Crohn’s disease is a chronic inflammatory disease of the digestive tract. In most patients, only the small intestine, large intestine and/or rectum is affected. Small inflammations and ulcers arise in the intestinal wall. The intestinal wall is not contiguously inflamed, but healthy and diseased intestinal parts alternate. Curing Crohn’s disease is not possible.
Cause
There are several factors that may have an impact on the development of Crohn’s disease:
- Our immune system protects the body from harmful invaders, like bacteria and viruses. In case of Crohn’s disease, the immune system is confused. The result is that inflammations arise in the intestine.
- Heredity. Five to ten percent of the relatives of a person with Crohn’s disease, have the disease too. In family members of people without the disease, this percentage is lower.
- Certain bacteria may play a role in causing the disease. At this moment, research is still going on.
- Excessive stress causes gastrointestinal discomfort in many people. Stress alone is not the only cause of Crohn’s disease. However, stress affects the severity of the symptoms.
- Smoking increases the risk of Crohn’s disease and has a negative effect on the course of the disease.
- Excessive hygiene, as occurs in the Western world, could contribute to the onset of the disease.
Poor living conditions decrease the risk of developing Crohn’s disease. Breastfeeding reduces the probability that the offspring will develop the disease.
Symptoms
The symptoms can vary significantly from person to person. Patients are often life-long affected, but there are periods with little to no symptoms. An attack can be quite severe and may well last a few weeks to months. Common signs and symptoms are:
- Loose stools or diarrhea. The inflamed intestine cannot absorb enough moisture.
- Weight loss, anemia or growth retardation. The inflamed intestine doesn’t absorb certain nutrients sufficiently, so shortages may arise in the body, for example vitamin B12. Resulting in fatigue.
- Blood loss. Inflammatory sores arise in the intestine, so blood loss in the stool may occur.
- Narrowing (stenosis). When the inflammation at a particular place is very intense (acute phase) or due to the development of scar tissue, a narrowing may arise in the intestine. Sometimes, this even leads to closure of the intestine.
In addition to these symptoms, other symptoms can occur too, such as fistulas, joint pain and eye and skin disorders.
Diagnosis
Making the diagnosis often takes some time, because it isn’t always clear what exactly is going on. Currently there is no simple test to determine Crohn’s disease. Apart from physical examination, further investigation is also required to make the diagnosis:
- With blood test can be examined whether there is anemia and inflammation. The doctor can also determine with a blood test the physical fitness and nutritional status.
- The stool is examined in order to exclude bacterial infections.
- Imaging studies, such as ultrasound, X-ray, CT scan or MRI scan.
- In the majority of cases, the diagnosis of Crohn’s disease is made by means of an internal exploratory examination (endoscopy). This way, the doctor can view the inside of the intestine. During an endoscopy, a piece of tissue can be taken from the intestinal wall (biopsy). This tissue sample is then analyzed under the microscope.
Treatment
The treatment of Crohn’s disease basically includes medication. Although drugs cannot cure Crohn’s disease, the treatment will usually ensure a reduction of symptoms and the inhibition of the inflammation. The medicines can also prevent the emergence of new infections. Some people are due to medication even (almost) free of symptoms. The following groups of medications are prescribed for Crohn’s disease: anti-inflammatories, immunosuppressants, TNF blockers, antibiotics and diarrhea inhibitors.
When medications don’t help sufficiently, surgery is sometimes necessary. An operation may also be necessary when a narrowing or blockage of the intestine has occurred. Inflamed areas or narrowings in the intestine are then removed by the surgeon. In some cases, a (temporary) stoma is applied after bowel surgery.
Prognosis
The course is unpredictable, the disease emerges again and again. About seven out of ten persons with Crohn’s disease are eventually being operated. The expected average life span can be slightly shortened by complications and operations. Regular monitoring by means of endoscopy may be needed to keep track whether no cancer of the large intestine develops.
