Crohn’s disease

Crohn’s disease is a chronic inflammatory bowel disease affecting the entire intestine, preferably the lower small intestine (the predilection site is the terminal ileum) and the large intestine. There is a discontinuous granulomatous inflammation of the intestine, which means that several sections of the intestine can be affected at the same time and healthy intestinal parts can be present in between. The cause and development is still unknown today, infectious, genetic and autoimmunological causes are discussed. Crohn’s disease is classified as an autoimmune disease because about 20% of patients have p-ANCA autoantibodies in their blood.

Crohn's disease usually begins in young adulthood with pain in the right lower abdomen, diarrhea, weight loss, nausea and vomiting. In addition to bowel symptoms, many patients also experience joint pain, changes in the skin, and inflammation of the eyes. The chronic inflammation of the intestine leads to changes in the intestinal mucosa and scarring, which can lead to constrictions and in the maximum case to an intestinal obstruction, fistulas and abscesses.

The first symptom is usually anemia (anemia) in addition to optional abdominal pain and diarrhea. Diagnosis involves a gastric and colonoscopy with biopsies (tissue samples) from the stomach, duodenum, terminal ileum and step biopsies from the large intestine, depending on the infestation. On the other hand, the image in an enteroclysis CT or better MR is so typical that if the small intestine is involved, the diagnosis can be made purely from radiological imaging without biopsies being available. A double balloon enteroscopy or capsule endoscopy can be almost entirely dispensed with.

The disease is not curable until now. The aim of treatment should be to avoid relapses as far as possible through appropriate medication or to couple them immediately. The classic complications of Crohn's disease usually only occur with inadequate or inadequate drug therapy. - Or if the disease does not respond to the medication.

In addition to a diet, therapy for Crohn's disease is always conservative for as long as possible. A distinction is made between basic therapy and therapy in the acute episode. The course of the disease and the response to therapy can be documented not only by colonoscopy with biopsies, but also by calprotectin in the stool. Calprotectin is a value that measures the exfoliation of leukocytes (immune cells) in the stool and is a good parameter for assessing the activity of IBD (inflammatory bowel disease).

In general, drugs such as glucocorticoids (cortisone), immunosuppressants and antibodies are used. In addition to drug therapy, a low-fiber diet and the substitution of vitamins and iron have a positive influence on the disease. In addition, psychotherapy and relaxation techniques can help cope with the disease and reduce the psychosomatic influencing factors. Taking prebiotics and probiotics can have very positive effects.

Often the complications of Crohn's disease, such as intestinal obstruction, enterocutaneous fistulas or abscesses, make an operation unavoidable, whereby the principle of maximum organ preservation is used and as little intestine as possible is removed.