What exactly is
Crohn's disease?
Crohn’s disease is one of the most common forms of chronic inflammatory bowel disease (IBD) and is characterized by recurrent inflammation of the digestive tract. It is regarded as an autoimmune disease in which the immune system mistakenly attacks the body’s own tissue.
Crohn’s disease can affect the entire digestive tract, from mouth to anus, with the small intestine and colon most commonly affected. In contrast to other forms of IBD, inflammation can also penetrate into deeper tissue layers and lead to the formation of fistulas. Another characteristic of Crohn’s disease is its intermittent course. During relapses, the symptoms can be very pronounced and significantly impair the quality of life of those affected.
About the symptoms
More information
Important facts about Crohn's disease
Consequences and symptoms of Crohn's disease:
- Abdominal pain and cramps, often in the lower abdomen
- Diarrhea, sometimes with blood or mucus
- Frequent and urgent urge to defecate
- Reduced appetite and weight loss
- Tiredness and general exhaustion
- Fever (in severe cases)
- Nausea and vomiting (in case of severe inflammation)
- Joint pain (concomitant disease in some patients)
- Skin changes such as rashes or ulcers (concomitant disease in some patients)
- Narrowing of the intestine (intestinal stenosis) with prolonged course
Course of the disease:
Crohn's disease is a chronic, i.e. incurable, disease with a variable course. There are phases of active inflammation and symptoms, known as relapses, and phases of remission, in which the symptoms subside or even disappear. Remission can take weeks, months or even years.
Over time, chronic inflammation can lead to the formation of fistulas. Fistulas can cause potentially life-threatening complications such as abscesses (accumulations of pus). In addition, the associated structural changes increase the risk of other complications such as bowel obstruction (loss of function due to a narrowing or blockage), bowel perforations (breakthroughs or holes in the bowel wall) or the development of bowel cancer. These complications are the most common in this form of inflammatory bowel disease and can lead to further symptoms and health challenges.
What are extraintestinal manifestations?
Extraintestinal manifestations are further consequences of Crohn’s disease. They are inflammatory diseases that can occur outside the digestive tract.
The most common are:
Fistula formations
Fistula formations
Fistula formations are unusual connections between different sections of the intestine or between the intestine and other organs
Joint inflammation
Joint inflammation
Painful inflammation of the joints (arthritis), which often occurs symmetrically and can affect various joints, especially large joints such as the knees, elbows or wrists.
Skin changes
Skin changes
Various skin changes, such as erythema nodosum. These are painful, red, inflammatory lumps that usually appear on the lower legs. Pyoderma gangraenosum is another skin disease that can cause severe, deep ulcers with necrotic tissue.
Mouth ulcers
Mouth ulcers
Mouth ulcers or aphthae are painful and occur in the mouth.
Eye inflammation
Eye inflammation
Eye inflammation (uveitis), an inflammation of the inner layers of the eye, which can be accompanied by eye pain, redness, blurred vision and sensitivity to light.
Gallstones and kidney stones
Gallstones and kidney stones
An increased risk of gallstone formation due to altered digestive processes and altered bile flow. The likelihood of developing kidney stones is also increased due to inflammation and changes in calcium metabolism.
Liver inflammation (hepatitis)
Liver inflammation (hepatitis)
In some people with Crohn's disease, inflammation can develop in the liver, which can lead to hepatitis.
What are the different forms of the disease?
There are various forms of Crohn’s disease, which differ depending on the area of the digestive tract affected:
Ileocolic form
This form affects the transition area between the lower small intestine (ileum) and the large intestine (colon). The ileocolic type is the most common form of Crohn's disease.
Ileal shape
In this form, only the small intestine (ileum) is affected. The area of inflammation typically extends over a longer section of the small intestine.
Colic form
This form is limited to the large intestine (colon) and can affect different sections of the colon, including the ascending, descending or entire colon.
Gastrointestinal form
In this rare form of Crohn's disease, the stomach and the upper part of the small intestine (duodenum) can also be affected.
This form affects the transition area between the lower small intestine (ileum) and the large intestine (colon). The ileocolic type is the most common form of Crohn's disease.
In this form, only the small intestine (ileum) is affected. The area of inflammation typically extends over a longer section of the small intestine.
This form is limited to the large intestine (colon) and can affect different sections of the colon, including the ascending, descending or entire colon.
In this rare form of Crohn's disease, the stomach and the upper part of the small intestine (duodenum) can also be affected.
What causes Crohn's disease?
The causes of chronic inflammatory bowel disease are not fully understood. However, there are risk factors for inflammatory bowel disease in general, such as genetic predisposition, disorders of the intestinal mucosal barrier and disorders of the microbiome, as well as environmental factors that increase the likelihood of occurrence.
How is Crohn's disease diagnosed?
The diagnostic procedure for chronic inflammatory bowel disease generally involves a combination of a detailed medical history, physical examinations, stool analysis, imaging procedures and endoscopy with biopsy. In order to differentiate Crohn’s disease from other intestinal diseases, such as ulcerative colitis, the following characteristics are examined:
Localizations in the entire digestive tract, from mouth to anus and beyond
Discontinuities in inflammation, skipping inflammation and deeper damage to the deeper layers of the intestine (transmural)
Involvement of the entire intestinal wall and occurrence of extraintestinal manifestations
Living with Crohn's disease
Treatment options
The treatment of Crohn's disease can vary depending on the severity and individual needs. Treatment options include anti-inflammatory drugs, immunosuppressants to suppress the immune system, biologics to specifically block inflammatory signals and antibiotics to treat infections. In some cases, surgical intervention may also be necessary to treat complications such as intestinal obstruction, fistulas or abscesses. Close cooperation with a specialist and adherence to the individual treatment plan are crucial for successful therapy.
Lifestyle and disease management
A healthy lifestyle for Crohn's disease includes individualized dietary adjustments, stress management techniques such as relaxation exercises and meditation, regular physical activity and avoidance of smoking to support the progression of the disease.
Pregnancy and family planning
Women with Crohn's disease can usually become pregnant, but should arrange careful antenatal care with their doctor to ensure the safety of mother and baby. There is a slightly increased risk of complications such as premature birth or low birth weight, so close monitoring is important. Most women can breastfeed their babies, but it is advisable to talk to your doctor about the possible effects of the medication on breastfeeding.
Sources
Please note that all content provided regarding individual medical conditions, treatments, procedures, etc. is general information and may vary depending on the physician:in and individual case and initial situation.
For more detailed information, please always consult your doctor.
German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS): S3 guideline on the diagnosis and treatment of Crohn's disease. Guideline: 1996
German Crohn's Disease / Ulcerative Colitis Association (DCCV) e.V.: "Crohn's Disease"
www.mocci.orgChronic inflammatory bowel diseases in clinic and practice. Jörg C. Hoffmann, Bodo Klump, Anton Kroesen, Britta Siegmund. Springer Verlag, 3rd edition 2020
Bemelman et al: ECCO-ESCP Consensus on Surgery for Crohn's Disease. Journal of Crohn's and Colitis
