Crohn’s disease is a chronic inflammatory process of the digestive tract. Although it can affect any part of the tube from the mouth to the anus, it usually appears in the lower portion of the small intestine (ileum) and large intestine (colon).
The anatomical involvement of Crohn’s disease is segmental, discontinuous and transmural. This means that it alternates between healthy and altered layers and affects all parts of the intestine, including mucosa. All this will determine the symptomatology in each patient.
Crohn’s disease is a chronic condition. Some people have prolonged periods of remission that can last for years, in which they have no symptoms. There is no way to predict when a recurrence of signs may occur.
Causes of Crohn’s disease
The cause is unknown, but it seems to be triggered by the interaction of genetic and environmental factors, with its prevalence predominating in more developed countries.
Current theories focus on an immunological cause (the body’s defense system) or a bacterial cause. Crohn’s disease is not contagious, but has a slight genetic tendency, i.e. hereditary.
What are the symptoms of Crohn’s disease?
The segmental nature and its variable location cause its variable symptoms. The classic signs of this disease are diarrhea, abdominal pain and weight loss; however, this triad is present in only 25% of cases at diagnosis.
Diarrhea is the main symptom and can be secondary to different circumstances: inflammation of the intestine, bacterial overgrowth, alteration in the absorption of bile salts, etc.
Abdominal pain will depend on the location of the disease. Generally, this is determined by the recruitment of nociceptive (nervous) mediators to the inflamed area.
Weight loss appears in 2/3 of the cases and is secondary to the inflammatory activity of the process (catabolism), malabsorption phenomena and coexistent anorexia.
Other symptoms that may appear are skin lesions, joint inflammation problems and perianal lesions, such as fissures, fistulas and abscesses, which require specific treatment.
How is Crohn’s disease diagnosed?
Despite the development of new imaging techniques for the study of the gastrointestinal tract, the basis for the diagnosis of Crohn’s disease has not changed in the last 3 decades. On the other hand, the lack of typical lesions of this disease and the lack of specific symptoms force the diagnosis to be established by the conjunction of tissue and imaging findings in patients with a compatible clinical picture.
Treatment of Crohn’s disease
Initial treatment is almost always with drugs. Although there is no “cure” for Crohn’s disease, therapy with one or more drugs serves to treat its early stage and alleviate symptoms. The most commonly prescribed drugs are corticosteroids and various anti-inflammatory agents.
We know that 90% of patients will require at least one surgical intervention. However, surgery should be reserved only for complications, as the disease will not be “cured” and recurrence is usually the norm.
In any case, these are generally young patients undergoing multiple treatments with a chronic and recurrent disease. Therefore, most experts in Coloproctology recommend the management of these patients in specialized units, where there is close coordination between all medical professionals.