Definition

Crohn's disease is a chronic inflammatory condition affecting the digestive tract. It causes symptoms such as diarrhea, abdominal pain, fatigue, weight loss, and nutritional absorption disorders. 

The inflammation associated with Crohn's disease can occur anywhere along the digestive tract, from the mouth to the anus, and the location varies between individuals. The most common areas affected are the small intestine and colon. Inflammation from Crohn's disease can also extend to the inner layer of the liver.

The intensity of symptoms can vary from mild to severe and may fluctuate over time. In severe cases, complications can be life-threatening.

Causes

The exact cause of Crohn's disease is remain unknown, but some studies suggest that the disorder arises from an incorrect immune response in the small intestine. The immune system can mistakenly target "good bacteria" in the intestine, leading to inflammation. This condition is also influenced by environmental factors such as medications, toxins, infections, and gut microbes. These environmental factors can particularly affect individuals who are genetically predisposed to Crohn's disease.

There is an association between genetic mutations in Crohn's disease at a young age, which increases the risk of needing surgical procedures on the currently inflamed intestine.

In Crohn's disease, inflammation initially occurs in the mucosa or mucous layer of the digestive tract. The inflammation can cause ulcers that gradually enlarge and involve every layer of the digestive tract wall. Continuous inflammation can lead to blockage and narrowing of the intestine.

Risk factor

Although the exact cause of Crohn's disease is not completely understood, several factors are believed to influence its onset or exacerbation. These factors include

• Genetic factors

Individuals are at a higher risk of developing Crohn's disease if they have direct relatives such as parents, children, or siblings with the condition. Approximately 20% or 1 in 5 people with Crohn's disease have family members who also have Crohn's disease or other inflammatory conditions of the digestive tract, such as ulcerative colitis.

• Age

Crohn's disease can affect individuals of all age groups. However, most patients are diagnosed when they are under 30 years old. It can also occur in adults aged around 50 to 70 years old.

• Smoking habits

Smoking can increase the risk of worsening symptoms of Crohn's disease and may necessitate surgical procedures for affected individuals.

• Medication

Although non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen do not directly cause Crohn's disease, they can worsen inflammation in individuals with the condition.

• Immune system disorders that attack the digestive tract

• Imbalance in intestinal bacteria.

Symptoms

In Crohn's disease, any part of the small intestine or large intestine can be affected, with symptoms ranging from mild to severe. While symptoms typically develop gradually, some patients may experience sudden onset without warning. Additionally, there are periods of remission lasting several years for some patients.

Symptoms during active periods include:

• Diarrhea, often with blood, mucus, or pus
• Fatigue
• Fever
• Abdominal cramps and pain
• Blood in the stool
• Decreased appetite and weight loss
• Mouth ulcers

As the disease progresses and inflammation widens in the digestive tract, more severe symptoms may arise, such as:

• Inflammation of the liver or gallbladder
• Skin, eye, and joint inflammation
• Iron deficiency anemia
• Kidney stones
• Ulcers or sores from the mouth to the anus
• Pain or discharge from the anus or surrounding area

Diagnosis

To establish a diagnosis of Crohn's disease, the doctor will conduct a comprehensive interview with the patient to assess their symptoms, medical history, treatment history, and family medical history. If further examination is deemed necessary, the doctor will then perform a physical examination and diagnostic tests.

Crohn's disease cannot be diagnosed with a single test; therefore, the doctor will conduct a series of examinations, including laboratory tests, imaging tests, and possibly biopsies (tissue sample examinations). The results of these tests will help the doctor diagnose the disease and determine its severity.

Laboratory tests

• Blood tests are conducted to check for signs of anemia, infection, inflammation, and specific antibodies to differentiate Crohn's disease from ulcerative colitis.
• Stool tests are performed to detect the presence of blood or microbes in the patient's stool.

Other idagnostic tests

• Colonoscopy: This imaging test allows the doctor to visualize the entire colon and the end of the small intestine using a thin, flexible camera tube. Tissue samples may also be collected for further analysis.
• CT Scan: This imaging technique provides a detailed view of the entire intestine and surrounding tissue.
• MRI: MRI imaging uses radio waves and magnetic fields to produce detailed images of organs and tissues.
• Capsule Endoscopy: In this procedure, the patient swallows a capsule containing a small camera. The camera takes pictures of the small intestine, which are transmitted to a recorder worn by the patient. The capsule is then passed out of the body through stool.

Management

At present, there is no specific cure for Crohn's disease. Treatment for affected individuals depends on the severity of their symptoms. The primary goals of medication are to reduce inflammation, alleviate accompanying symptoms, and avoid the need for surgical intervention.

Medication:

• For Mild to Moderate Symptoms:

Patients may be prescribed steroid medication to reduce inflammation in the digestive tract, as well as immunomodulators and immunosuppressants to modify and suppress the immune system's response.

• For Severe Symptoms:

Patients may receive a combination of immunomodulators and biological immunoglobulin, or biological immunoglobulin alone. Biological immunoglobulin is an antibody designed to combat substances in the body involved in the inflammation process.

Surgery:

Surgical intervention is recommended for patients who develop complications such as intestinal blockage, perforations (holes) in the digestive tract, abscess formation (pockets containing pus), and fistulas (small passages that form between the skin near the anus and rectum). Surgery is considered a last resort in the treatment of Crohn's disease. Typically, the digestive tract has already undergone severe inflammation leading to tissue death, and the goal of surgery is to remove the affected tissues.

In cases involving a fistula, surgery may be performed to either close the fistula or redirect the pus that forms in the digestive tract due to the infection process.

Complications

If inflammation in the digestive tract due to Crohn's disease is left untreated, it can lead to worsening conditions in patients, including:

• Narrowing and slowing down of food or digestive residue movement in the intestines
• Intestinal blockage
• Formation of abnormal channels penetrating the intestinal wall, which are prone to infection
• Infections may lead to the formation of abscesses or pockets containing pus in the digestive tract, causing pain and swelling
• Disorders in the digestive tract can result in malnutrition or nutrient absorption disorders
• Inflammation may spread and affect other organs such as the liver, gallbladder, skin, eyes, or joints 

Prevention

While the onset of Crohn's disease cannot be prevented, there are several ways to reduce its symptoms if you are affected. These involve lifestyle changes, including:

• Avoid smoking to prevent the worsening of the inflammation process.
• Steering clear of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
• Reducing intake of acidic, spicy, fatty, dairy products, caffeine-containing drinks, soda, and high-fiber foods.
• Managing stress and depression, which can be exacerbated by the disease, through counseling with a psychologist, practicing meditation, or engaging in regular exercise to promote mental health.

When to see a doctor?

If you experience continuous changes in passing stool, severe abdominal pain, loss of appetite accompanied by significant weight loss, or if diarrhea and digestive tract symptoms persist despite medication, it's important to seek immediate medical attention. Visit the nearest health facility or consult a specialist doctor promptly.