Crohn’s disease is a chronic inflammation that may affect any part of the digestive tract, from the mouth to the anus, although it lies more often the last segment of the small intestine (ileum) and the large intestine. Inflammation can extend to all sections of the gastrointestinal wall, leading to the formation of ulcers, and it can be continuous or not, as inflamed areas alternate with healthy areas.
People with Crohn’s disease experience alternating periods of active disease with remission-like periods with no symptoms, which can last for months or years. It’s not impossible, however, to predict when any of these phases will occur nor for how long will it last. Remission periods may derive from pharmacological treatment or surgery, and rarely can be spontaneous. The inflammation associated with new disease episodes may occur in the same location of the previous or near, but may also affect other regions.
Although it can affect people of any age, Crohn’s disease is often diagnosed in young adults with a similar incidence in men and women.
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What causes Crohn’s disease?
The cause of Crohn’s disease is not known. Immune system disorders, an infection by an unknown microorganism, or a reaction to certain foods are commonly identified as possible causes. Considering that immune changes in Crohn’s pacients are common — although it is not entirely clear whether they are the cause or consequence — it is likely that the disease is caused by these disorders in association with environmental effects. That’s why Crohn’s disease is classified as an autoimmune disease.
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Regardless of its cause, Crohn’s disease induces an inaccurate and excessive bodily reaction to compounds or other food sources in the digestive tract, although those foods are harmless, they will not be recognized as such.
Since Crohn’s disease can affect any portion of the digestive tract, symptoms are variable and related to the location of the disease. The most common are diarrhea, abdominal pain, fever, loss of appetite and weight loss. However, because of the possible complications of Crohn’s disease at the digestive level (stricture, fistulas, abscesses, anal fissures) and in other locations, Crohn’s may present various symptoms such as constipation, fatigue, pain, anal, rectal bleeding, intestinal obstruction, feces contaminated with blood, nutritional deficiencies, joint pain, skin lesions, symptoms associated with the presence of kidney stones and gallstones, among others. Children with Crohn’s disease can also suffer from stunted growth. The symptoms, as well as their severity, may vary in successive episodes of the disease.
Diagnostic methods for Crohn’s disease
The diagnosis of Crohn’s disease is based on clinical history, symptoms at examination, and additional tests if necessary. Among these, it may be advisable to take blood samples, which may suggest the existence of an inflammation; analysis of feces which may prove blood loss; and contrast x-rays to locate areas of inflammation, ulcers, or stenosis. A colonoscopy might also be advisable to view the inside of the colon, assess the distribution and severity of inflammation and lesions, to detect any possible complications and allow more samples to confirm the diagnosis. More recently, videoenteroscopia per capsule has been used as a diagnostic aid in the examination Crohn’s disease.
Treatment options for Crohn’s disease
In general, the treatment approach to Crohn’s disease starts with medication, both for combating the symptoms and simultaneously avoiding side effects that may be associated with long-term treatments. If pharmacological treatment is not effective in more advanced or severe cases of the disease, a surgical solution may be required.
It is estimated that approximately 75% of patients with Crohn’s disease need surgery at some stage of the infection. In most cases, these are surgical interventions only to resolve complications, since the location of Crohn’s disease throughout the gut and the lesions from subsequent episodes don’t always appear at same location of the previous lesions. This makes the surgical treatment preventive, but not curative.
Thus, while Crohn’s disease surgery allows a significant improvement of patients’ life quality, usually associated with a prolonged period of remission, in most cases the disease symptoms return to after some time.
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