Crohn’s Disease

Crohn’s Disease is a long-term illness with no known specific cause in which there is a transmural inflammatory process of the bowel that can affect any part of the gastrointestinal tract from the mouth to the anus. In most cases, the small bowel, particularly the terminal ileum is involved. Males and females are equally affected. The disease usually begins at the age of 15 to 30yrs.

Depending on the part involved, Crohn’s disease is classified into various types such as Ileocolic Crohn's disease which affects both the ileum and the large intestine, Crohn's ileitis which affects the ileum only and Crohn's colitis which affects the large intestine.

The patient with Crohn’s disease presents with pain in the abdomen, loose stools, flatulence, bloating, perianal discomfort, and other systemic and extraintestinal symptoms. The exact cause of the disease is unknown but genetic and environmental factors have been known to result in this condition.

Diagnosis of Crohn's disease requires various investigations. A colonoscopy is 70% effective in diagnosing the disease via direct visualization of the colon and the terminal ileum. Capsule endoscopy helps in endoscopic diagnosis. 30% of Crohn's disease involves only the ileum, cannulation of the terminal ileum is required in making the diagnosis.

Other investigations like blood tests, serum levels of albumin, magnesium, zinc, and selenium, and acute phase protein measurements may correlate with disease activity. Treating this condition involves medications, lifestyle changes, and surgery in required cases.

Crohn’s Disease: Causes

Various genetic and environmental factors play an important role in the development of Crohn’s disease The following are the important causes of developing Crohn’s disease −

• It is suggested to occur because of the autoimmune response in which the body thinks the good bacteria of the digestive tract as foreign bodies initiating an immune response against it leading to inflammation of the bowel

• Genetics plays an important role; it is known to run in families. Mutations in certain genes, such as NOD2 and ATG16L1, have been associated with an increased risk of developing Crohn's disease.

• Smoking has been known to increase the risk of development of the disease thrice compared to normal. Other environmental factors like stress and diet also have been known to influence its development

• Imbalance in the microorganisms that live in the digestive tract, due to various causes also known to the development of Crohn's disease.

Crohn’s Disease: Symptoms

The patient with Crohn’s disease presents with intestinal and extraintestinal symptoms that vary from person to person depending on the severity. It mainly presents with the following symptoms −

Intestinal symptoms include −

• The patient mainly presents with pain in the abdomen usually more after eating and can be associated with cramps in the abdomen

• Nausea and vomiting

• Low-grade fever

• Loose stools and sometimes blood can be present in the blood

• Bloating and flatulence

• Fatigue or weakness

Non-intestinal symptoms include −

• Up to 30% of children with Crohn's disease present with retardation of growth.

• Among older people, Crohn's disease presents with weight loss due to decreased food intake. in severe conditions, the patients have malabsorption of carbohydrates or lipids, which can further increase weight loss.

• As the condition increases the risk of blood clots; painful swelling of the lower legs can develop indicating deep venous thrombosis.

• Difficult breathing may be present as a result of pulmonary embolism.

• Some patients may present with Autoimmune hemolytic anemia, a condition in which the immune system attacks the red blood cells.

• Skin problems, such as rashes and ulcers, particularly around the anus can be present

Crohn’s Disease: Risk Factors

Several factors play an important role in the development of Crohn’s disease which includes −

• Age − The onset of the disease more commonly occurs between 15 to 30yrs of the age group

• Family history − The person with a family history of Crohn’s disease is at increased risk.

• Smoking increases the risk thrice than the normal people

• Low fiber diet can also influence its development

• Disturbance of the normal gut flora due to various causes increase the risk

Crohn’s Disease: Diagnosis

The diagnosis of Crohn’s disease is mainly done based on clinical presentation, investigations and some of the tests may be required to look for complications caused by the disease which include −

• A colonoscopy is more effective in diagnosing the disease by direct visualization of the colon and the terminal ileum.

• Capsule endoscopy helps in endoscopic diagnosis.

• In some patients Crohn's disease involves only the ileum, cannulation of the terminal ileum is required in making the diagnosis.

• A complete blood count is advised to look for anemia caused either by blood loss or vitamin B12 deficiency.

• Erythrocyte sedimentation rate(ESR) and C-reactive protein measurements help to check the degree of inflammation.

• Testing for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammation of the intestine.

• A barium X-ray is where barium sulfate suspension is ingested and fluoroscopic images of the bowel are taken to check inflammation and narrowing of the small bowel. This helps in Identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through, or in the detection of colonic fistulae.

Crohn’s Disease: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Conservative treatment includes −

• Antibiotics are prescribed to reduce inflammation

• Corticosteroids are also used in some patients but not advised for long term due to their side effects.

• 5-aminosalicylic acid (5-ASA) is used for the long term in these patients

• Immunomodulators such as azathioprine, mercaptopurine, methotrexate, infliximab, and adalimumab

• Hydrocortisone should be used in severe attacks of Crohn's disease.

Lifestyle modifications include −

• Dietary modifications such as proper hydration and smoking cessation reduce symptoms.

• Eating a healthy balanced diet with and eating small meals frequently instead of big meals.

• Regular exercise and take enough sleep

• Identifying foods that trigger symptoms and avoiding them should be done

Surgical Treatment

• The surgery is required in case of obstructions, fistulas, and abscesses, or if the disease does not respond to drugs

• For patients with an obstruction due to a stricture, resection of the affected part and strictureplasty is advised.

Crohn’s Disease: Prevention

Some of the measures that can help to prevent Crohn’s disease include −

• Consuming a Healthy balanced diet with proper carbohydrates, protein, and micronutrients. Foods containing high fiber are advised. Taking small meals frequently rather than larger meals is advised

• Intake of plenty of liquids

• Avoid smoking

• Probiotics, fish oil, and other herbal and nutritional supplements are advised.

Conclusion

Crohn’s disease is an inflammatory disease that affects the gastrointestinal system. The exact cause of Crohn’s disease is not known. However, genetics and environmental factors are known to influence its occurrence. The patient mainly presents with pain abdomen, loose motion, low-grade fever, nausea, weight loss, joint pain, and skin problems.

The condition is mainly diagnosed by endoscopy and colonoscopy. When strictures of the colon are too small for a colonoscope to pass through barium, X-ray is done. Other investigations like CBC with ESR, CRP, serum levels of albumin, magnesium, zinc, and selenium, and testing for anti-Saccharomyces cerevisiae antibodies and anti-neutrophil cytoplasmic antibodies should be done.

Treatment of Crohn’s disease involves antibiotics, steroids, immunosuppressants, lifestyle modifications, and surgery may be required in severe cases.