Palene Health

• Did you know that as of 2024, Crohn’s disease affects approximately 30 to 50 million people worldwide? Yes, with higher prevalence rates in North America and Europe than in other regions. 
• The annual incidence is about 6 to 12 new cases per 100,000 people, with most cases diagnosed between ages 15 and 35. 
• Both genders are affected equally, though women may experience slightly higher prevalence. The disease poses a significant economic burden,  with annual healthcare costs ranging from $20,000 to $50,000 per patient in the U.S. 
• Hospitalization rates are around 20-30%, and about 10-20% of patients face substantial disability. 
• Although Crohn’s disease has a low overall mortality rate, complications such as colorectal cancer can impact long-term outcomes. 
• Ongoing research includes over 200 clinical trials exploring new treatments and potential cures.

What is Crohn’s Disease?

Crohn’s disease is a chronic inflammatory condition that primarily affects the gastrointestinal (GI) tract. The gastrointestinal tract is comprised of the mouth, pharynx (throat0, esophagus, stomach, small intestine, large intestine, rectum and anus. Crohn’s disease as we know it, is one of the two major types of inflammatory bowel disease (IBD). 

The other disease in the IBD group is ulcerative colitis. Unlike ulcerative colitis, which only affects the colon, Crohn’s disease can affect any part of the GI tract, from the mouth to the anus. The disease results in severe digestive issues and complications, pushing individuals suffering from it to require long-term management.

Crohn’s disease is an autoimmune-mediated condition. This means that the body’s immune system mistakenly attacks its healthy tissues, causing inflammation. This inflammation spreads deep into the layers of affected bowel tissue, leading to painful and sometimes debilitating symptoms. Here are similar conditions to Crohn’s disease: https://www.webmd.com/ibd-crohns-disease/crohns-disease/digestive-diseases-crohns-disease

Signs and Symptoms of Crohn’s Disease

The symptoms of Crohn’s disease can vary greatly from person to person. They also depend on which part of the GI tract is affected. Common symptoms include:

• Abdominal Pain. Ideally, this pain is usually crampy and occurs in the lower right quadrant of the abdomen.
• Diarrhea. Depending on the severity of the disease, the diarrhea may range from mild to severe. Sometimes, this diarrhea may contain mucus, blood, or pus.
• Fatigue.  Chronic fatigue is common in people with Crohn’s disease. It occurs as a result of the body’s ongoing battle with inflammation.
• Weight Loss. As the disease progresses and becomes more severe, the patient may experience unintentional weight loss. This happens as a result of malabsorption and loss of appetite.
• Fever. A mild fever can accompany flares of the disease.
• Mouth Ulcers. These ulcers may be very painful, making it difficult to eat or drink through the mouth.
• Reduced Appetite. This leads to weight loss and malnutrition.
• Anemia. As the disease penetrates through the deeper tissues of the gastrointestinal tract, it may cause wounds. With time, these wounds may bleed, leading to chronic blood loss, and causing inflammation-induced anemia.
• Rectal Bleeding. This is caused by inflammation and ulceration that occurs near the rectum.

Causes of Crohn’s Disease

The exact cause of Crohn’s disease is unknown. However, scientists believe that Crohn’s disease is a result of a combination of genetic, environmental, and immune system factors.

1. Genetics

Genetics play a crucial role in the development of Crohn’s disease, though the exact mechanisms are complex. The disease often runs in families, indicating that genetic factors contribute to susceptibility. There are several specific genes linked to Crohn’s disease, including:

NOD2/CARD15. This gene is a major risk factor for Crohn’s disease. It helps the immune system respond to bacterial infections. Mutations in this gene can impair this response, leading to inflammation in the intestines.

IL23R. Variants in this gene affect how the immune system regulates inflammation. IL23R is involved in producing interleukin-23, a cytokine that contributes to inflammatory responses. Changes in this gene can increase susceptibility to Crohn’s disease.

ATG16L1. This gene is important for autophagy, a process that helps clear pathogens and damaged cells. Mutations in ATG16L1 can disrupt autophagy, leading to chronic inflammation.

TNFSF15. This gene regulates immune responses and its variants are associated with an increased risk of Crohn’s disease, especially in certain populations.

2. Immune System Response

In Crohn’s disease, the immune response becomes dysregulated, leading to chronic inflammation in the digestive tract. Here’s how this process occurs;

Immune System Malfunction. In a healthy immune system, the body identifies and attacks harmful pathogens while leaving healthy cells unharmed. In Crohn’s disease, however, the immune system mistakenly targets the body’s gastrointestinal tissues as if they were foreign invaders. This misdirected immune response leads to ongoing inflammation.

Triggering Inflammation. The immune system’s abnormal reaction causes inflammation in various parts of the digestive tract. Immune cells such as T cells and macrophages become activated and release inflammatory cytokines. One of these cytokines is tumour necrosis factor-alpha (TNF-alpha), which promotes inflammation and damages the lining of the intestines.

