More detailed description about Crohn´s disease

Crohn's disease is a relatively rare disease. It usually affects young people, aged between 20 and 30, but it can also occur later in life. The disease is prevalent in Europe and in the U.S., it affects somewhere around 0.4% of the total population. Crohn's disease is common in whites, but it most often affects those of Jewish origin. Due to genetic predisposition, the disease occurs more frequently in some families.

Disease development

There are several factors which contribute to the development of the disease, such as the environmental, immune, inflammatory and particularly genetic factors.

Some theories assume that the presence of bacteria and viruses in the body is responsible for the start of the inflammatory process in the body. The immune system reacts improperly to the presence of micro-organisms, which causes chronic inflammation of the intestines.

Smoking and life in an urban environment significantly contribute to the development of the disease. Every fifth patient has a relative that suffers from the disease. This is an indication that genetic factors play a considerable role in the disease´s development.

The disease often starts with an inflammation in the lower part of the small intestine. The inflammation is not limited to a specific part of bowel, because the localised areas of affected tissue can be surrounded by islets of healthy tissue. The inflammation may span the entire depth of the intestinal wall. As a result of this inflammation, a deep ulcer in the GI tract mucosa can occur. This can lead to constriction of the digestive tube or to perforation of the GI tract wall.

Disease consequences

Crohn's disease is chronic, usually lasting all of the patients life. In the course of the disease there are periods when symptoms occur (called relapses). They are followed by periods of improvement (called remissions). Signs and symptoms of the disease can be non-specific. The disease most often starts with weight-loss, fatigue, slightly elevated body temperature and persistent pain in the abdomen. The symptoms can also be cramps, diarrhoea, and mixture of blood and mucus in the stool. In the course of the disease other organs can be affected as well, such as eyes, spine, joints and skin.

Due to the fact that the inflammation spreads through the entire bowel wall, there may be numerous and extremely serious complications. These include bowel obstructions, ulcers of the wall, fistula (abnormal connections between the intestines and other organs, such as the bladder), anal fissures (tears around the anus). Patients lose weight due to poor uptake of nutrients and water through the GI tract wall. Crohn's disease greatly increases the possibility of developing cancer of the colon and rectum.

Diagnosis

A diagnosis is usually established through description of the problems and through a thorough medical examination. Any history of defecation of blood and mucus in the stool is a suspicious sign that could be attributed to Crohn's disease. The disease is usually confirmed by endoscopy (colonoscopy) and by removal of affected tissue for a histological examination.

Prevention

Crohn's disease cannot be fully prevented, because all the factors involved in the formation of the disease have not yet been determined. Genetic predisposition plays an important role, as well as external factors, such as bacterial flora in the GI tract. Habits also play important role, such as smoking.
Preventive action is aimed primarily at preventing the deterioration of the situation:

• Regular administration of therapy to prevent sudden deterioration and keep the disease in remission,
• Avoid the use of non-steroid anti inflammatory drugs such as aspirin, ibuprofen or naproxen because it can cause a sudden deterioration of symptoms. If use of NSAID cannot be avoided, it is recommended to use acetaminophen instead,
• Quit smoking,
• Eating healthy and balanced diet.

Therapy

The aim of treatment is the reduction of inflammation in GI tract and consequently reduce the signs and symptoms. A number of different drugs with various effects can be used. Optimal combination of drugs is sometimes difficult to find.

Anti inflammatory drugs are the first step in treatment of Crohn's disease. They include:

• Sulfasalzine – is useful when the most infected part of GI tract is the colon. Side effects are nausea, vomiting, headache and esophageal reflux disease.
• Corticosteroids – are used for treatment of moderate and severe types of this disease, and are aimed to reducing the inflammation. Normally they are used for shorter time periods (approximately for 3-4 months). Side effects are swelling of the face, insomnia, night sweats, hyperactivity and many others. Longer use causes even more problems, such as raised blood pressure, diabetes type 2, osteoporosis, etc. It can also be used in combination with immunosuppressive drugs.

Immunosuppressive drugs

Immunosuppressive drugs act directly on immune system and reduce the intensity of inflammatory response. They include:
Azathioprine and Mercaptopurine – these drugs are used when drugs mentioned above fail to work efficiently. Both drugs reduce the level of white blood cells and increase susceptibility to infections.
Tumor necrosis factor alpha is a protein, which takes part in the inflammatory process. The antagonists, like infliximab, adalimumab and others are used for moderate and severe types of this disease. The drugs are contraindicated for people with heart failure, multiple sclerosis and cancer. Side effects are severe because of the danger of serious infections, which occur because of the reduced immune response.
Methotrexate – is used seldom, when other drugs fail to produce appropriate remission of symptoms.
Cyclosporines – are also used when other treatments fail and for complications of the disease, such as fistulas.

Antibiotics

Antibiotics are used when there is a need for a treatment of fistulas or abscesses. They also reduce the amount of bacteria in the GI tract and consequently reduce the inflammation. The most important antibiotics are metronidazole and ciprofloxacin.

Others

Beside the drugs that interact directly with the inflammation, there are also other drugs available that reduce signs and symptoms. Those drugs can be laxatives in case of diarrhoea, or acetaminphen if the patient suffers pain. In addition, there are food supplements such as iron, vitamin B12, calcium and vitamin D that regulate the symptoms of anemia. If the patient is scheduled for surgery, then parenteral food is given in the form of infusions, which enables the GI tract to rest.

Surgery

When other means of treatment fail to produce the desired effects, the affected part of GI tract can also be surgically removed. Although this is only a temporary measure, because Crohn's disease usually reoccurs. Surgery is also used to remove or reduce the complications of the disease.

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