Crohn’s Disease In Detail




Crohn’s Disease In Detail. In this article, you will read What is Crohn’s disease, Causes Of Crohn’s Disease, Symptoms Of Crohn’s Disease, Diagnosis Of Crohn’s Disease, and Treatment Of Crohn’s Disease. Crohn’s disease is a chronic inflammatory disease of the digestive system. Evolving in flare-ups, it preferentially affects young individuals, but can occur at any age. Its causes remain partly mysterious. Its symptoms are varied, but essentially digestive (diarrhoea, abdominal pain, etc.). Follow-up and appropriate treatment allow patients to live normally and reduce the risk of complications.

Crohn’s Disease In Detail:

With approximately one million people affected in Europe, including approximately 90,000 in France, Crohn’s disease is the most common chronic inflammatory bowel disease (IBD). The other IBD is ulcerative colitis. The good news for patients is that its current care allows many of them to carry out their life projects, whether personal or professional.

What Is Crohn’s Disease?

Crohn’s disease is a chronic inflammation of the lining of the digestive tract. It can affect any portion of the digestive tract from the mouth to the anus, but in 95% of cases, the inflammatory areas are preferentially located in the ileum (terminal part of the small intestine), the large intestine (colon) and/or anus. The inflammation is segmental (affected segments of the digestive tract alternate with healthy segments) and radially asymmetrical with respect to the longitudinal axis of the digestive tract.

This IBD (Inflammatory Bowel Disease) preferentially begins in young adults between the ages of 20 and 30, or even in adolescence or childhood (5 children out of 100,000/year), but it can also begin later, in mature adults. Its evolution by successive attacks interspersed with remissions of variable durations is characteristic. About 30% of patients have a single attack. In others, the natural history of the disease evolves towards worsening of the lesions over the flare-ups, causing in the long run permanent damage to the intestines and complications.

Causes Of Crohn’s Disease:

The origin of the disease is still unknown. But several factors could favour its occurrence:

1.Genetic factors: Crohn’s disease could occur preferentially in individuals with genetic predispositions. Many genes including the NOD2/CARD15 gene having recently been identified as associated with the disease.

2.Immunological factors: It could also result from an abnormal immune reaction following a disruption of the intestinal flora.

3.Environmental factors: This disruption of the intestinal flora could be favoured by environmental factors like excessive hygiene, a diet rich in refined sugars, bacterial and fungal infections, etc.

4.Smoking has a detrimental influence on the natural history of this disease, contributing to its aggravation and the frequency of flare-ups. However, its role in the onset of the disease remains controversial.

Symptoms Of Crohn’s Disease:

Most often responsible for symptoms Crohn’s disease are:

Crohn's Disease In Detail - symptoms

1.General signs: a deterioration in general condition with weight loss, fatigue, fever, and in children a break in the curves of weight and height;

2.Digestive signs: stomach aches, diarrhoea that drags on despite the absence of intestinal infection (cocultures are negative), false urges to defecate, mucus and blood emissions in the event of rectum involvement. In case of ano-perineal localization of the disease, anal pain with bleeding when going to the saddle linked to an anal fissure, anal pain and swelling of the perineum linked to a perineal abscess or perineal discharge linked to a perineal fistula.

3.Extra-digestive manifestations: More rarely, these are extra-digestive manifestations that draw attention: inflammatory rheumatism of the peripheral joints (arthritis) or spine, inflammatory eye disease ( uveitis ), or even dermatological disorders ( erythema nodosum, pyoderma gangrenosum, disabling mouth ulcers ).

It sometimes happens that this chronic inflammation is discovered by chance, on the occasion of an acute digestive complication, which can occur early in the history of the disease or after years of silent evolution.

Diagnosis Of Crohn’s Disease Based On Visualization Of Lesions:

Diagnosing Crohn’s is most often made during a flare-up. The clinical interview allows the examination of the patient and the collection of his symptoms. Beyond this initial assessment, the doctor may use blood tests to assess the effects of the disease on the kidneys, liver, and and nutritional balance. The diagnosis is mainly determined by endoscopic visualizations and biopsies of the colon (or large intestine) and of the ileum (extreme part of the intestine hail).