Chronic Inflammation. Unlike a normal immune response that resolves after the pathogen is eliminated, the inflammation in Crohn’s disease is persistent. The continuous immune attack leads to damage in the gut lining, forming ulcers and causing symptoms like abdominal pain, diarrhea, and bleeding.

Formation of Immune Complexes. In Crohn’s disease, the immune system may also form immune complexes. These are clusters of antibodies and antigens that are deposited in the intestinal tissues. These complexes contribute to ongoing inflammation and tissue damage.

Disruption of Gut Microbiome. The immune system dysregulation works by affecting the balance of the gut microbiome. The gut microbiome is the community of microorganisms living in the intestines. An imbalance in this microbiome can exacerbate inflammation and contribute to the development of Crohn’s disease.

3. Environmental Factors

Environmental factors play a significant role in the development and exacerbation of Crohn’s disease. While the exact cause of Crohn’s remains unclear, several environmental influences are known to contribute to its onset and progression. Here’s how these factors impact the disease:

Smoking. Smoking is one of the most well-established environmental risk factors for Crohn’s disease. It worsens symptoms, increases the risk of flare-ups, and contributes to complications. Smoking impacts the immune system and alters gut microbiota, both of which can enhance inflammation and disease severity.

Diet. Dietary factors can influence Crohn’s disease, though their exact role is complex. Certain foods may trigger or worsen symptoms, especially during flare-ups. High-fat diets, dairy products, and foods high in sugar and fibre can be problematic for some individuals. However, diet alone is not considered a direct cause of Crohn’s but rather a factor that can affect symptom severity.

Antibiotics. The use of antibiotics, especially during childhood, has been linked to an increased risk of developing Crohn’s disease. Antibiotics can disrupt the gut microbiome, which may contribute to the immune system’s misdirection and inflammation.

Stress. While stress does not cause Crohn’s disease, it can exacerbate symptoms and trigger flare-ups. The relationship between stress and Crohn’s is bidirectional; stress can worsen the condition, and dealing with Crohn’s can increase stress levels.

Hygiene Hypothesis. The hygiene hypothesis suggests that reduced exposure to infections and microbes in early childhood may lead to an increased risk of autoimmune diseases like Crohn’s. According to this theory, a lack of microbial exposure might lead to an overactive immune response, contributing to the development of Crohn’s.

Geographical and Seasonal Factors. Crohn’s disease has varying prevalence rates depending on geographical regions and is more common in developed countries. Some studies suggest that living in urban areas and having a higher socioeconomic status might be associated with a higher risk of developing Crohn’s. Seasonal variations in the incidence of Crohn’s could also be linked to environmental factors like exposure to different pathogens or seasonal changes in diet.

4. Infections

Certain infections may trigger Crohn’s disease or contribute to its progression. Bacterial or viral infections could provoke an inappropriate immune response in genetically predisposed individuals, leading to inflammation and the onset of Crohn’s disease.

Diagnosis of Crohn’s Disease

Diagnosing Crohn’s disease can be a challenging task. This may be due to its overlapping symptoms with other GI disorders such as ulcerative colitis. Therefore, a proper diagnosis requires a combination of tests including:

Blood Tests. This test aims to check for anemia or infection.

Stool Tests. This procedure is for ruling out infections and checking for inflammation.

Colonoscopy. This is one of the major diagnostic tools. It allows direct visualization of the colon and terminal ileum, where biopsies can be taken.

Endoscopy. This examination test analyses the upper GI tract.

Imaging Studies. CT scans, MRI, and intestinal ultrasound are used to assess the extent of inflammation and detect complications like abscesses or fistulas.

Capsule Endoscopy. The procedure is performed by swallowing a small, camera-equipped capsule. It captures images as it travels through the GI tract.

Treatment Options for Crohn’s Disease

Currently, there is no cure for Crohn’s disease. The goal of treatment is to manage symptoms, induce and maintain remission, and improve quality of life. Ongoing research is exploring new treatment options and a potential cure, but for now, Crohn’s disease remains a chronic, lifelong condition. Common treatment strategies include:

1. Medications. 

• Aminosalicylates. These medications are used to reduce inflammation in mild cases.
• Corticosteroids. These are powerful anti-inflammatory drugs used for short-term control of acute flares.
• Immunomodulators. These medications include azathioprine or methotrexate. They are used to suppress the immune system and maintain remission.
• Biologics. These medications target specific proteins in the immune response. They may include TNF inhibitors (e.g., infliximab) or integrin inhibitors (e.g., vedolizumab).
• Antibiotics. Antibiotics are used to treat or prevent infections that may occur in the presence of fistulas or abscesses.  Check more medications here: https://my.clevelandclinic.org/health/diseases/9357-crohns-disease

2. Surgery. 

• Resection. This involves removing the damaged portion of the intestine.
• Strictureplasty. In this surgery, the surgeon aims to widen a narrowed area of the intestine without removing it.
• Colectomy. Colectomy surgery removes the colon. In some people, it may sometimes require an ostomy.

