Crohn's disease is a chronic inflammatory disease. This was named after its discoverer (Burrill Bernard Crohn). Crohn's disease can occur in the entire digestive tract (from the mouth to the anus) in several places simultaneously (discontinuously), but preferably in the end of the small intestine (= terminal ileum, therefore, ileitis terminalis) and the beginning of the colon. The inflammation affects all wall layers of the intestine (not just the mucous membrane as in ulcerative colitis).
Crohn's disease: causes and triggers
Despite intensive research, no clear cause of Crohn's disease has yet been found. The significant accumulation of cases of Crohn's disease in recent years could be accompanied by greatly improved hygienic conditions. It is believed that lack of immune stimulation by intestinal parasites (worms), the immune system does not learn to distinguish own from foreign. As a result, the immune system attacks its own structures (for example intestinal cells), which leads to chronic inflammation.
Whether one is right with this assumption, will show. Familial accumulation indicates that genetic factors also play a role in Crohn's disease. Certain pathogens (bacteria and viruses) may be important in triggering the autoimmune mechanism. The influence of psychic or physical stress on the onset of Crohn's disease seems obvious.
Crohn's disease: symptoms and signs
Although the entire digestive tract may be affected by Crohn's disease, in the majority of cases the small bowel and large intestine are affected. The inflammation of all wall layers leads to a thickening with narrowing of the diameter of the intestine. As symptoms of Crohn's disease also ulcers and fissures occur in the intestinal layers.
Patients often suffer from symptoms such as abdominal pain and fever, especially during a spurt. However, diarrhea is less common in Crohn's disease and, if so, usually with little or no blood. Pain characteristics and localization (usually right lower abdomen) can be very similar to appendicitis, which is why a thorough clarification of a doctor is particularly important.
Crohn's disease: diagnosis
In addition to the clinical evidence (the experienced physician pays attention to anal fistulas, which often occur as the first symptom), apparatus examination methods are of great importance in the diagnosis of Crohn's disease:
- With colonoscopy, the typical changes are visible and can be localized.
- By simultaneously taking a tissue sample, Crohn's disease can be confirmed under the microscope.
- To obtain a complete overview of the digestive tract, an X-ray image is taken after the contrast medium inlet. As a result, the individual disease spots can be better recognized.
- The thickened intestinal walls are also visualized by means of ultrasound.
- In acute episodes, the blood laboratory values show the typical signs of inflammation (many white and few red blood cells, high erythrocyte sedimentation rate).
To rule out a bacterial cause of the infection, the stool must be examined. Circulatory disorders of the intestine can cause an inflammatory change, especially in older patients. After a tumor irradiation in the abdominal cavity, the intestinal loops are often thickened and inflamed.
The distinction from other chronic intestinal diseases, such as ulcerative colitis and diverticulitis or appendicitis, usually succeeds by a thorough history and examination of the patient.
Crohn's disease: life expectancy and history
Crohn's disease is in progress. High activity periods are followed by pauses in which the disease is less symptomatic. Thus, the probability of a resurgence after a rest period of one year is 30 percent, after two years of rest already 40 percent. In the clinic, the activity is determined by means of an activity index. The average life expectancy of Crohn's disease patients is not lower than that of healthy subjects with optimal therapy.
Unfortunately, the likelihood of Crohn's disease disappearing is quite low. The regular recurrence of relapses often causes complications and makes surgery often unavoidable. However, healing is not possible (in contrast to ulcerative colitis).
Complications of Crohn's disease
Since this autoimmune disease affects the entire body, there are signs of it:
- on the skin (redness, ulcers)
- at the joints (arthritis, spinal inflammation)
- on the eye (inflammation inside the eye)
- on the liver (inflammation of the bile vessels)
In the digestive system, disorders of absorption of essential nutrients and vitamins can lead to weight loss and in children to growth retardation.
In advanced disease, there is a risk that constrictions (stenosis) in the intestine form, which can lead to complete intestinal obstruction. Perforations of the intestine are less common in Crohn's disease. Particularly uncomfortable and painful are fistulas, which are found especially in the area of the anus. They establish a connection between the large intestine and the intestinal exit (surroundings of the sphincter muscle). If there is a closure of the fistula, an abscess may form.
After years of illness, colon cancer can develop. However, this risk is lower in Crohn's disease than in ulcerative colitis.
Crohn's disease: treatment and therapy
The Crohn's disease therapy consists on the one hand in the observance of a special diet. If the large intestine is affected, aminosalicylates are used in conjunction with cortisone. In small bowel infestations, cortisone causes an acute attack. In addition, in severe cases of Crohn's disease, antibiotics and immunosuppressants (drugs that suppress the immune system) are also administered.
Due to the relatively common complications (perforation, intestinal obstruction, fistulas) not seldom surgical treatment is required. Since a cure for Crohn's disease is not possible, it is gently operated with the removal of only short intestinal sections and subsequent connection of the bowel ends.
Adapted diet for Crohn's disease and good medical (including psychological) care can influence the course of disease favorably, preventing the disease is not possible, however. Immunomodulatory measures (with intestinal parasites) are still in the testing phase, but could play a key role in interfering with the mechanism of Crohn's disease.