WHAT IS CROHN'S DISEASE?
It is a chronic granulomatous inflammatory disease of the intestine but can affect the entire digestive tract, from the mouth to the anus. More frequently, it affects the terminal ileum and/or the sigmoid-rectum. It is an autoimmune disease and, in severe cases, can manifest in other parts of the body, such as the eyes (uveitis) and joints (arthritis). It is, however, a chronic condition that can flare up at any point in life. Many patients experience long periods of complete remission during which symptoms are entirely absent. Unfortunately, it is impossible to predict when and how symptoms will reoccur.
WHAT ARE THE SYMPTOMS OF CROHN'S DISEASE?
Since it can affect any part of the intestine, symptoms can vary and differ from patient to patient. Typical symptoms include cramp-like abdominal pain, often located on the right, mimicking acute appendicitis. The pain is often accompanied by diarrhea (numerous bowel movements per day), abdominal bloating, and weight loss. Other associated symptoms can include anal pain with the formation of fissures, perianal abscesses, and fistulas, as well as joint pain (arthritis). Crohn's disease can also manifest with obstructive symptoms, including vomiting, severe pain, and fever, or even with peritonitis due to intestinal perforation.
WHO DOES IT AFFECT?
It can affect both sexes at any age. However, the majority of patients are young adults aged between 16 and 40 years. Approximately 20% of Crohn's disease patients have a family member, often a sibling, affected by the same condition.
WHAT ARE THE CAUSES OF CROHN'S DISEASE?
The exact causes are not known. However, it is almost certain that the causes are of autoimmune and/or bacterial origin. Crohn's disease is not a contagious condition, but it seems to have a hereditary tendency.
HOW IS CROHN'S DISEASE DIAGNOSED?
If the location is typical, a radiological study of the small intestine may be sufficient. If it affects the recto-sigmoid area, biopsies (samples of small pieces of intestinal tissue) can be taken through colonoscopy and sent for histological examination. Sometimes, Crohn's disease can present with an acute abdominal picture (peritonitis), as in the case of acute appendicitis. The patient is taken to the operating room and undergoes an emergency appendectomy: if the surgeon suspects Crohn's disease, depending on the severity of the clinical picture, the surgeon may choose to remove the cecum and part of the ileum (right hemicolectomy) or suspend the operation and initiate medical therapy.
HOW IS CROHN'S DISEASE TREATED?
Initial treatment is medical. Unfortunately, specific cures for Crohn's disease do not exist to date, but medical therapy with one or more drugs is often sufficient to control the condition very well. The most commonly used drugs are 5-ASA (Mesalazine and others) and corticosteroids (prednisone and methylprednisolone). Other less frequently used drugs include 6-Mercaptopurine, Azathioprine, and Cyclosporin A, which are immunosuppressive drugs. Antibiotics like Metronidazole are often combined with these medications. Other drugs have been successfully tested and are increasingly being used (Infliximab). When medical treatments fail, surgery is necessary.
If Crohn's disease presents with peritonitis due to intestinal perforation or with obstruction, it will be necessary to perform a resection of the affected intestinal segment. If it presents with perianal abscesses, it will be necessary to incise and drain them, followed by treatment of fistulas through specific procedures in conjunction with medical therapy. It is unfortunate to emphasize that neither surgery nor medical therapy can cure Crohn's disease. Surgical treatment should be reserved for severe cases and should be as conservative as possible.
It is a chronic granulomatous inflammatory disease of the intestine but can affect the entire digestive tract, from the mouth to the anus. More frequently, it affects the terminal ileum and/or the sigmoid-rectum. It is an autoimmune disease and, in severe cases, can manifest in other parts of the body, such as the eyes (uveitis) and joints (arthritis). It is, however, a chronic condition that can flare up at any point in life. Many patients experience long periods of complete remission during which symptoms are entirely absent. Unfortunately, it is impossible to predict when and how symptoms will reoccur.
WHAT ARE THE SYMPTOMS OF CROHN'S DISEASE?
Since it can affect any part of the intestine, symptoms can vary and differ from patient to patient. Typical symptoms include cramp-like abdominal pain, often located on the right, mimicking acute appendicitis. The pain is often accompanied by diarrhea (numerous bowel movements per day), abdominal bloating, and weight loss. Other associated symptoms can include anal pain with the formation of fissures, perianal abscesses, and fistulas, as well as joint pain (arthritis). Crohn's disease can also manifest with obstructive symptoms, including vomiting, severe pain, and fever, or even with peritonitis due to intestinal perforation.
WHO DOES IT AFFECT?
It can affect both sexes at any age. However, the majority of patients are young adults aged between 16 and 40 years. Approximately 20% of Crohn's disease patients have a family member, often a sibling, affected by the same condition.
WHAT ARE THE CAUSES OF CROHN'S DISEASE?
The exact causes are not known. However, it is almost certain that the causes are of autoimmune and/or bacterial origin. Crohn's disease is not a contagious condition, but it seems to have a hereditary tendency.
HOW IS CROHN'S DISEASE DIAGNOSED?
If the location is typical, a radiological study of the small intestine may be sufficient. If it affects the recto-sigmoid area, biopsies (samples of small pieces of intestinal tissue) can be taken through colonoscopy and sent for histological examination. Sometimes, Crohn's disease can present with an acute abdominal picture (peritonitis), as in the case of acute appendicitis. The patient is taken to the operating room and undergoes an emergency appendectomy: if the surgeon suspects Crohn's disease, depending on the severity of the clinical picture, the surgeon may choose to remove the cecum and part of the ileum (right hemicolectomy) or suspend the operation and initiate medical therapy.
HOW IS CROHN'S DISEASE TREATED?
Initial treatment is medical. Unfortunately, specific cures for Crohn's disease do not exist to date, but medical therapy with one or more drugs is often sufficient to control the condition very well. The most commonly used drugs are 5-ASA (Mesalazine and others) and corticosteroids (prednisone and methylprednisolone). Other less frequently used drugs include 6-Mercaptopurine, Azathioprine, and Cyclosporin A, which are immunosuppressive drugs. Antibiotics like Metronidazole are often combined with these medications. Other drugs have been successfully tested and are increasingly being used (Infliximab). When medical treatments fail, surgery is necessary.
If Crohn's disease presents with peritonitis due to intestinal perforation or with obstruction, it will be necessary to perform a resection of the affected intestinal segment. If it presents with perianal abscesses, it will be necessary to incise and drain them, followed by treatment of fistulas through specific procedures in conjunction with medical therapy. It is unfortunate to emphasize that neither surgery nor medical therapy can cure Crohn's disease. Surgical treatment should be reserved for severe cases and should be as conservative as possible.