3. Nutritional Support.

• Dietary Changes. Avoiding trigger foods, eating smaller meals, and staying hydrated may help ease the pain and reduce the progression of the disease.
• Nutritional Supplements.  In cases where the disease has caused deficiencies, getting supplements such as iron is important, particularly during flare-ups.
• Enteral Nutrition. Where the patient’s GI tract has been severely damaged, liquid diets may be used to reduce inflammation and maintain nutrition.

4. Lifestyle Modifications. 

Smoking Cessation. Smoking is a known risk factor for worsening Crohn’s disease. Quitting it may help in reducing inflammation.

Stress Management. Techniques like meditation, yoga, and counselling can help reduce stress, which may trigger flares.

Crohn’s Disease in Children 

Crohn’s disease can also affect children. When this occurs, children may experience challenges in growth and development. Symptoms in children may include delayed growth, weight loss, and delayed puberty, in addition to the symptoms seen in adults. Early diagnosis and treatment are crucial to prevent long-term complications in children, including bone health issues and nutritional deficiencies.

Complications of Crohn’s Disease

1. Intestinal Obstruction

When left untreated or treated poorly, Crohn’s disease may cause inflammation and scarring in the intestinal walls. This leads to a narrowing of the intestines known as a stricture. This stricture can obstruct the normal passage of food and waste, resulting in severe abdominal pain, bloating, and vomiting. Over time, the obstruction may worsen, potentially requiring surgical intervention to remove or bypass the blocked section of the intestine.

2. Fistulas

Chronic inflammation in Crohn’s disease can cause abnormal connections, or fistulas, to form between different parts of the intestines. This connection may also form between the intestine and other organs, such as the bladder, vagina, or skin. Fistulas can lead to severe infections, abscesses, and other complications, often requiring surgical repair. They can also cause significant pain and discomfort, impacting the patient’s quality of life.

3. Malnutrition

Crohn’s disease interferes with the body’s ability to absorb nutrients due to chronic inflammation. Malnutrition may also occur as a result of damage to the intestinal lining, or surgical removal of affected sections of the intestine. This malabsorption can lead to malnutrition, resulting in weight loss, fatigue, anemia, and deficiencies in essential vitamins and minerals. Managing malnutrition often requires dietary adjustments, supplements, and sometimes intravenous nutrition.

4. Perforation of the Intestine

Severe inflammation and ulceration in Crohn’s disease can weaken the intestinal wall, leading to a perforation or hole in the intestine. This is a medical emergency. Why? This perforation allows the contents of the intestines to spill into the abdominal cavity, causing a life-threatening infection called peritonitis. Immediate surgical intervention is typically required to repair the perforation and treat the infection.

5. Increased Risk of Colorectal Cancer

Patients with long-standing Crohn’s disease, especially those with extensive involvement of the colon, have an increased risk of developing colorectal cancer. Chronic inflammation can cause changes in the cells of the intestinal lining, leading to dysplasia and eventually cancer. Regular screening and monitoring are crucial for early detection and prevention of colorectal cancer in patients with Crohn’s disease.

6. Abscesses

Crohn’s disease can lead to the formation of abscesses, which are collections of pus resulting from bacterial infections in the tissues of the intestines or surrounding areas. Abscesses can cause fever, severe abdominal pain, and tenderness. If not treated promptly, they can spread the infection and become life-threatening. Treatment often involves antibiotics and drainage of the abscess.

7. Joint Inflammation

Crohn’s disease is associated with extraintestinal manifestations, including inflammation of the joints, known as enteropathic arthritis. This condition can cause pain, stiffness, and swelling in the joints, particularly in the knees, hips, and spine. The inflammation may worsen during flare-ups of Crohn’s disease, and managing joint symptoms often requires a combination of medications, physical therapy, and lifestyle adjustments. Here are more complications: https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304

Frequently Asked Questions (FAQ) About Crohn’s Disease

1. Can you live a ‘normal’ life with Crohn’s?

Yes, with proper management, many people with Crohn’s disease can live full, active lives. Adhering to treatment plans, maintaining a healthy diet, and avoiding known triggers are essential.

2. What are the early warning signs of Crohn’s disease?

Early signs often include diarrhea, abdominal pain, fatigue, weight loss, and mouth sores. If you experience these symptoms, consult a healthcare provider.

3. Is there a special diet for Crohn’s disease?

While no specific diet can cure Crohn’s, certain foods may trigger symptoms. Many patients find relief by avoiding high-fibre foods, dairy, fatty foods, and processed foods during flare-ups. Keeping a food diary can help identify triggers.

4. Can Crohn’s disease be fatal?

While Crohn’s itself is not usually fatal, complications from the disease, such as severe infections or colorectal cancer, can be life-threatening. Regular medical follow-up is important to manage risks.

5. Is Crohn’s Disease a Disability?

In many cases, Crohn’s disease can be considered a disability, especially if it significantly impairs a person’s ability to work or carry out daily activities. The chronic nature of the disease, coupled with frequent medical visits, hospitalisations, and surgeries, can justify disability claims. However, the process can be lengthy, and individuals may need to provide detailed medical documentation.