Crohn’s disease
What is Crohn’s disease?
It typically occurs in the last part of the small intestine and in the large intestine, but can occur in any part of the alimentary canal from the mouth to the anus.
The inflammation affects several distinct sections of the intestine and is therefore segmental.
In the affected areas, however, not only the mucosa but the entire intestinal wall and all its layers become inflamed.
Prevalence of Crohn’s disease
The incidence is the same in men and women, affecting about 0.18% of the population.
Familial cumulation has been observed as well as the role of ethnicity.
There are twice as many cases among whites as among people of colour.
And in recent decades, the number of those detected affected has been increasing.
Causes of Crohn’s disease
The origin of Crohn’s disease is unknown, but it is probably an autoimmune process.
Emotional stress also plays a major role in the development of the disease, but genetic factors may also be involved.
It has been found that there is a 20 percent risk of recurrence among blood relatives.
The role of possible pathogens is controversial.
Individual observation of patients suggests that diet is likely to play a role.
Diagnosis of Crohn’s disease
COLONOSCOPY: If the disease involves the colon, endoscopic visualisation of the lesion and microscopic examination of the tissue obtained during the examination can be decisive.
GASTROSCOPY: A gastroscopy may reveal diseased sections of intestine in the oesophagus and stomach, possibly in the duodenum.
The examination may allow further histological sampling.
CAPSULE ENDOSCOPY: A new test procedure in which the patient swallows a capsule-sized video camera that transmits an image of the inside of the feeding tube as it passes through.
The disadvantage is that it is expensive and does not provide a histological sample.
However, it does allow you to see areas that cannot be examined with an endoscope.
In about 10 percent of patients, especially if it affects only the colon, the disease cannot be distinguished from ulcerative colitis.
In such cases, the course of the disease may provide a clue.
GITOMETROINtestinal passaging test: it is also possible to detect Crohn’s disease by taking a barium X-ray contrast medium, called a gastric passaging test.
The barium clearly shows the scarred narrowed sections and the dilated areas between them.
The aim of the X-ray examination is to detect fistulas and to distinguish narrowed areas from tumours.
While tumours usually only cause narrowing in one section of the bowel, in Crohn’s disease several sections may be affected.
OPTICAL DIAGNOSIS: The presence of the disease is sometimes detected during abdominal dissection for suspected intestinal obstruction, internal fistulas, peritonitis, appendicitis.
Here again, the histologist has the final say.
However, even in cases of definite clinical Crohn’s disease, a negative histological picture is often obtained.
The course of Crohn’s disease
There are four pathological stages of the disease.
NON-SPECIFIC BLEEDING: Typically occurs in the cecum (right lower abdomen), where the last part of the small intestine, the ileum (hence the name ileitis terminalis), joins the large intestine.
Because of this inflammation, appendectomy is often performed.
However, in Crohn’s disease, fistulas sometimes form at the site of the operation.
GRANULOMES:In the second stage of Crohn’s disease, tuberculoid (similar to the characteristic histological lesions seen in tuberculosis, TB) tubercles develop.
These are spherical formations with a cluster of not completely dead, visible nucleated cells in the centre, surrounded by areas of chronic inflammation.
INGESTINAL CONCLUSIONS: as the inflammation affects the whole intestinal wall, all its layers, the peritoneal surface of the intestine also becomes inflamed.
This can result in intestinal adhesions, which can cause severe disturbances in bowel movements, which can eventually progress to intestinal obstruction.
FISTULULATION: Fistulas are small passages between inflamed areas and other tissues.
Through these, inflammatory sweat is discharged, e.g.: through the skin, to the outside.
In other cases, a fistula is formed between the fused intestinal tubules, which bypasses certain sections of the intestine, further reducing the surface area for absorption and exacerbating diarrhoea.
Fistulas can also often appear around the anus.
Of course, the occurrence of the four stages is not a matter of course if the treatment is effective.
However, the development of Crohn’s disease is not yet preventable.
Treatment of Crohn’s disease
The treatment of Crohn’s disease depends on the location of the inflammation, the severity of the lesion, complications and the effectiveness of previous treatments.
Treatment aims to reduce inflammation, correct deficiencies and relieve symptoms (abdominal pain, diarrhoea, rectal bleeding).
Treatment may be with medication or surgery, or with nutritional supplements.
PHARMACEUTICALS: Sulphasalazine is one of the most commonly used molecules.
Its active ingredient mesalamine (5-aminosalicylic acid) is an effective anti-inflammatory, and is an ingredient in many drugs that release the active ingredient only at different stages in the small or large intestine.
Sometimes steroidal anti-inflammatory drugs may also be used, although doctors prefer to avoid this because of its many side effects.
Immunosuppressive drugs may also be needed.
These, of course, are not able to selectively weaken the immune system, so they increase the body’s susceptibility to other functions, such as infectious diseases.
The use of antibiotics may be necessary mainly to prevent complications from abscesses and fistulas, and sometimes as a surgical preparation to prevent infectious complications.
In addition, a drug may be used to reduce the activity of the disease.
NUTRITION: Particularly in childhood, it may be necessary to ensure the child’s physical development by providing calorie-rich fluids.
In particularly severe cases, temporary intravenous feeding may be necessary.
OPERATION: The aim of the surgery may be to remove sections of the intestine that do not respond to medication, to relieve intestinal obstructions, to cure fistulas, abscesses, to stop major bleeding.
Surgery does not cure the disease, as the disease is prone to recur in the bowel segments that are not removed.
It may also be necessary to remove the entire colon if it has become too large and damaged.
The faeces are then allowed to pass through a stoma in the lateral part of the abdomen, below the navel.
