Crohn's disease is a chronic inflammatory disease primarily affecting the gastrointestinal (GI) tract. Although any part of the gastrointestinal tract from the mouth to the anal canal (back passage) can be involved, the end part of the small intestine (ileum) and/or large intestine (colon and rectum) is most often affected.
Crohn's disease is a chronic disease and can flare up many times throughout life. Some patients have long-term remissions, sometimes for several years, without any symptoms of the disease. It is impossible to predict when remission will begin or when symptoms of the disease will return.
What are the symptoms of Crohn's disease?
Because Crohn's disease can affect any part of the digestive tract, symptoms of the disease can vary greatly from patient to patient. The most common symptoms are: cramping, abdominal pain, diarrhea (diarrhea) mixed with blood and mucus, fever, weight loss and bloating. However, not all patients experience all of these symptoms; some experience none of them. Other symptoms may include anal pain or discharge, skin lesions, rectal abscess, anal fissure, and joint pain (arthritis).
Common symptoms of Crohn's disease:
- Stomach ache
- Diarrhea
- Fever
- Weight loss
- Bloating
- Pain in the anus during bowel movements
- Perianal skin lesions
- Abscesses of the rectum
- Anal fissure
- Joint pain
Who does the disease affect? The disease affects all age groups, but most patients are young people aged 16 to 40 years. Crohn's disease occurs most often in people living in northern countries. The disease affects men and women equally and is often common in some families. About 20 percent of patients with Crohn's disease have a relative, most often a sibling or sometimes a parent or child, who has some form of inflammatory bowel disease.
Crohn's disease and a similar disease, ulcerative colitis, are often described together as inflammatory bowel diseases. About two million people in the United States alone suffer from Crohn's disease or ulcerative colitis.
What causes Crohn's disease? The exact cause of the disease is not known. Today, the most common theories of the occurrence of the disease are based on immunological and/or bacterial causes. Crohn's disease is not contagious; it has a slight genetic (hereditary) predisposition. An X-ray of the small intestine may be used to diagnose Crohn's disease.
How to treat Crohn's disease? Initial treatment is almost always conservative (not surgical). Currently, there is no universal cure for Crohn's disease, but therapy using one or more drugs is aimed at early treatment of the disease and alleviation of its symptoms. The most common medications are corticosteroids such as prednisolone and methylprednisolone, as well as various anti-inflammatory drugs.
Other drugs, such as 6-mercaptopurine and azathioprine, which have immunosuppressive effects, are often used. Metronidazole, an antibiotic that targets the immune system, is often effective in patients with perianal manifestations of Crohn's disease.
For more common and complex cases of Crohn's disease, surgery may be indicated. Sometimes, with the development of serious complications of the disease, such as bleeding, acute intestinal obstruction or intestinal perforation, emergency surgical interventions have to be performed.
Other, less urgent indications for surgery include the formation of abscesses, intestinal fistulas (pathological communications of various parts of the gastrointestinal tract), severe forms of perianal lesions, and the lack of effect of conservative treatment.
Not all patients with complicated Crohn's disease require surgery. This decision is best made after consultation with a gastroenterologist and coloproctologist.
Should we try to avoid surgical treatment of CD at all costs?
Although medical (conservative) treatment is preferred as an initial step, it is important to understand that about 3/4 of all patients ultimately require surgical treatment. Many patients mistakenly believe that surgery for Crohn's disease is dangerous or inevitably leads to complications.
Surgery is not a panacea, but after one operation many patients will not require additional surgery. The most common treatment procedure is conservative therapy with limited bowel resection (removal of only the affected area of the bowel).
Surgery often provides long-lasting relief from Crohn's disease symptoms and reduces or eliminates the need for ongoing medication use. Surgical treatment is best performed by a coloproctologist surgeon working in a clinic that has experience in complex treatment of patients with Crohn's disease.
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