or food intolerances are more common in patients with inflammatory bowel diseases such as Crohn’s disease. As a result of the numerous diarrhea episodes, other symptoms may develop due to the high protein and fluid loss. There is often fatigue and exhaustion. Furthermore, there is loss of appetite, which in turn can lead to severe weight loss. Various deficiencies can develop due to malabsorption of nutrients in the intestine. Typical is a vitamin B deficiency, which can be the cause of anemia. During an episode, there is usually a general feeling of illness. Thus, in addition to the symptoms of anemia, there may be fever and an increase in white blood cells. Other organs may also be affected. For example, symptoms of hepatitis, kidney stones, joint pain, bone loss, eye inflammation or painful skin conditions are observed in about 40 percent of patients with Crohn’s disease.Often, the high disease activity causes psychological problems that manifest themselves, among other things, in depression.
Complications
Because Crohn’s disease permanently damages the tissues of the digestive tract through inflammation, fistulas occur. Depending on how they progress and whether they provide for an unintended mixing of substances in the body, these must be surgically removed. The same applies to ulcers that develop. In the worst case, these can degenerate and lead to tumor formation. The risk of tumor diseases in the digestive tract is increased. Intestinal obstruction occurs at least once in up to 30 percent of those affected and represents an acute emergency. Severe narrowing of individual sections of the intestine also occurs. Both result in surgery. Inflammatory abscesses in the various parts of the digestive tract – especially in the intestine – also occur. They can also cause severe inflammation and, if opened mechanically, lead to symptoms of poisoning. In addition, the deteriorated absorption capacity of the intestine, in combination with occurring diarrhea, often leads to deficiency symptoms and metabolic imbalances. In addition to general fatigue, this also leads to problems in the bone tissue (osteoporosis; also favored by cortisone therapy of the disease) and to further tissue weaknesses. Urinary stones also occur more frequently. In addition, a protein deficiency can develop, which is unfavorable for the overall cellular maintenance of the body. As a result of the fact that people with Crohn’s disease should avoid certain foods, there is often an undersupply of certain nutrients, which must be compensated for with medication or the administration of dietary supplements.
When should you see a doctor?
Schematic diagram to the the symptoms and symptoms of Crohn’s disease. Click to enlarge. Diarrhea, pain in the stomach or intestines, and unintentional severe weight loss need to be evaluated by a doctor. Before taking any analgesic medication, consultation with a medical professional is always recommended due to possible risks and side effects. A characteristic feature of the disease is the episodic occurrence of the symptoms. Between the phases, the affected person experiences a period of freedom from symptoms, which in some patients can last several months or years. Nevertheless, a visit to the doctor is necessary so that extensive medical tests can clarify the cause and thus enable a diagnosis to be made. An increase in existing irregularities during a relapse should be presented to a physician as soon as possible, as they contribute to a severe impairment of the quality of life. In case of fatigue, tiredness, loss of appetite as well as internal weakness, a visit to the doctor should be made. If the organism shows intolerance reactions during food intake or if inflammations occur, a visit to the doctor is advisable. In case of joint pains, discomfort of the eyes, kidney stones or hepatitis disease, Crohn’s disease may be present as a cause. Therefore, a doctor is needed to order further examinations. Irritability, inner restlessness as well as mental abnormalities are also signs of a present health disorder. A visit to the doctor is recommended as soon as the complaints persist for several days or weeks.
Treatment and therapy
In the acute episode of Crohn’s disease, the bowel is relieved by parenteral nutrition. Medication is the use of cortisone in the first place. This can be applied either systemically or, in cases of deep involvement, as a clysma or rectal foam. Relief of symptoms is the rule, and often there is even a remission of disease symptoms. Salazosulfapyridine and mesalazine may also be used, but efficacy is relatively low. Antibiotic therapy may be useful in cases of complications. Antibodies against TNF-alpha (tumor necrosis factor) belong to a very young group of active agents, which to date have shown a promising effect even in severe courses. Immunosuppressants and TNF-alpha blockers are used for remission therapy (i.e. to prevent new relapses). Often, a maintenance dose of cortisone cannot be avoided. Surgical therapy should be used as sparingly as possible and usually limited to treatment of complications only.Indications are, for example, narrowing of the intestine (stenosis) up to intestinal obstruction, perforation through the intestinal wall (perforation), tunneling between intestinal loops, to other organs or to the skin surface (fistula), inflammatory fusions (conglomerate tumor) and abscesses. Accompanying psycho- stress management and body awareness therapy is recommended.
