Crohn’s disease

Crohn’s disease is a chronic inflammatory disease of the digestive system. In contrast to ulcerative colitis (another chronic inflammatory bowel disease or IBD), Crohn’s disease can affect any part of the digestive tract from the mouth to the anus. It can affect multiple, non-adjacent segments of the digestive tract.

However, the inflammation most commonly occurs in the final segment of the small intestine and in the adjoining segment of the large intestine. Crohn’s disease affects not only the uppermost layer of the mucosa but also deeper layers of the lining of the gut.

Crohn’s disease can have various symptoms that occur either in isolation or in combination with one another. These include:

• cramping abdominal pain
• chronic diarrhea lasting at least 4 weeks – the stool may contain blood, mucus, or both
• weight loss
• fatigue
• high temperature (fever)
  

More rarely, the disease may cause stenoses, i.e. narrowing of the bowel, or fistulas, i.e. abnormal tunnels that develop between the anal canal and the skin around the anus.

Crohn’s disease may also cause symptoms in parts of the body outside of the digestive tract, e.g. inflammation of the eyes, joints, and skin.

The symptoms of Crohn’s disease are caused by an inflammation of the intestinal mucosa that lines the digestive tract.

The body’s immune system attacks its own mucosa. It is not yet known what triggers this inappropriate immune system response.

However, research indicates that certain genetic changes increase the risk of developing Crohn’s disease. Auto-immune disorders, environmental influences, and imbalances in intestinal flora are also regarded as possible triggers.

People who have close family members with an inflammatory bowel disease are also at an increased risk of developing Crohn’s disease.

Other inflammatory diseases or auto-immune disorders, as well as smoking and taking antibiotics are also considered risk factors.

It is estimated that Crohn’s disease affects between 100 and 200 out of every 100,000 people in Germany. Every year, an average of around 7 out of every 100,000 people develop Crohn’s disease.

The disease usually begins in early adulthood between the ages of 20 and 30 approximately.

Crohn’s disease is a chronic condition, which means that it cannot be cured.

However, very few people with the disease suffer from inflamed mucosal tissue on a continuous basis. Instead, they typically have recurring flare-ups that alternate with phases of being either symptom-free or having only mild symptoms. The inflammation clears up during these dormant phases.

However, if symptoms persist over a long period, they can lead to malnutrition, anemia, and, in some cases, life-threatening complications.

In addition, people with Crohn’s disease have an increased risk of developing bowel cancer (colorectal cancer). Doctors therefore recommend regular colonoscopies for early detection.

Inflammation of the intestinal mucosa may have a range of causes. For example, it may be due to other chronic inflammatory diseases, such as ulcerative colitis, an acute infection, or a food intolerance.

Doctors can run various tests to exclude these possible causes and diagnose Crohn’s disease.

Doctors begin by taking a detailed medical history to pinpoint what type of symptoms are being experienced and when they began. They will also find out:

• whether the patient has a known food intolerance
• whether the patient is taking medication and, if so, which type
• whether they smoke
• whether they have family members with Crohn’s
• whether they traveled abroad recently

Next, a blood test is performed to detect anemia, an elevated platelet count, as well as certain inflammatory markers that point to Crohn’s disease. A stool sample is also tested to exclude infections with intestinal bacteria.

If Crohn’s disease is suspected, doctors usually suggest an endoscopic examination of the colon (colonoscopy) and, in some cases, of the stomach (endoscopy/gastroscopy). A sample of mucosal tissue can be taken during this procedure.

Under certain circumstances, additional investigations, such as an ultrasound or magnetic resonance imaging (MRI) scan are required to determine the nature and severity of the disease.

The treatment of Crohn’s disease depends on its severity in each case, i.e. whether it causes mild or severe symptoms, as well as on the part of the body that is affected.

Crohn’s disease can often be managed effectively with medication. There have been significant advances in treatment options over recent years.

An operation may also be required in particularly severe cases or if complications arise. The surgery may involve opening segments of the bowel that have become narrowed or removing individual parts of the bowel.

By adapting their diet, people with Crohn’s disease can improve their quality of life. Severe diarrhea often causes the body to lose vitamins, minerals, and trace elements. This, in turn, can lead to a deficiency in potassium, calcium, iron, or zinc. To prevent this, it is useful for patients to discuss a nutritional plan with their doctor.

It is advisable to avoid or quit smoking, as it can lead to a more severe progression of the disease.

Psychological support may help patients deal better with stress, anxiety, or depression.

There are many services offering support for people with Crohn’s disease in Germany. These include self-help groups and advice centers.

You can find self-help groups through the database provided on the website of the National Contact and Information Point for Encouraging and Supporting Self-Help Groups (NAKOS).