Crohn’s Disease FAQ

Crohn’s disease is classified as one of the so-called inflammatory bowel diseases (IBD) and is a chronic condition characterized by intermittent flare-ups, leading to inflammation of the intestines. It can occur anywhere along the gastrointestinal tract, from the mouth to the anus. All layers of the intestinal wall can be affected.

Typical clinical signs or symptoms of Crohn’s disease include:

• Cramping abdominal pain
• Diarrhea, especially with mucus
• partly fever
• weight loss
• Perianal fistulas, which are small, sometimes oozing openings near the anus
• In blood tests, there are often elevated markers of inflammation and iron deficiency.
• Extraintestinal symptoms That refers to symptoms that do not affect the intestines.
These include primarily inflammatory swellings of the joints, characteristic patchy skin redness (Erythema nodosum), and inflammation of the eyes (Uveitis).

The diagnosis of Crohn’s disease is sometimes straightforward and sometimes very difficult to make because the symptoms can vary greatly.
The diagnosis of Crohn’s disease is sometimes straightforward and sometimes very difficult to make because the symptoms can vary greatly.
This icludes:

• Anamnesis interview
• Physical examination
• Blood test
• Stool examination
• Endoscopy with Colonocopy and Gastroscopy
• Histology (tissue samples taken during gastroscopy and colonoscopy)
• Imaging techniques such as abdominal ultrasound and enteroclysis MRI

A relapsing course means that after a symptom-free, inflammation-free period (remission phase), there is a recurrence of inflammation (acute flare-up). The inflammation activity or severity of the acute flare-up, as well as the duration of the inflammation phase and the remission phase, can vary greatly.

Crohn’s disease is a chronic inflammation that occurs in episodes. The disease can be treated with a variety of medications, but currently cannot be cured permanently. This means it is a lifelong diagnosis that also requires lifelong drug management.

Due to the fact that Crohn’s disease can theoretically occur anywhere in the gastrointestinal tract, i.e. from the oral cavity to the anus, and can also affect all layers of the intestinal wall, very severe courses are also possible.
In very severe cases, Crohn’s disease can occur simultaneously in multiple locations. Furthermore, complications such as inflammatory strictures (narrowing of the intestine), fistulas, abscesses, etc., can occur.

Such complications often require surgical intervention in addition to medical therapy, meaning surgeries may be necessary. Fatal outcomes are theoretically possible in very severe cases, but have become very rare today.

Since Crohn’s disease can occur in various parts of the gastrointestinal tract, the localization of pain often depends on the location of inflammation. One area where Crohn’s disease commonly occurs is the region where the small intestine (ileum) joins the large intestine (cecum, the first part of the large intestine). This region is referred to as the ileocecal region and is located in the lower right abdomen.

In principle, Crohn’s disease can occur at any age, i.e. children can also develop Crohn’s disease. However, there are 2 frequency peaks in which Crohn’s disease occurs particularly frequently. The first frequency peak is between the ages of 20 and 30. Most patients become ill during this period. The second frequency peak occurs after the age of 60.

The etiology or cause of Crohn’s disease is not fully understood and is believed to be multifactorial. This means that several factors lead to the occurrence of Crohn’s disease, with the origin of the disease being. Genetics is also a factor in the development of the disease, and this is inherited.

Once the diagnosis has been made, the choice of therapy depends on various factors. This includes the pattern of involvement, the activity level of inflammation (i.e., how severe the inflammation is), the presence of extraintestinal symptoms, and complications such as fistulas and abscesses.

Various medications are available for drug therapy and are used either individually or in combination.
This icludes:

• Steroids in different forms of application and dosages
• Immunosuppressive therapies such as Azathioprine (AZA) and purines like 6-mercaptopurine (6-MP)
• 5-ASA preparations (mesalazine), which, however, only play a minor role in Crohn’s disease, in contrast to ulcerative colitis

Various biologics. These are artificially produced antibodies that intervene at specific points in the inflammatory process. These are administered either intravenously (IV) or subcutaneously (SC) at intervals of several weeks. Several different antibodies are now available for the treatment of Crohn’s disease.
These include: Infliximbab (IFX), Adalimumab (ADA), Unstekinumab (UST), Vedolzumbab (VDZ), Golinumab.

The clinical courses and the duration of symptom-free remission phases between active flare-ups vary greatly. Some patients have very mild or no symptoms at all, while others experience a very severe course of the disease.
Without therapy, there is a risk of a severe flare-up with complications such as inflammatory strictures (narrowing of the intestine) or fistulas and abscesses, which often require surgical intervention.

Diarrhea, especially with mucus, is one of the hallmark symptoms of Crohn’s disease, but it does not always occur in all patients.

The etiology or cause of Crohn’s disease is not precisely understood, but it is believed to involve a multifactorial origin. This means that several factors lead to the occurrence of Crohn’s disease. Factors attributed to playing a role in the pathogenesis of Crohn’s disease include genetics, immunological factors, inflammation, environmental influences, and the microbiome.

Since the cause and pathogenesis of Crohn’s disease have not yet been fully elucidated, a permanent causal cure for the condition is currently not possible. However, significant progress has been made in the treatment of the disease to bring patients with an acute flare-up back into remission and to maintain remission for as long as possible.

One of the factors that likely plays a role in the development of the disease is probably nutrition. Since nutritional studies are very challenging to conduct due to long-term effects, there is limited hard data on this matter, and therefore, no strict dietary recommendations exist.
However, it is recommended to avoid processed and packaged foods, especially in the context of Crohn’s disease. Instead, it is advisable to prepare and consume mainly fresh and “healthy” foods.

For pain associated with active Crohn’s disease, it is especially important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), as they can further damage the intestinal lining.
Examples of NSAIDs include acetylsalicylic acid (aspirin), ibuprofen, naproxen, diclofenac, tenoxicam, etc.

Paracetamol and metamizole are more suitable. However, paracetamol poses a risk of toxic liver damage. Therefore, pain therapy for Crohn’s disease should, if possible, be carried out under medical supervision.