Crohn’s disease: symptoms and treatment

With a cycle of abdominal cramps, bloody diarrhoea, weakness and fever, Crohn’s disease is on the increase worldwide, and for many people it’s an unwanted companion for life.

This is because chronic bowel disease is incurable. The causes are unknown. With a healthy lifestyle and medical support, most sufferers can still lead a fulfilling life.

Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the digestive tract – from the mouth to the anus. However, the inflammation most frequently occurs in the area where the small intestine joins the large intestine. Recurrent episodes of abdominal pain, diarrhoea, fatigue and fever are typical, but there are also periods without symptoms, known as remission. The centres of inflammation usually develop in several places in the intestine and may not be continuous, with healthy areas alternating with inflamed areas.

Crohn’s disease and ulcerative colitis are the most common types of chronic inflammatory bowel disease. They cause similar symptoms such as diarrhoea or abdominal pain, but differ in some respects. While Crohn’s disease can affect the entire digestive tract, ulcerative colitis is limited to the large intestine. In Crohn’s disease, the inflammation can also affect all layers of the intestinal wall. Ulcerative colitis, on the other hand, only inflames the uppermost layer of the mucous membrane, which often causes ulcers and bloody, slimy diarrhoea. In addition, ulcerative colitis often progresses more evenly and the bowel is not affected by scattered centres of inflammation.

If only the large intestine is inflamed, even experienced doctors cannot always easily distinguish between Crohn’s disease and ulcerative colitis, according to Cantonal Hospital Zurich. Sometimes it is necessary to wait for the disease to progress before making a diagnosis, and sometimes even this doesn’t help.

Chronic inflammatory bowel diseases are relatively common in this country. According to Zurich University Hospital, one in 350 people suffer from it. This means that more than 25,000 people are affected. Gender doesn’t seem to play a role. And age? Chronic inflammatory bowel disease can occur at any time of life. However, it usually strikes for the first time between the ages of 15 and 34.

Crohn’s disease is a mystery to doctors: the cause of the disease is unknown. However, it is certain that Crohn’s disease is not contagious. A combination of different factors is suspected, including genes and various environmental factors.

Some risk factors could increase the likelihood of developing Crohn’s disease or worsen an existing condition. 

• Genetic predisposition probably plays a role: the disease occurs more frequently in some families. 
• Environmental factors that occur in our western lifestyle are also thought to increase the risk. This is suggested by the accumulation of the disease in the western world over the last 50 years and increasingly in China and Indonesia. 
• According to University Hospital Zurich, the latest research also suggests that a disturbed intestinal flora could be linked to Crohn’s disease. 
• In Crohn’s disease, the barrier of the intestinal mucosa which ensures that bacteria from the intestine cannot penetrate the intestinal wall, probably also does not function properly. If they do manage to do so, this is followed by violent immune reactions in the intestinal wall. According to Cantonal Hospital Zurich, the organism categorises the bacteria as dangerous, even if they aren’t. Because the body activates various inflammatory cells as a defence against danger, intestinal inflammation develops. 
• Treatment with antibiotics during adolescence could also be linked to the bowel disease.
• Smoking is also considered a risk factor and can worsen the course of the disease. 
• Mental stress such as chronic stress or conflicts are also said to have a negative influence on the course of the disease (once it has broken out).  

The symptoms of Crohn’s disease vary and depend on which parts of the digestive tract are affected. Common symptoms include:

• Abdominal pain: Often occurs in the right lower abdomen and can feel like cramps.
• Chronic diarrhoea: Sometimes it contains blood or mucus. 
• Loss of appetite
• Weight loss and deficiency symptoms: Diarrhoea causes the body to lose weight, even with adequate nutrition. Anaemia also occurs due to a lack of iron and vitamin B12. 
• Tiredness and exhaustion: Inflammation puts a strain on the entire body.
• Feeling ill
• Fever

In severe cases, complications can occur, such as fistulas, abscesses or intestinal constrictions, which can lead to intestinal obstruction. In addition, symptoms outside the intestine are possible, such as joint pain, skin changes, eye inflammation, kidney stones or liver inflammation.

As the causes of Crohn’s disease are not known, there is no direct way to prevent it. A healthy lifestyle – with a balanced diet, avoiding smoking and reducing stress – can help to reduce the risk of flare-ups and improve quality of life. Anyone who notices symptoms such as persistent diarrhoea, abdominal pain or weight loss should seek medical advice quickly. If Crohn’s disease is detected early, it can be treated more effectively and the risk of health consequences and complications is reduced.

Early detection and regular check-ups play an important role in Crohn’s disease because sufferers have an increased risk of developing bowel cancer.

The disease is diagnosed on the basis of the symptoms and through various examinations, such as a colonoscopy, capsule endoscopy, intestinal X-ray, stool samples to detect bacteria and exclude other diseases, and blood tests to detect inflammatory processes and blood loss (anaemia).

Crohn’s disease is treated with medication using preparations that slow down inflammation and inhibit the immune system. Surgical interventions are also necessary in the event of intestinal perforations, intestinal obstruction, abscesses or fistula formation. As the disease puts a strain on the psyche and sufferers have to learn to live with Crohn’s disease, psychotherapy and discussion groups can help to improve quality of life.

If there is an acute attack with fever, bed rest and plenty of fluids are important. Iron supplements and vitamins can be taken to prevent nutrient deficiencies.

An adapted diet always plays an important role in treatment in order to relieve the digestive system and prevent nutrient deficiencies.

Diet plays an important role in Crohn’s disease and must be adapted to the respective phases of the disease. 

• In the acute phase, when the inflammation is particularly severe, the food should be easy to digest. A light diet or puréed food is often recommended. Foods that could irritate the intestines – strongly spiced, processed, sugary, fatty or high-fibre foods – are off the menu. Artificial feeding via a tube may be necessary on occasion. Once the flare-up has subsided, a gradual transition to a normal diet should be made. 
• After the flare-up, a balanced diet is important to provide the body with nutrients: initially with carbohydrates, later with protein and healthy fats. Low-fat dairy products and lean meat, wholemeal bread, potatoes, pasta and well-tolerated vegetables such as carrots, tomatoes or fennel are recommended. Fruit and salads can also be slowly integrated into the diet.

The foods that are well tolerated vary from person to person. Tip: Work out your personal diet plan with a professional nutritionist. 

The course of Crohn’s disease varies greatly from person to person, but it cannot be cured; the aim of treatment is to reduce flare-ups and control inflammation. Despite the disease, life expectancy is generally normal if the disease is treated well and complications are recognised and treated in good time. The use of medication in combination with lifestyle changes, including a healthy diet and less stress, enable most sufferers to lead a fulfilling life despite their unpleasant companion.