Crohn’s disease 

What is Crohn’s disease? 

Crohn’s disease is a chronic condition that causes inflammation in any part of the digestive tract, from the mouth to the anus, although it most frequently affects the small intestine and colon. Unlike ulcerative colitis, which only affects the colon, Crohn’s disease can affect discontinuous segments of the digestive tract, with healthy areas between the affected regions. 

Classification of Crohn’s disease 

Crohn’s disease is classified according to the location of the inflammation and the depth of intestinal involvement: 

• Ileitis: it only affects the ileum (final part of the small intestine). 

• Colitis: it only affects the colon. 

• Ileocolitis: it affects both the ileum and the colon. 

• Upper gastrointestinal tract: it affects any level of the upper digestive tract (duodenum, jejunum, stomach). 

It is also classified according to the behavior of the disease: 

• Inflammatory: inflammation predominates. 

• Stricture (stenosis): strictures form in the intestine. 

• Penetrating (fistulizing): fistulas (abnormal connections) form between the intestine and other organs. 

Causes of Crohn’s disease 

The exact cause of Crohn’s disease is unknown. It is believed to be due to a combination of genetic, environmental, and immunological factors.  de Crohn se desconoce. Se cree que se debe a una combinación de factores genéticos, ambientales e inmunológicos.

Risk factors for Crohn’s disease 

Some risk factors that may increase the likelihood of developing Crohn’s disease include: 

• Family history: having a close relative with the disease. 

• Smoking: smoking significantly increases the risk. 

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs): prolonged use of NSAIDs may increase the risk. 

• Age: although it can occur at any age, it is more common in young adults. 

Complications of Crohn’s disease 

While treatment can effectively control Crohn’s disease in many cases, chronic inflammation can lead to various complications: 

• Intestinal obstruction: inflammation and thickening of the intestinal wall can narrow the intestine, making it difficult for food to pass through. This can cause severe abdominal pain, nausea, vomiting, and constipation. 

• Fistulas: abnormal connections that form between the intestine and other organs, such as the bladder, vagina, or skin. Fistulas can cause infections, abscesses, and drainage of intestinal contents. 

• Abscesses, accumulations of pus that form inside the abdomen. Abscesses can cause pain, fever, and other signs of infection. 

• Malnutrition: chronic inflammation and malabsorption of nutrients can lead to malnutrition, with vitamin and mineral deficiencies. 

• Ulcers: ulcers can develop anywhere in the digestive tract affected by Crohn’s disease, including the mouth, esophagus, stomach, small intestine, and colon. 

• Colon cancer: people with Crohn’s disease that affects the colon have a higher risk of developing colon cancer. It is recommended to perform regular surveillance colonoscopies to detect any abnormalities early. 

• Toxic megacolon: it is a serious and rare complication characterized by extreme dilation of the colon. It can cause severe abdominal pain, fever, abdominal bloating, and shock. 

• Perianal disease: Crohn’s disease can affect the area around the anus, causing fissures, fistulas, and perianal abscesses. 

• Extraintestinal manifestations: in some cases, Crohn’s disease can affect other parts of the body, such as the joints, skin, eyes, and liver. 

It is important to note that not everyone with Crohn’s disease develops these complications. Regular medical follow-up and appropriate treatment help minimize the risk and effectively manage any complications that may arise. 

Diagnosis of Crohn’s disease 

Diagnosing Crohn’s disease can be a complex process due to the similarity of its symptoms to other gastrointestinal conditions. The diagnostic process generally involves a combination of the following tests: 

• Medical history and physical examination: the doctor will review your complete medical history, including family history of IBD, eating habits, symptoms, and their duration. The physical examination may include palpation of the abdomen to detect tenderness, bloating, or masses. 

• Blood tests: blood tests are performed to look for inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as to detect anemia, which can be caused by blood loss or iron malabsorption. Tests can also be performed to rule out other conditions, such as celiac disease. 

• Stool analysis: a stool analysis can help rule out bacterial or parasitic infections, as well as detect the presence of fecal calprotectin, a marker of intestinal inflammation. 

• Endoscopy: endoscopic procedures allow the doctor to directly see the lining of the digestive tract. 

• Colonoscopy: it examines the entire colon. 

• Sigmoidoscopy: it examines the lower part of the colon (rectum and sigmoid). 

• Esophagogastroduodenoscopy (EGD): it examines the esophagus, stomach, and duodenum. 

• Capsule endoscopy: it is used to examine the small intestine. 

• Double-balloon enteroscopy: it allows for the examination of areas of the small intestine that are not accessible with capsule endoscopy. 

• MR enterography (MRE): performance of a magnetic resonance imaging (MRI) scan that allows evaluation of the small intestine and detection of signs of inflammation, strictures, and fistulas. 

During the endoscopy, biopsies (small tissue samples) can be taken for examination under the microscope to confirm the diagnosis. At HM Hospitales, we offer upper and lower digestive endoscopy services. 

Treatment of Crohn’s disease 

The treatment of Crohn’s disease is individualized according to the severity of the disease, the location of the inflammation, and the presence of complications. The goal of treatment is to induce and maintain remission (absence of symptoms), as well as to prevent long-term complications. Treatment options include: 

1. Non-pharmacological treatment: 

As part of non-pharmacological treatment, a healthy and balanced diet is recommended, and in some cases a low-residue or elemental diet may be helpful; a dietitian can help identify foods that trigger symptoms. Quitting smoking is essential, as tobacco worsens the disease, and stress management through techniques such as meditation, yoga, or cognitive-behavioral therapy can also be beneficial. 

2. Pharmacological treatment 

Regarding pharmacological treatment, aminosalicylates are useful anti-inflammatories in mild cases, while corticosteroids are used to induce remission in acute flares, although their prolonged use is not recommended because of their side effects. Immunomodulators help maintain remission and reduce the need for corticosteroids, and biologics, which target specific molecules of the immune system, are effective in moderate to severe cases. Furthermore, antibiotics are used to treat infections such as abscesses or fistulas. 

3. Surgical treatment:  

If medications are ineffective or complications such as bowel obstruction, fistulas, or abscesses arise, surgical treatment is considered, which includes intestinal resection (removal of the affected part), stricturoplasty (widening a narrow section without removing it), or surgery to drain abscesses and repair fistulas. 

4. Endoscopic treatment: 

Endoscopic treatment is reserved for strictures or obstructions, using endoscopic balloon dilation or placement of a colonic prosthesis (stent) in refractory cases or extensive strictures.  

The management of Crohn’s disease requires a multidisciplinary team of gastroenterologists, digestive surgeons, nutritionists, and other health professionals. This will facilitate diagnosis, improving the prognosis and minimizing the impact of the disease on the patient’s life. 

Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have Crohn’s disease, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.