Outlook and prognosis
Crohn’s disease has a very individual prognosis, but it is always a lifelong condition for all affected individuals. As many individuals age, symptoms and relapses become less frequent. About one-third of Crohn’s disease patients experience episodes with no symptoms in between. This freedom from symptoms can sometimes last for months. In about one fifth of all patients, however, chronic inflammatory bowel disease manifests itself as a permanent condition without phases of improvement. It has been shown that about half of all patients with Crohn’s disease experience at least one severe relapse within one year. Within two years, this figure is up to 70 percent. Important factors regarding a possible flare-up are diet and lifestyle habits. Cigarettes and alcohol usually worsen inflammatory symptoms. No particular diet is currently recommended. However, deficiencies may occur due to weak bowel and should be compensated for a better prognosis. Necessary surgery worsens the quality of life in some sufferers. Similarly, about one-third of sufferers develop inflammation elsewhere in the body, such as in the eyes or bones. Lifelong therapy, as well as possible stresses on the body from surgery and the frequent inflammation, slightly reduce the life expectancy of Crohn’s disease patients.
Prevention
Crohn’s disease is one of the chronic inflammatory bowel diseases. Unlike ulcerative colitis, Crohn’s disease can inflame the mucosa of the entire digestive system, from the mouth to the anus. Since no cause for Crohn’s disease has been identified to date, specific prevention is not possible. Only risk factors can be avoided (especially smoking). Complications can be avoided or delayed by early diagnosis and subsequent adequate therapy. Prevention of deficiency symptoms as a result of impaired absorption from the intestine (e.g., deficiency of fat-soluble vitamins, osteoporosis due to calcium deficiency, massive weight loss due to fat loss through the intestine) is also one of the building blocks in the therapy of Crohn’s disease.
Follow-up
In Crohn’s disease, follow-up examinations and treatments are extremely important components of the disease process. In essence, they help patients come to terms with and live with the disease. Due to its chronic course, the disease can spread and affect other regions of the gastrointestinal tract. Follow-up examinations can localize foci of inflammation at an early stage. Furthermore, follow-up examinations also serve to prevent colorectal cancer. Endoscopy of the intestine can thus detect changes and diseases in the colon as well as at the end of the small intestine. In this way, the treating physician always keeps an eye on the patient’s risk of developing colorectal cancer. Patients with Chron’s disease are usually integrated into appropriate therapy programs. This includes ongoing counseling on nutrition and a healthy lifestyle. For example, a balanced, healthy and individually tailored diet can be helpful in the long term. Sporting activities and dealing with stressful situations also play a crucial role in helping patients with Chron’s disease to cope with everyday life. The goal of follow-up treatment is to achieve a remission phase that lasts as long as possible, during which the patient is as well as possible. Talking about the disease with a psychotherapist is also helpful. Likewise, exchange with other Crohn’s disease patients in the context of self-help would be beneficial.
What you can do yourself
Adherence to the treatment plan prescribed by the physician is extremely important in the treatment of Crohn’s disease; to avoid complications, the dosage of medication must not be changed on one’s own authority, even if the symptoms improve. Stress can worsen the symptoms, so regular rest breaks should be included in everyday life.Learning relaxation techniques and exercising while taking into account one’s own capacity can also contribute to an increase in well-being. Smoking has a negative effect on the course of the disease and should be avoided. Eating habits play a major role: It is advisable to keep a food diary in order to detect intolerable foods – these must be consistently eliminated from the menu. Occasionally, a change in the way food is prepared can help to improve tolerance: raw vegetables, for example, trigger complaints far more often than cooked vegetables. Particular attention must be paid to adequate nutrient intake, as these are poorly absorbed from food as a result of chronic intestinal inflammation. Some vitamins and minerals, including calcium and vitamin D, which are important for bone health, may need to be supplemented after consultation with the treating physician. Detailed information about the disease and the limitations and options associated with it can help people to accept the condition more easily – an exchange in a self-help group often contributes to this.
