Crohn’s Disease Symptoms, Diagnosis, Complications and Treatment

Crohn’s Disease

Crohn’s disease, along with ulcerative colitis is an inflammatory bowel disease. In the past it was called terminally ileitis, but it has been shown that Crohn’s disease affects the terminally portion of the ileum in 30% of cases, in about 50% of cases the disease is located both in the ileum, and the colon, and sometimes Crohn’s disease can affected only the colon. In fact, the disease may affect any segment of the digestive tract, including the esophagus and stomach. The exact cause of the disease is not know, but there are several theories. A number of bacteria, viruses and dietary factors are considered to be involved. Genetic predisposition in developing Crohn’s disease has a very important role.

Crohn’s Disease

Crohn’s Disease Symptoms

Symptoms can sometimes be absent, and other times may be suggestive for Crohn’s disease. Usually, are divided into digestive symptoms and extradigestive symptoms.

Digestive symptoms:

• Diarrhea but without blood, which can differentiate this disease from ulcerative colitis;
• Diffuse abdominal pain;
• Malabsorption;
• Perianal lesions (perianal fistulas, characteristic for Crohn’s disease).

Extradigestive symptoms:

• Fever or low grade fever;
• Asthenia;
• Weight loss;
• Arthritis;
• Nodosum eritema;
• Uveitis.

The context that can lead to clinical diagnosis of Crohn’s disease is the chronic diarrhea with low grade fever, fatigue, and perianal lesions.

Clinical examination may reveal a painful abdomen to touch, sometimes can be  palpated a mass in right iliac fossa and  the presence of cutaneous fistulas.

Crohn’s Disease

Crohn’s Disease Diagnosis

Diagnosis is not always easy, often can be done intraoperatively or during the occurrence of complications, such as a digestive fistula.

Positive diagnosis is based on endoscopy with biopsy.

Endoscopy will reveal mucosal lesions with deep, liniar ulceration. Mucosa has a cobblestoning aspect.

Biopsy is mandatory, it shows that inflammation includes the entire thickness of the intestinal wall, and the presence of fibrosis and stenosis.

Ultrasound examination will show thickening of the intestinal wall in the area of inflammation and can thus evaluate extending the inflammation . It may reveal the presence of complications such as perforation or the presence of fistulas.

Computer tomography and MRI are methods that allow a good visualization of lesions.

Crohn’s disease stadialization:

Stadialization of Crohn’s disease is done after several parameters that form  CDAI (Crohn’s Disease Activity Index) indexes. These parameters are:

• Number of stools per day;
• Abdominal pain;
• General condition;
• Extradigestive symptoms (fever, arthritis);
• Use of antidiarrheal medication;
• Palpation of an abdominal mass;
• Presence of anemia;
• Weight loss.

Based on CDAI is estimated the severity of a flare.

Crohn’s Disease

Montreal classification of Crohn’s disease is based on the age at which the disease began, the location of lesions and lesion behavior (ABL):

A (Age):

• A1 <16 years;
• A2: 17-40 years;
• A3> 40 years.

L (Location):

• L1: the last part of the ileum;
• L2: colon;
• L3: contain both ileum and colon;
• L4: isolated disease only in upper digestive tract;

B (Behavior):

• B1: non-stenosing and non-penetrating form of Crohn’s disease;
• B2: stenosing form of Crohn’s disease;
• B3: penetrating form, fistulising of Chron’s disease;
• P: perianal manifestations.

Crohn’s Disease Complications

Complications of Crohn’s disease are:

• Stenosis;
• Internal or external fistulas;
• Perforation;
• Abscess;
• Sepsis.

Crohn’s Disease

Crohn’s Disease Treatment

In the acute phase of disease is recommended to use corticosteroids for a period of about six weeks. Corticosteroid therapy may be associated with the use of Mesalazine, Metronidazole and Imuran.

In severe forms of Crohn’s disease is generally recommended the administration of anti TNF (tumor necrosis factor) medications, because it has been observed that this type of medication cause remission of severe forms of the disease.

Surgical treatment is aimed primarily to the complications or to the unresponsive to drug therapy forms of disease . Sometimes is attempted the recalibration of stenosis by endoscopic procedures.