learn about this chronic intestinal disease

Crohn’s disease: everything you need to know

A Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the digestive tract. However, it usually affects the terminal part of the small intestine (ileum) and the large intestine (colon).

This inflammation can reach the entire thickness of the intestinal wall and thus cause ulcers in its inner wall. This disease is also characterized by periods of aggravation and remission.

Symptoms

The symptoms of Crohn’s disease may vary depending on which segment of the digestive tract is inflamed. Yet, the most common symptomatology is:

  • Diarrhea (which may contain blood and thus cause anemic states);
  • Abdominal pain (especially around the navel or on the right side, especially after meals);
  • Loss of appetite;
  • Weight loss.

Symptoms not directly related to the digestive tract may also occur, such as:

  • Fever;
  • Joint pain;
  • Skin lesions.

Other signs of this disease are lesions in the perianal area such as:

  • Cracks;
  • Fistulas (openings of the intestine on the surface of the skin near the anus);
  • Abscesses.

Causes

The causes of Crohn’s disease remain unknown. However, it is known that genetics may make some individuals more susceptible to this disease than others.

The interaction between foreign elements (antigens, bacteria or viruses) and the immune system can also be the cause of intestinal damage and, consequently, of Crohn’s disease. Similarly, emotional stress and strain can also interfere with the course of the disease, causing or aggravating flare-ups.

Diagnosis

To make the diagnosis of Crohn’s disease, it is necessary to consider the patient’s clinical history and physical examination, as well as :

  • Laboratory tests (clinical analyses);
  • Endoscopic study, which looks inside the colon, through a flexible tube (sigmoidoscope or colonoscope), to assess the activity and extent of inflammation ;
  • The removal of fragments of intestinal tissue for microscopic examination (biopsies).
  • X-rays with barium, to detect possible ulcers and strictures (stenoses) ;
  • CT and MRI to diagnose problems such as fistulas and abscesses.

Complications

The most recurrent complication of Crohn’s disease is intestinal obstruction, which is a difficulty in moving the contents of the intestine forward. This complication is due to the fact that this pathology causes inflammation and thickening of the intestinal wall.

In addition, Crohn’s disease ulcers can cause tunneling (fistula) with adjacent segments of the intestine or with other organs (bladder, vagina, skin), and form areas infected with pus: abscesses.

In addition to these complications, Crohn’s disease can also cause problems in other parts of the body, such as the joints, skin, mouth, eyes, liver and bile ducts. An example of these complications is the formation of kidney and gallstones.

Treatment

With regard to therapy, to reduce the inflammation caused by Crohn’s disease, medications such as messalazine or corticosteroids may be prescribed (in the acute phase and in more severe conditions).

In case of fistulas, immunosuppressive drugs (azathioprine, methotrexate) and biologic therapies (infliximab) may also be recommended. In case of perianal complications, antibiotics (metronidazole and ciprofloxacin) may be necessary and, in more severe cases, surgical drainage of perianal abscesses or surgical treatment of fistulas.

Surgery is recommended only if medical treatment fails or if there is a complication such as intestinal obstruction, perforation, abscess, or hemorrhage.

Surgical intervention is primarily used to improve the patient’s quality of life. The most common procedures are: drainage of the abscess or removal (resection) of the diseased intestinal segment with connection of the ends of the sections (anastomosis).

In bowel resection surgery, the goal is to resect the minimum amount of bowel, as this is a disease with multiple exacerbations and requiring multiple surgical interventions.

Care and feeding

Most patients with Crohn’s disease do not have dietary restrictions but must follow a balanced diet. They also need to adopt a healthy lifestyle.

However, in the acute phases of the disease, it may be advisable to reduce fiber intake to help control diarrhea and abdominal pain.

There are also patients who must avoid milk because of their inability to digest lactose.

When strictures are detected in the small intestine, a liquid or low-solid diet may also be necessary.

Patients with malabsorption should also take vitamins and minerals. Patients with ileitis or those who have undergone surgical resection should receive vitamin B12.

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