Crohn's Disease

Crohn's disease belongs among inflammatory bowel diseases (IBD) together with ulcerative colitis. It is a chronic autoimmune disorder that can cause a lifelong impairment of life quality and many complications. It can affect virtually any part of the digestive tract but most usually it attacks the intestines and the onset is often in young age between 20-30 years of age.


The real cause of the disease is still unknown. Crohn's disease is related to autoimmune inflammation of a segment of the gastrointestinal tract. The mucosa is damaged by immune cells and autoantibodies. The reason may be a genetic predisposition that is combined with some outer factors.


Affected mucosa is irritated, swollen and ulcers may appear in more severe course of the disease. Crohn's disease usually manifests with chronic diarrhea, blood in stool and sometimes mucus presence, abdominal pain, weight loss and various signs of malabsorption of nutrients (vitamin deficiency, sideropenic anemia, vitamin D deficiency, osteoporosis, etc). Some forms of the disease cause inflammatory fistulas connecting together the intestines or connecting the intestine with other organ or body cavity. Anal form of Crohn's disease is especially irritating by creating skin fistulas around the anus or fistulas connecting rectum to the urinary bladder or gynecological organs. Chronic inflammation of the intestine may cause a formation of strictures and intestinal obstruction. Damage to the anal sphincter may lead to fecal incontinence. Chronic inflammation of the large intestine by Crohn's disease can increase the risk of colon cancer development.


Medical history and physical examination should be the first. We should take a look on the anal area and do the digital rectal examination. In blood tests we check nutrition parameters, blood count and CRP and sedimentation rate (markers of inflammation). Stool examination can also be quite informative. Large intestine and terminal part of the small intestine can be examined endoscopically by the colonoscopy. Colonoscopy not only allows us to visualize the mucosa but also take samples from suspicious-looking lesions. Small intestine is more difficult to examine - we can use capsule endoscopy or imaging methods such as CT enteroclysis (combination of enteroclysis and computed tomography) or MR enteroclysis (combination of enteroclysis and magnetic resonance imaging).


There is also a modern diagnostic method consisting of measurement of faecal calprotectin that is used to confirm the IBD presence and to evaluate its remissions and bouts.


Main way of treatment represents the pharmacotherapy. We use a number of anti-inflammatory agents (mesalazine, corticosteroids, azathioprine, etc.) administered orally, intravenously or locally (as enemas). The choice of the particular preparation and its way of administration depends on the individual situation and severity of the disease. Most modern therapeutic method is the so-called biological therapy. In this case it means a repeated application of antibodies precisely targeting some pro-inflammatory substances in our body, thus suppressing the inflammation.


Surgical treatment is used in severe acute course of Crohn's disease when other therapy is not possible and in chronic complications such as intestinal strictures and fistulas. Removing the affected part of the digestive tract is however not curative as the inflammation tends to reoccur in another location.


Chronic patients with the Crohn's disease usually need a broad approach and solving of many complications including iron and nutrient supplements in anemia and malabsorption syndrome.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources