What is Crohn’s disease? Causes, symptoms and treatments
Crohn’s disease is a chronic autoimmune disease that causes inflammation of the tissues of the digestive tract. Symptoms include abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition. While the disease may go into remission for periods, it often significantly impacts the quality of life.
Globally, Crohn’s disease affects 1-10 people per 100,000 annually, with a prevalence of around 300 patients per 100,000. In Europe and North America, the incidence is higher compared to other regions, and it is estimated that around 300,000 people suffer from it in Europe alone. The disease usually manifests between ages 20 and 40 affecting both men and women, particularly those with predisposing factors such as smoking, a family history of the condition, or altered gut microbiota.
What is the cause of Crohn’s disease?
The exact cause of Crohn’s disease is unknown. It is thought to result from an abnormal immune response, potentially triggered by intestinal content. Additionally, genetic variants can contribute to disease onset. However, they only explain about ¼ of new diseases. Remarkably, diet is getting more important, and there is increasing evidence that non-processed food conveys protection from disease onset and disease flares.
Additional risk factors include genetic ancestry, with greater prevalence in individuals of European descent and is especially prevalent among Eastern European Jews. Smoking is the most significant modifiable risk factor, as it can not only contribute to the development of the disease but also worsen it and increase the need for surgery.
Symptoms
Inflammation can affect any part of the small or large intestine, occurring in isolated segments or continuously. In some cases, it is limited to the colon, which is part of the large intestine. Symptoms vary in intensity and may develop gradually or appear suddenly. The most common manifestations include diarrhea, fever, fatigue, abdominal pain, blood in the stool, loss of appetite and weight, as well as perianal and internal fistulas.
In addition to intestinal symptoms, extraintestinal problems may arise in Crohn’s disease. These can include inflammation in the skin, eyes, joints, and liver as well as kidney stones and anemia. In children, the disease can cause delays in growth and sexual development.
Crohn’s disease can also cause serious complications such as intestinal obstruction due to strictures that narrow the intestinal lumen, and ulcerations throughout the digestive tract. Fistulas, which are abnormal connections between the intestine and other parts of the body, can also develop. Other problems include perianal fistulizing disease, malnutrition, increased risk of colon cancer, skin disorders such as hidradenitis suppurativa, and various conditions such as anemia and osteoporosis. Additionally, medications to treat the disease can increase the risk of cancer and blood clots, highlighting the need for careful medical monitoring.
The diagnosis
Diagnosis involves a combination of symptom assessment and diagnostic tests. The most important test is endoscopy, which consists of the introduction of a flexible device through the anus that allows visualization of the interior of the intestine and through which biopsies can be obtained. Imaging tests such as MRI or ultrasound are also used. The analysis of the cell composition of biopsies serves to confirm the presence of inflammation.
Cure or treatment?
While there is no cure for Crohn’s disease, treatments can control inflammation, reduce symptoms, and achieve long-term remission. Most patients can lead normal lives with appropriate management. The basis for recovery is pharmacological treatment, which has improved greatly in recent years, and the adoption of healthy lifestyle habits.
Regarding treatment, there are several options available, such as corticosteroids, immunosuppressants, biological agents, and small molecules. These are administered by the gastroenterologist based on the activity and location of the disease, among other factors. Adherence to treatment plans is essential to prevent relapses and complications.
Advocacy and support for Crohn’s disease
The European Federation of Crohn’s & Ulcerative Colitis Associations (EFCCA) plays a vital role in representing 46 national patient associations focused on Crohn’s disease and ulcerative colitis, collectively known as Inflammatory Bowel Diseases (IBDs). This organization is committed to improving the lives of over 10 million individuals living with IBD worldwide, including approximately 3.4 million in Europe. The EFCCA focuses on raising awareness, promoting better treatments, and improving the quality of life for those affected.
Like ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, psoriasis and psoriatic arthritis, Crohn’s disease is one of the six immune-mediated inflammatory diseases (IMID) for which the DocTIS project seeks to improve treatment effectiveness through combination of existing medications.
According to Professor Dr Britta Siegmund, Medical Director of the Department of Gastroenterology, Infectiology, and Rheumatology at project partner Charité – Universitätsmedizin Berlin, “finding new treatments for Crohn’s disease, including those anticipated by DocTIS, is crucial to improving patients’ quality of life, addressing unmet medical needs, and reducing complications”.
(Above image by Freepik)
