Crohn’s disease – symptoms, treatment, duration of therapy

Proven content

Crohn’s disease is a dysfunction of the intestines, consisting in the persistence of inflammation in the digestive tract. The causes of the disease are not fully defined, however, the influence of geographical conditions on its development was found.

Crohn’s disease is a disease that is difficult to diagnose because its clinical picture is very diverse. Symptoms of the disease may include:

1. abdominal pain and diarrhea,
2. sometimes a fever,
3. the disease can also manifest itself as skin lesions,
4. arthritis or eye inflammation.

The child is most often treated by an ophthalmologist, rheumatologist, dermatologist, and when unpleasant digestive system ailments appear, he or she goes to a gastroenterologist.

Symptoms of Crohn’s disease

In children, Crohn’s disease inhibits growth and causes weight deficiencies, although in the current obesity epidemic, a sick child does not have to be thin. The disease interferes with sexual development – in girls it delays or inhibits the onset of menstruation. It also causes anemia. Sometimes it is mild, sometimes violent. Sometimes it also happens that a child goes to the hospital with suspicion of appendicitis, and only during the operation it turns out that it is Crohn’s disease. – It sometimes takes several or even several years from the onset of symptoms to the moment of diagnosis. Although on average it is about a year – says Dr. Małgorzata Sładek from the Department of Paediatrics, Gastroenterology and Nutrition of the Jagiellonian University Medical College. Today it is known that around 450 children suffer from it in Poland. – These data are underestimated, because until recently there was no patient registry, so no one counted them. In addition, in some young patients the disease may not be diagnosed – believes Dr. Sładek.

Diagnostics of the small intestine

There is no single test that can confirm or rule out the presence of Crohn’s disease.

1. Family history is important as Crohn’s disease may be genetically determined. To determine the likelihood of developing the disease for genetic reasons, purchase Inflammation of the intestine – a genetic test of the NOD2 gene, which can be carried out by mail order.

2. It is also necessary to examine the patient’s intestine. They are made with endoscope, i.e. a special flexible tube ended with a camera, which is inserted into the intestine through the anus. In young children, this test is performed under general anesthesia. During endoscopy, a piece of mucosa is collected for examination. This method allows you to view the large intestine and a fragment of the small intestine.

3. To examine the small intestine, you need to perform an MRI or other radiographs.

4. Examination of the small intestine can also be performed using a special capsule with a wireless camera, which the child must swallow. Unfortunately, the National Health Fund does not refund this study.

All the elements of diagnostics put together can give an answer whether we are dealing with Crohn’s disease.

Immunity disorder

Crohn’s disease apparently affects only the intestines. – It is a dysfunction of the immune system, the cause of which we do not know – explains Dr. Małgorzata Sładek. However, it must be remembered that the intestine is not just a tube several meters long through which the stool is excreted. There are more nerve cells in the intestine than in the brain, the cells of the immune system are present, and the flora of the intestine is about 2 kg of bacteria in an adult. In the course of Crohn’s disease, inflammation is formed in the intestine as a result of impaired immunity. It often causes a thickening of the intestinal wall, making it difficult for the digested food to pass through. Inflammation can also result in the formation of fistulas, i.e. tunnels that cut into the surrounding tissues and organs, and towards the skin. It often affects the anus area as well.

Treatment of Crohn’s disease

Crohn’s disease is incurable for now. The goal of treatment is to control inflammation and relieve symptoms, including abdominal pain and diarrhea, and keep your children at an appropriate pace. The therapy makes it possible to achieve a symptom-free state, i.e. remission of the disease, which may last for many years. However, the disease usually progresses and recurs, and the entire procedure should be started from the beginning, which is associated with long-term specialist care and periodic check-ups. Patients are most often treated:

1. steroids,
2. anti-inflammatory drugs and drugs that modulate the immune system.

Surgery is sometimes necessary. However, there is a group of patients for whom this type of treatment is ineffective. The so-called biological medicines.

Biological drugs

In the production of biological drugs, scientists used the natural mechanism of the human body – the ability to create antibodies against viruses, bacteria or other factors that cause disease. They have such an ability lymphocytes, or white blood cells. Were it not for them, the most ordinary infection could turn out to be fatal for humans. Lymphocytes produce a protein that kills an intruder attacking the body. So they created transgenic mice that were implanted with human genes, thanks to which their lymphocytes were “humanized”. Human lymphocytes created in the body of mice were introduced to various pathogens. A trained lymphocyte produces antibodies that block the factors responsible for inflammation when given to patients. Unfortunately, these drugs are not perfect and have side effects as well. They can, first of all, cause allergic reactions, even anaphylactic shock, as well as infections, sometimes with a very severe course. Therefore, when deciding to use these drugs, the risk-benefit ratio must be considered. In patients who are not helped by standard therapy, they are drugs of last resort.

Crohn’s disease and biological drugs

Currently, the National Health Fund (NFZ) finances individual biological treatment programs, and the patients in charge of such programs are directed to them.

Duration of biological therapy

Another problem is that the program can only treat biological drugs for a year and under a very rigid regimen. – This is a decision based on the state of science 10 years ago, when short-term therapy was considered sufficient. Today it is known that Crohn’s disease is chronic and long-term treatment with doses adjusted to the patient’s needs is necessary, and only the doctor knows when to stop the therapy – explains Dr. Sładek. In addition, relapse means the loss of the condition that has been obtained with biological therapy, which is often associated with further, malignant progression of the disease.

Few parents can afford to buy a drug for their child by themselves, because the cost of one dose is several or even several thousand zlotys, and the drug is administered every 8 weeks.

Meanwhile, a child who takes biological drugs does not have to stay in hospital for a long time, can go to kindergarten or school, participate actively in life with peers and be free from the symptoms of the disease.

Poorly treated Crohn’s disease inhibits the child’s development, prevents social functioning and increases the risk of operations, which are also expensive and, above all, may lead to disability, such as the emergence of a stoma or short bowel syndrome. In addition, such a patient may require parenteral nutrition in the future, which also comes at a cost. It often happens that he gets a disability pension.