Crohn's disease: what it is and how to treat it

By Cristiano Antonino On Feb 20, 2022

Crohn’s disease is an inflammatory bowel disease and can affect the entire gastrointestinal tract

Depending on the location, the symptoms that can occur are different and, for the sufferer, can turn into a highly disabling condition.

Thanks to research, however, the therapies available today to interfere with the inflammatory and autoimmune processes in Crohn’s disease are increasingly targeted and effective.

What is Crohn’s disease?

Crohn’s disease, together with ulcerative rectocolitis, are the two main forms of inflammatory bowel disease (IBD), characterised by chronic or relapsing immune activation in the gastrointestinal tract.

The continuous immune response, which is triggered against the intestine, in turn causes severe inflammation.

Although it can affect the entire gastrointestinal tract, in most cases Crohn’s disease affects the last part of the small intestine and the colon and is mainly characterised by ulcers resulting from inflammation.

If not treated properly, these can lead to complications such as stenosis (narrowing of the intestines) or even fistulas (perforations), which in some cases require surgery.

Causes and symptoms of Crohn’s disease

To date, unfortunately, the causes of Crohn’s disease are not yet known, and researchers are working to understand the main factors that cause the cells of the immune system to ‘attack’ the intestine and cause the resulting chronic inflammation.

Symptoms can be very different and vary depending on the gastrointestinal tract affected.

The most frequent symptoms of Crohn’s disease are:

abdominal pain
chronic diarrhoea (i.e. which persists for more than 4 weeks); and
fever;
weight loss.

In more severe cases, the inflammation can lead to ulcers in the wall of the intestine, causing the development of serious complications, such as fistulas, abscesses or stenosis.

However, with today’s available therapies and regular check-ups, patients can safely control the progression of the disease in most cases.

Early diagnosis and prevention of complications

Crohn’s disease is often confused with irritable bowel syndrome, which leads to diagnostic delays and complications.

Although it is unfortunately not possible to prevent the onset of Crohn’s disease, it is important to intervene early through correct diagnosis and to prevent any complications through careful monitoring.

Keeping the development of the disease under control helps patients to lead a more regular life.

Early diagnosis of Crohn’s disease and prevention of complications is achieved mainly through:

blood tests
stool analysis;
non-invasive examinations of the abdomen (ultrasound of the intestinal loops, CT scan, abdominal MRI) in the case of chronic diarrhoea, abdominal pain, weight loss etc. These examinations serve to evaluate the intestinal wall, to exclude or diagnose possible complications.

In addition, there are invasive examinations – such as gastroscopy or colonoscopy – which allow doctors to assess the condition of the intestinal mucosa live and investigate, at a microscopic level, whether there are any structural changes to the tissue.

Biopsies taken at regular intervals can help prevent intestinal neoplasms.

Crohn’s disease: treatments

The common goal of the currently available treatments for Crohn’s disease is to ‘switch off’ the intestinal inflammation in order to induce a remission of symptoms and maintain the condition in the long term.

In the case of severe and irreversible complications, surgery remains a key approach.

Among the most commonly used classes of drugs are immunosuppressants, such as azathioprine, 6-mercaptopurine and methotrexate, to reduce the activity of the immune system.

Thanks to research in recent years, we have the latest generation of therapies that are able to interfere, in an increasingly specific way, with the inflammatory and autoimmune processes characteristic of Crohn’s disease.

One example is monoclonal antibodies such as ustekinumab.

How best to set up therapy

In addition to the choice of the most suitable drug, it is important to define the dosage of therapy.

For some diseases, such as rheumatoid arthritis, diabetes and hypertension, treat-to-target strategies are used, which ‘adjust’ therapy and dose escalation based on specific indicators and monitoring.

Others rely on the clinical assessment of patients and thus on their symptoms alone.

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