Crohn's disease

What is it?

It is a chronic inflammatory disease that can affect any part of the digestive tract, but most commonly the terminal small intestine (ileum) and/or colon. The reasons are still unknown. However, it appears to be determined by a combination of factors, such as genetic predisposition, environmental factors (e.g., cigarette smoke, infections), and changes in the immune response.

The characteristic features of this disease that distinguish it from ulcerative rectocolitis are:

  • Possible presence of "jumping lesions”, meaning that inflammation may affect certain segments of the intestinal tract while sparing the normal segments between the affected areas;
  • Inflammation is transmural, that is, it affects the entire thickness of the intestinal wall;
  • There is usually no involvement of the rectum.

Which are the symptoms?

Symptoms vary depending on the focus of the disease. The most common symptoms are chronic diarrhea, sometimes accompanied by bleeding from the rectum, convulsive abdominal pain, impaired absorption of food with subsequent weight loss. Fever (especially in the evening), anemia, and positive signs of inflammation in laboratory tests are common. Patients may also complain of extraintestinal symptoms such as joint pain. Crohn's disease can often lead to complications such as narrowing (stenosis) of the small intestine with the risk of intestinal obstruction and/or abscesses and fistulas, especially around the anus.

How is it diagnosed?

Diagnosis is made by means of radiological and endoscopic methods. Colonoscopy with visualization of the ileum makes it possible to assess the condition of the intestinal mucosa, from which a biopsy sample can be obtained, which is necessary for histological diagnosis.

Another endoscopic method is represented by enteroscopy with a video capsule, a noninvasive endoscopic method useful for diagnosing small intestinal lesions inaccessible by colonoscopy. Its use is limited by the inability to take a biopsy and the risk of retention in case of intestinal stenosis.

Radiological studies used include:

  • Ultrasound of intestinal loops, in the process of which the intestinal wall is examined in detail for the presence of any complications in a non-interventional mode;
  • CT enterography and MRI enterography, which make it possible to localize inflammation, assess any complications, and evaluate the extent and activity of inflammation

Suggested exams

How is it treated?

Drug therapy varies depending on the severity of the inflammatory bowel condition, ranging from cortisone to immunosuppressive drugs (azathioprine, mercaptopurine) and, finally, biological agents. Drugs with antibacterial activity (antibiotics and/or metronidazole) or substances that block the body's immune response can also be prescribed. In severe cases, especially in the presence of digestive fistulas, it is necessary to suspend oral nutrition and feed the patient with parenteral nutrition.

Surgical treatment is necessary for complications of the disease, such as intestinal obstruction due to stenosis or the presence of fistulas or abscesses. However, surgical removal of the affected area of the intestine does not cure the disease, which may reappear in the remaining areas.

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