Recognising and treating Crohn’s disease
Crohn’s disease is a chronic inflammatory bowel disease in which the gastrointestinal tract becomes inflamed again and again. A flare-up usually begins with abdominal cramps and diarrhoea. Although Crohn’s disease cannot be cured, the right treatment can extend symptom-free periods.
Alongside ulcerative colitis, Crohn’s disease is one of the chronic inflammatory bowel diseases (IBD). The inflammation occurs in flare-ups. Acute phases alternate with periods of few symptoms.
Crohn’s disease can affect any part of the gastrointestinal tract – from the mouth to the anus. However, the inflammation usually occurs at the end of the small intestine and the transition to the large intestine. In contrast to ulcerative colitis, the inflammatory sites do not form a contiguous area, but occur in sections. All layers of the intestinal wall may be affected.
In Switzerland, around 25,000 people live with IBD, with women being affected about as often as men. Chronic inflammatory bowel diseases usually occur for the first time between 25 and 35 years of age. However, people of all ages can develop them – including children.
The symptoms caused by Crohn’s disease vary from person to person. Some sufferers experience frequent, severe pain, while others only have mild symptoms. Possible signs include:
- Cramp-like abdominal pain
- Frequent urge to defecate
- Diarrhoea (sometimes with blood and mucus)
- Loss of appetite
- Weight loss
- Fistulas (connections to other organs), e.g. in the anus area
- Deficiency symptoms
- Nausea, vomiting if the stomach is affected
- Inflammation in other parts of the body, such as the skin, eyes, joints or bile ducts
Crohn’s disease cannot be cured. The aim of treatment is to extend symptom-free periods and alleviate symptoms during a flare-up. This often involves a combination of several medications. Complications may also require surgery.
- Corticosteroids (e.g. prednisolone, budesonide): these medicines inhibit inflammation during a flare-up.
- Aminosalicylates (such as the active substance mesalazine): these are better tolerated than cortisone, but less effective in treating Crohn’s disease, which is why they are mainly used in mild cases.
- Immunosuppressants such as methotrexate, azathioprine, 6-mercaptopurine
- Antibodies (biologics), such as anti-TNF therapy (e.g. adalimumab, vedolizumab, ustekinumab)
Other medications (such as diarrhoea medicines, anticonvulsants or antibiotics) and dietary supplements (e.g. iron, vitamin D or zinc) may also be useful.
Patients with Crohn’s disease sometimes develop fistulas and abscesses, which must be surgically removed. IBD can also cause other complications that require surgery. These include intestinal obstruction, narrowing of the bowel (stenosis), bleeding and inflammation of the peritoneum (peritonitis). Sometimes sections of the intestine are completely removed. However, this does not mean that the inflammation cannot flare up again elsewhere.
Patients with chronic inflammatory bowel diseases such as Crohn’s disease do not need to follow a special diet. During periods without symptoms, they should eat a balanced diet to meet their nutritional requirements.
Patients should avoid foods that they have not tolerated well in the past. These often include foods that irritate the stomach and intestines, such as very fatty or spicy foods, unripe fruit, carbonated drinks and alcohol. Milk and dairy products are also often hard for people with gastrointestinal diseases to digest. In case of narrowing of the intestine (stenosis), high-fibre foods and those with long plant fibres (such as asparagus or pineapple) should be avoided.
During an acute flare-up, it is important to relieve the intestine by consuming easily digestible and low-fibre food. White bread, oat porridge, cooked vegetables, potatoes and rice relieve the digestive system. Liquid foods help to supply the body with all the nutrients it needs. Water and tea are best suited for hydration. In severe cases, it may also be advisable to receive artificial nutrition via a drip.
How Crohn’s disease develops is not fully understood. The following may play a role:
- Genetic factors: IBD occurs frequently in some families and seems to be inherited.
- Impaired barrier function of the intestine: the intestinal wall is less resistant to bacteria, which penetrate it and cause inflammation.
- Altered intestinal microbiome: the intestine is colonised by different bacteria than in healthy people.
- Environmental factors such as smoking can influence the risk of developing Crohn’s disease.
If babies are breastfed for at least six months, their risk of developing chronic inflammatory bowel disease later in life is significantly reduced.
Blood tests provide information on certain inflammatory values – C-reactive protein (CRP), white blood cells (leukocytes), blood sedimentation (BSR), kidney, thyroid and liver values.
A stool examination can rule out pathogens as the cause of the symptoms.
A colonoscopy is used to determine changes in the bowel. A gastroscopy may be useful to check whether Crohn’s disease has infected the stomach.
Imaging techniques such as ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) can also help to detect changes in the intestine.
Even with good treatment, everyday life with a chronic illness can be challenging. People suffering from severe symptoms are more likely to go off sick from work. In children, school performance may decline due to tiredness or frequent absences. It is therefore essential that teachers are informed of the illness.
Relaxation techniques and exercise can improve quality of life. Psychotherapy and dialogue with other patients (e.g. via the self-help association Crohn Colitis Schweiz) help patients to cope with the psychological strain.
For more information and support services, please visit:
- Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS): Diagnostik und Therapie des Morbus Crohn (Stand August 2021)
- Patientenleitlinie „Diagnostik und Therapie des Morbus Crohn“ (Stand: 2014)
- Darmzentrum Bern: Morbus Crohn, unter: www.darmzentrum-bern.ch (Abrufdatum: 02.11.2022)
- Internisten im Netz: Morbus Crohn: Prognose, Vorsorge & Tipps, unter www.internisten-im-netz.de (Abrufdatum: 03.11.2022)
- Crohn Colitis Schweiz: Leben mit CED, unter www.crohn-colitis.ch (Abrufdatum: 03.11.2022)