Crohn's disease: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On May 29, 2023

Crohn’s disease (or disease), also known as terminal ileitis or segmental ileitis, is an inflammatory bowel disease with similarities and differences from the other, more widespread inflammatory bowel disease, which is ulcerative colitis (or ulcerative colitis)

Both Crohn’s disease and ulcerative colitis are considered auto-inflammatory (not really autoimmune) diseases

To date, the causes of this disease are unknown.

Inflammation, which is not always a symptom of infection, is a defence mechanism of our organism and is always present to some extent in certain portions of the digestive tract.

When it becomes exaggerated, it leads to acute and chronic, sometimes severe, damage.

What causes Crohn’s disease?

While a single, precise cause of Crohn’s disease is not known, it does recognise precipitating or triggering factors.

In one respect, we could consider them contributory causes.

Moreover, this disease is neither hereditary nor genetic, although a certain familial predisposition is recognised.

Here are some of the main such factors:

Medications such as antibiotics or anti-inflammatory drugs
Infections
Both physical and psychological stress

Crohn’s disease can affect every part of the digestive tract, from the mouth to the anus

The most affected sites are the small intestine (also called the small intestine, which is many metres long and difficult to explore), especially its last tract called the ileum (terminal ileitis), and the colon (large intestine).

Several segments, even non-contiguous ones, may be affected at the same time or at different times in the course of the disease.

Depending on the segment involved, segmental or terminal nomenclature is defined.

The inflammation affects the mucosa of the affected tracts, giving rise to ulcers, but may spread to the other layers of the digestive tract wall (unlike ulcerative colitis).

Risk factors for Crohn’s disease include:

age: Crohn’s disease can occur at any age, but in most cases it is diagnosed before the age of 30;
smoking: cigarette smoking is the most important controllable risk factor for the development of Crohn’s disease. Smoking also leads to more serious illness and an increased risk of undergoing surgery;
use of non-steroidal anti-inflammatory drugs: although they do not cause Crohn’s disease, they can lead to inflammation of the intestine that worsens Crohn’s disease.

Symptoms of Crohn’s disease

Symptoms occur in various associations or individually, and may be as follows:

Diarrhoea, sometimes with visible blood in the stool
abdominal pain
asthenia
vomiting
fever
nutritional deficiencies
weight loss
abdominal abscesses (collections of pus)
fistulas (abnormal communication between viscera)
abnormal anal fissures and other anal or peri-anal diseases (abscesses, fistulas)
intestinal stenosis (narrowing of the bowel that reduces or prevents the passage of contents)
arthritis
dermatitis, stomatitis (mouth ulcers)

A characteristic feature of Crohn’s disease, in common with ulcerative colitis, is the often fluctuating course of the disease, with improvements, sometimes spontaneous, and relapses.

For diagnosis, in addition to the comprehensive medical examination, which is essential, various laboratory tests and instrumental and imaging tests are used.

Crohn’s disease: what tests should be done?

Faecal calprotectin: provides an indirect measurement of the degree of inflammation in the intestine.

Echography of the intestinal loops: this test requires specialised ultrasound probes and a lot of experience on the part of the operator.

Enterorisonance: nuclear magnetic resonance of the intestine; involves drinking a liquid contrast agent before the test; an intravenous contrast agent is also used.

Colonoscopy: in the case of Crohn’s disease it should, if technically possible, always go so far as to view the last loop of the ileum. Several biopsies should always be taken at various levels of the colon and the ileum. The histological test is essential.

Recommended therapy

The therapy makes use of many effective drugs and allows brilliant results with many complete regressions and an often fairly good if not excellent quality of life.

Some of them are administered orally, others by injection, intravenous phleboclysis, subcutaneously, and others rectally.

In some cases it is necessary to resort to surgery, which generally tends to be carried out as conservatively as possible.

How to treat Crohn’s disease?

Nutrition and dietary care is very important, especially in the acute and subacute phases, but not only. Except in acute phases, a diet that completely excludes certain foods is generally not necessary.

Tobacco smoking should be abolished.

The treatment of Crohn’s disease can be rather complex and it is preferable to be entrusted to a physician who is an expert in the field and who can, if necessary, avail himself of the collaboration of other colleagues in an interdisciplinary team.

Vaccines are indicated in this disease as in the rest of the population, and even more so, except in very particular cases and for generally limited periods, in which it is advisable to postpone them for some time.

Lastly, it must be borne in mind that, even if the patient diagnosed with Crohn’s disease is completely well, it is always advisable for him or her to undergo regular check-ups with their trusted specialist.

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