Crohn’s Disease

Crohn’s disease is a type of chronic inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract.
Synonyms: Crohn’s Syndrome, Regional enteritis, Chronic Ileitis
Causes: Exact cause unknown
It is thought to be caused by a combination of genetic factors, immunological factors, and environmental causes.

Clinical Features

Signs and symptoms often include abdominal pain, diarrhea, fever, and weight loss. Extra-gastrointestinal tract symptoms may include anemia, skin rashes, arthritis, inflammation of the eye, and fatigue. Bowel obstruction is also common.

Pathology

It is thought to be a disease where the immune system attacks the cells of the Intestinal tract. But it is not an autoimmune disease as the trigger for the immune system is environmental due to some bacterial infections.
A transmural pattern of inflammation – the inflammation spanning the entire depth of the intestinal wall is seen. Ulceration is an outcome seen in the highly active disease. There is usually an abrupt transition between unaffected tissue and the ulcer—a characteristic sign known as skip lesions.
There is infiltration of the mucosa by leukocytes especially mononuclear cells.
There is weakened mucosal layer and inability to clear bacteria from the intestinal walls, and microorganisms are taking advantage of this.

Diagnosis

Symptomatology along with family history are crucial in diagnosis.
A colonoscopy showing signs of ulcers, inflammation, or bleeding along the mucosal layers is approximately 70% effective in diagnosing the disease. During a colonoscopy, biopsies of the colon are often taken to confirm the diagnosis. Multinucleated giant cells is a common finding in the lesions of Crohn’s disease.

Epidemiology

About 10% to 20% of people with Crohn’s disease have at least one other family member who also has the disease and it is also common in some ethnic groups(Jews, Caucasians). It is thought to be due to one or other abnormality in about 70 pairs of genes leading to increased susceptibility.
Increased intake of animal proteins, milk etc are associated with Crohn’s disease and it is more prevalent in industrialized areas. Smoking also is considered as a contributory etiology.
Crohn’s disease can be categorized by the specific tract region involved. The ileum is the most affected part. Ileocolic Crohn’s accounts for fifty percent of cases. Crohn’s ileitis, manifest in the ileum only, accounts for thirty percent of cases, while Crohn’s colitis, of the large intestine, accounts for the remaining twenty percent of cases and may be particularly difficult to distinguish from ulcerative colitis.

Treatment

There is no specific treatment. Lifestyle modification with reduced stress may be helpful in reducing Crohn’s. Dietary modification to eat lesser amounts at frequent intervals and avoiding animal proteins may be advised. Acute symptoms are controlled by medication if needed.

Prognosis

Crohn’s is an incurable chronic condition characterized by periodic remission and relapse. There is a rare possibility for intestinal cancers in some patients.

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