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Crohn's disease

Crohn's disease

Crohn's disease (first described in 1932 by the New York physician Burill B. Crohn) is not limited to the intestinal area and can affect all area of the digestive tract from the mouth to the anus. Typically, however, the inflammatory bowel lesions are found in the last portion of the small intestine, at the transition to the large intestine and in the first portion of the large intestine. Frequently, affected and healthy intestinal areas alternate. The inflammation affects the wall of the entire intestine.  If the disease spreads to the colon and rectum, recalcitrant fistulas and recurrent abscesses in the anal area may form. The inflammatory processes change these tissue structures including the intestinal glands, so that the intestines gradually lose their digestive function. Crohn's disease can occur at any age, even in infants and young children. Usually, however, the disease manifests in early adulthood (20–40 years).


The exact reason why some people develop Crohn's disease has not yet been elucidated. But there is increasing evidence that a genetic predisposition, environmental factors and the immune system are involved in the development.

The digestive system forms the interface between the inner body and outer body environment and is equipped with a large number of immune cells of various types.

These are among the immune cells that prevent the penetration of harmful foreign proteins or other substances into the body.

In patients with Crohn's disease, these immune cells are increased in numbers and activated in the intestinal mucosa. They produce too many pro-inflammatory and too few anti-inflammatory cyto-kines (chemical messengers).

All in all, however, it is believed that Crohn's disease is caused by several factors; this is called a multifactorial process.

It can be considered as proven that environmental factors play a role, as Crohn's disease is increasing in frequency and is much more common in the high-tech countries than in all other regions of the world. The contribution of psychological factors is controversial. The majority opinion is that psychological stress can indeed trigger a bout of the existing disease process, but is not the initial cause of inflammatory bowel disease.


In many cases, Crohn's disease develops slowly and causes very unspecific symptoms. In addition to general symptoms, such as decreasing vitality, fatigue, loss of appetite and sometimes fever, the main symptoms are directly related to the intestines.

There are often diarrhoea-like stools that can occur up to 10 – 20 times per day. After prolonged illness, perianal fistulas may occur. As iron is lost with the blood, the bone marrow lacks the necessary iron for the production of new blood. The result is so-called iron deficiency anaemia.

Rheumatoid arthritis and Crohn's disease can affect each other; a "rheumatoid" arthritis can accom-pany Crohn's disease. Furthermore also eye inflammation (especially of the iris and conjunctiva) and skin alterations (painful, reddish discoloured lesions) may occur.

Almost one in ten of Crohn's disease patient develops kidney stones (nephrolithiasis). A major cause of this phenomenon is seen in the increased absorption of oxalic acid by an injured colon.

Patients with Crohn's disease of the colon (large intestine) have, if the disease persists for many years (more than 10 years), an increased risk of developing colon cancer. Therefore, patients with Crohn's disease of the colon should undergo a colonoscopy every 1 – 2 years.

The course of the disease is not continuous. Crohn's disease occurs intermittently and is interrupted by symptom-free intervals of longer or shorter duration.


The focus is on drug treatment: often patients cannot do without cortisone preparations. But fortu-nately in some patients the complaints abate by themselves again even without any treatment. However, relapses may occur at any time.

The most important information for the doctor is the symptoms and their impact on everyday life. So it is worthwhile to prepare a weekly protocol with information on the frequency of bowel move-ments, stool consistency (hard, soft or watery), blood in the stool, abdominal pain, general health, weight, and body temperature.

A template for such a weekly protocol can be downloaded here.

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