Crohn’s disease

The small intestine extends from the stomach to the large intestine (colon) and is part of the human digestive tract. It includes an immobile segment, the duodenum, followed by two mobile segments, the jejunum and the ileum. The colon extends from the cecum to the rectum.

In Crohn’s disease, any segment of the digestive tract – from the mouth to the anus – may become inflamed. However, the disease most commonly affects the ileocecal area, where the small and large intestines meet.

Depending on the extent, location and degree of inflammation of the lesions, the disease’s clinical picture includes lasting diarrhea, sometimes containing blood; abdominal pain; weight loss; and fever. Stenosis may cause bowel obstruction.

Other symptoms may include pain or drainage around the anus.

In some cases, non-digestive symptoms affecting the skin, joints and eyes can be associated with the disease.

• 1 in 1,000 people have Crohn’s disease
   
• The disease mainly develops in people aged 20 to 30, but can appear at any age, even after 60
   
• 10 to 20 percent of people with the disease experience a lasting remission following their first bout of the disease

• 50 to 70 percent of patients undergo surgery within ten years of disease onset

Inflammation can be caused by a variety of genetic, autoimmune and environmental factors.

• Some genes can increase the risk of developing the disease. Patients with a family history of Crohn’s disease, as well as certain ethnic groups, especially people of Ashkenazi Jewish descent, are at greater risk of developing the disease.

• Environmental factors, smoking in particular, can significantly influence the onset of the disease.  

Crohn’s disease is diagnosed based on several factors:

• Blood tests confirming the presence of an inflammatory syndrome and/or specific antibodies; specific stool analysis
• Medical imaging (MRI or CT scan)
• Gastroscopy and colonoscopy to view and determine the extent of inflammation in the intestinal mucosa and to perform biopsies
• In some cases, examination of the small intestine via capsule endoscopy is needed to confirm the diagnosis

The purpose of treatment is to eliminate both the lesions and the inflammation in the intestinal mucosa. Several options are available:

• Corticosteroids, mainly prescribed for brief periods during flare-ups
• Immunosuppressants, composed of thiopruines (azathioprine, 6-mercaptopurine) and methotrexate, which target specific components of the immune system to reduce the inflammatory response  
• Monoclonal antibody therapy, such as TNF inhibitors, targeting the sources of digestive inflammation

In addition, it is vital to quit smoking. All measures designed to better manage stress are encouraged.

Surgery can also be considered, depending on how the disease evolves.