Crohn’s disease symptoms

In the Crohn's disease It is a disease inflammatory bowel that can affect any section of the digestive tube, that is, from the mouth to the anus, although it mainly affects the small intestine. It is a chronic disease that usually affects young people, especially between 15-30 years of age, and that can be reactivated several times throughout the patient's life.

It generally affects the entire colon but the extent of the lesion can be variable, for example, we speak of proctitis if it only affects the rectum. In Crohn's disease, as in the disease, the mucosa of the colon is affected, which causes ulcerations and inflammation.

How is it produced?

The cause is not known of Crohn's disease but genetic, immunological, environmental and infectious factors have been implicated. On the other hand, there are a series of factors that predispose the patient to suffer from it, such as being white, living in the first world and having first-degree relatives who suffer from the disease. The tobacco as an environmental factor clearly related to Crohn's disease, which generates a greater predisposition, worse evolution and greater risk of relapses.

Crohn's disease symptoms

Each patient shows evolves and different symptoms but, in addition, the clinical course of this disease is unpredictable. There are patients who suffer continuous symptoms, while others show very long periods without symptoms. By affecting any area of ​​the intestine, symptoms can be very varied because it is related to its location. In fact, there are portions of the intestine affected that are separated by other healthy areas.

As we have said, the symptoms change from one patient to another, although some of them appear differently. generalized form in Crohn's patients:

• Diarrhea is the common symptom in all cases.
• Abdominal pain may appear
• Presence of and / or rectal bleeding
• Fever
• Weightloss
• Fistulas
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As a consequence of the inflammation, a series of symptoms related to the poor absorption of nutrients and anemia. In the case of children, there may also be a delay in growth as a consequence. In addition, this disease can have extra-intestinal manifestations such as involvement of the skin, the joints (inflammation), the liver and the eyes.

Finally, as a consequence of all these symptoms, arise other complications, such as intestinal obstruction, fistulas, cancer, toxic megacolon, skin, bladder and vagina problems in women.

Diagnosis

The diagnosis is based on the medical history, laboratory data, and the findings of specific digestive tests, including endoscopy and radiological studies. The following determinations are generally indicated:

• blood test: markers indicating inflammation and infection may be elevated. There may also be anemia and a deficit of nutrients.
• Opaque enema: it is usually the one in the diagnosis because it allows to see the affectation of the small intestine after the ingestion of barium porridge (visible contrast to X-rays) allowing to see the extension of the lesions, possible stenoses (narrowing), polyps, etc.
• The scintigraphy with marked leukocytes is the test of choice to determine the extent of inflammation and the severity of the disease.
• The endoscopy, although it is not as useful as in ulcerative colitis.
• Other tests that may be useful are: abdominal ultrasound, abdominal CT (especially to see complications such as abscesses) and endoanal ultrasound (when there is involvement of the rectum: fistulas and abscesses).

Treatment types

The treatment aims manage symptoms during the outbreak or acute episode of the disease and control relapses but There is not a cure for this disease. The treatment may differ from patient to patient depending on the severity and characteristics of each case.

General measures

• The patient should avoid possible triggers such as infections (respiratory or intestinal), tobacco and non-steroidal anti-inflammatory drugs.
• There are no specific dietary recommendations, except following a complete and balanced diet rich in fiber. No harmful food has been identified in patients or to lead to an outbreak. The diet does not modify the evolution of the disease in the long term but pnutritional supplements may be necessary and advice by a. In certain cases you have to opt for the parenteral nutrition (intravenously) or enteral (through a nasogastric tube with specially prepared porridges).
• Patients should not self-medicate as it can be counterproductive and cause imbalances in the intestinal flora.
• It is recommended avoid stress and sleep enough.
• For relief of pain and diarrhea, antidiarrheal and antispasmodic drugs may be prescribed.

Pharmacotherapy

Pharmacological treatment is administered both in outbreaks and in asymptomatic periods, calling it maintenance treatment. Generally, in outbreaks, more active treatment is necessary and even in severe cases, hospitalization is necessary. In the asymptomatic phases, the patient must continue receiving maintenance treatment to reduce relapses. In this case, the derivatives of salicylic acid (5-ASA), such as mesalazine.

• There are several treatment options that include drugs with effect local anti-inflammatory, corticosteroids, immunosuppressants and antibiotics. Some of these drugs can be given by orally or in the form of enemas, the latter is especially suitable when the disease affects the sigmoid and rectum.
• One of the most recent immunosuppressants They are the so-called anti TNF that has an effect on the immune system reducing its inflammatory activity. This treatment has restricted indications, limiting itself to cases that are refractory to conventional treatment.
• During acute outbreaks of the disease, special use is made of corticosteroids due to its anti-inflammatory activity and its ability to slow down the immune response. Corticosteroids can be administered orally or in the form of enemas.

Surgical treatment

Treatment with surgery is reserved for the treatment of complications: intestinal perforation, hemorrhage, fistulas, etc. Sometimes especially when the disease is not controlled with medical treatment, surgery can improve the quality of life, but it is not curative as in the case of ulcerative colitis, so it should be indicated in a thoughtful and prudent manner. Even if a piece of intestine is removed, the disease recur and appear anywhere in the digestive tract.

Information of interest:

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Dra. Eva Ormaechea Alegre

Intensive Medicine Specialist