Several imaging techniques of the digestive tract are used to highlight the lesions:

1.Colonoscopy is mainly performed in cases of chronic diarrhoea. It allows us to examine of the colon, and the terminal ileum and performs biopsies for an anatomopathological examination in search of suggestive lesions (inflammatory granuloma). In the case of colonic involvement, the risk of colon cancer is higher in the general population

Crohn's Disease In Detail - diagnosis

2.CT-enteroclysis and entero-MRI have replaced small bowel transit for the exploration of this part of the digestive tract. Entero-MRI is today the technique of choice for exploring the small intestine. On the one hand, it is very effective both for the diagnosis of Crohn’s disease.

3.The Enter capsule (or endoscopic capsule or video-capsule ) of the small intestine is indicated in case of suspected Crohn’s disease when colonoscopy and entero-MRI did not show any lesion.

Treatment Of Crohn’s Disease:

There is not any inflammatory bowel disease treatments. Nevertheless, multidisciplinary care allows living normally. The treatment is essentially aimed at reducing symptoms, calming flare-ups, preventing relapses and improving the patient’s quality of life. For this, dietary, medicinal or even surgical measures are possible.

Hygiene measures:

The treatment is based on several approaches, with hygiene measures in the first place, and in particular stopping smoking, which is essential. In smokers with Crohn’s disease, stopping smoking is extremely beneficial. The disease flare-ups become less severe with fewer complications, but they disease does not disappear. Tobacco helps maintain the state of remission. Avoiding stress can help out too in controlling the disease.


In terms of food, patients are not restricted to a particular diet during remission. The recommendation is to have a balanced diet. During flare-ups, on the other hand, doctors advise a diet without fiber (avoid fruits and vegetables, flour, etc.), without milk (but with yoghurts and cheeses) and without polyols (such as sorbitol and other sweeteners present in sodas, cakes, sweets, jams… called “sugar-free”) in order to limit pain, diarrhea and the risk of occlusion.

Drug treatment:

Drug treatment, which has recently improved the quality of life of many patients, seeks to postpone recourse to surgery.

Doctors have their disposal at different therapeutic classes:

Anti-inflammatories: salicylates: 5-aminosalicylates (5-ASA), mesalazine ( Pentasa ®);

Topical corticosteroids: budesonide ( Entocort ®);

Systemic corticosteroids: prednisone ( Cortancyl ®) or prednisolone ( Solupred ®, hydrocortancyl ®);

Immunosuppressants: azathioprine ( Imurel ®) and 6-mercaptopurine ( Purinethol ®), “

Anti-TNF alpha biotherapies: infliximab ( Remicade ® ) and adalimumab ( Humira ®);

Antibiotics: metronidazole , ciprofloxacin ;

Iron: iron tablets make up the deficiencies linked to Crohn’s disease responsible for anemia.

Surgical treatment:

If the drug treatment proves to be insufficient, the intervention of a surgeon is sometimes necessary. Surgery can treat some health problems, but the disease remains. The operation consists of removing the parts of the intestine affected by lesions. This operation may be accompanied by a stoma, a temporary opening of the abdomen, in order to allow time for the operated parts to heal. In the event of acute complicationslike perforation, stenosis, fistula, haemorrhage, etc. emergency surgery is then necessary.

The removal of the damaged parts of the intestine does not guarantee the absence of recurrences in the remaining intestine.

Living with Crohn’s disease:

Once the diagnosis has been made, the disease will require medical monitoring and regular examinations to check the effectiveness of the treatments and the evolution of the disease. These are blood tests and regular endoscopies, the rhythm of which will be defined by your doctor.

Today, treatments allow the vast majority of patients to return to an almost normal life.

To limit flare-ups, it is advisable to stop smoking, follow a balanced diet without deficiencies (see a low fiber diet during flare-ups so as not to accentuate the symptoms).

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