Mysterious Crohn’s disease

Proven content

The advancement of today’s medicine is enormous. Unfortunately, in many cases we cannot cure the disease, but only stop its expansion and eliminate the symptoms. This is the case with diabetes, AIDS, many cancers, neurodegenerative diseases, psoriasis and the title Crohn’s disease.

It cannot be denied that medical science is booming. If we compare the state of medical science at the beginning of the 100th century with what a doctor can do today, the leap that has taken place is truly impressive. Even the possibility of treating diseases of bacterial origin with antibiotics, transplantology, more and more perfect methods of cancer treatment, the possibility of saving the lives of prematurely born children, all modern and actually digital imaging diagnostics, etc. All this was completely unknown and inaccessible to the doctor and patient XNUMX years ago. We know more and more about our body and the diseases that torment it, we are able to heal, even effectively, most diseases. Actually, there is probably no situation in which a patient would not leave the doctor’s office with a prescription or prescribed therapy. So how to explain why so many people still get sick, why so many patients join hospital wards? The answer is simple and sad at the same time – yes, we can diagnose and treat the disease, but unfortunately, in many cases we are not able to cure it, but only sometimes we can stop its expansion and eliminate symptoms, such as in the case of diabetes, AIDS, many cancers , neurodegenerative diseases, psoriasis or the title Crohn’s disease.

Discovery of Crohn’s disease

Crohn’s Disease (CD) belongs to the group of diseases called chronic (inflammatory bowel disease) (IBD). The term IBD has been used in medical literature since 1932, when the New York physician Burrill B. Crohn and his colleagues: Leon Ginzburg and Gordon D. Oppenheimer were the first to describe a new disease entity called Crohn’s disease. A dozen or so years before Crohn published his work in Poland, the Warsaw doctor Antoni Leśniowski repeatedly describes cases of chronic inflammation of the intestines – for this reason, it is common in the Polish medical literature to refer to CD as Crohn’s disease.

Incidence of Crohn’s disease

The incidence of Crohn’s disease varies depending on the geographic location of a given human population and depends on the degree of socioeconomic development of the society. Generally, an increased incidence is observed in highly developed countries and lower in countries with a lower degree of socioeconomic development. For many years, there has been a worrying trend to lower the age at which CD or IBD is first diagnosed. The disease is most often diagnosed in children, but it is not uncommon for cases to be diagnosed in adults.

Symptoms of Crohn’s disease

Crohn’s disease is a chronic disease of unknown cause. Its course and symptoms indicate that it is an inflammatory ailment that can affect any part of the digestive tract, from the mouth to the anus, although it most often attacks the large intestine. Inflammatory changes in the digestive tract are discontinuous, which means that there is a normal mucosa next to the inflamed mucosa. The lesions cover the intestinal wall along its entire thickness. Symptoms depend on the location of the lesions, generally the following can be distinguished:

1. abdominal pain (usually on the right side, at hip level, which is often mistaken for appendicitis),
2. flatulence
3. weight loss
4. weakness and fever,
5. the formation of fistulas is also observed, i.e. pathological connections between the intestine and the skin or bladder, or sometimes with the vagina, in women,
6. perianal abscesses.

Additionally, parenteral symptoms of CD may also appear, e.g. skin complications (erythema nodosum), arthritis, iritis, pericarditis, myocarditis, vasculitis and thromboembolic changes, and others.

Causes of CD

Although the symptoms of CD are well known, the cause of the disease is still a matter of scientific inquiry. It is generally suspected that the development of the disease may be influenced by genetic factors, a malfunction of the immune system in response to microbes inhabiting the gastrointestinal tract, and external factors.

Genetic factors: the results of the research suggest an influence on the morbidity and the course of CD of genetic factors related to mutations of many genes. New mutations that are associated with chronic enteritis are constantly being described. The earliest discovered and best known mutation is the NOD2 / CARD15 gene located on the 16th chromosome of the human genome, others are e.g. mutations in the OCTN and MDR1 genes. Genetic mutations are not always detected in CD patients. Genetic changes are responsible, inter alia, for disturbances in the response to antigens present in the intestine.

Malfunction of the immune (immune) system: the gastrointestinal tract is inhabited by numerous bacteria, which are natural in every healthy person, the presence of which is necessary for the proper digestive process and the assimilation of ingredients, and has a protective effect against the invasion of pathogenic microorganisms. People with chronic enteritis, including Crohn’s disease, often have an abnormal reaction of the immune system to these bacteria. This is a pathological situation that can lead to the development of inflammation and the appearance of CD symptoms.

External factors: one of the most controversial is the so-called the hygienic hypothesis, according to which, due to the drastic increase in the hygienization of living conditions, the human immune system does not respond properly to pathogenic antigens. A high degree of hygiene (sterilized food, improved sanitary hygiene, reduced number of infections, fewer parasites, wide use of antibiotics) is observed in highly developed countries, which correlates with a higher incidence of CD and other autoimmune diseases such as allergies. The lack of an adequate number of microbial agents (“germs”) in early childhood, when the immune system matures, leads to a weaker immune response in the future or to hypersensitivity to antigens that are constantly present in the human environment. Another factor associated with the incidence of CD is smoking – this addiction increases the risk of developing the disease, and the course is more severe. It has been observed that women who used oral contraception had an increased risk of developing Crohn’s disease.

As you can see, the range of factors that are taken into account as a cause of developing CD is wide, and it is not really certain which of these factors can actually trigger the symptoms of the disease. It is possible that several factors must be present at once.

Treatment of Crohn’s disease

Diet is used to treat Crohn’s disease. In this disease, the absorption of nutrients from the gastrointestinal tract is very often impaired, so you should pay attention to following a properly balanced diet that allows you to meet the body’s energy needs and prevents weight loss. There are no specific dietary recommendations for patients. In general, you should avoid foods that are not well tolerated by the patient and supplement deficiencies of electrolytes and vitamins. In the case of a severe disease relapse, a non-residual (no fiber) diet or enteral or parenteral (intravenous) nutrition are used.

When it comes to pharmacotherapy, drugs with anti-inflammatory, antibacterial (antibiotic) and immunosuppressive (immune-lowering) properties are used to reduce the abnormal reaction of the immune system causing inflammation. Currently, biological treatment is introduced into therapy, most often in the form of anti-TNF antibodies. The preparation of these antibodies often improves the patient’s clinical condition when other pharmacological treatments fail, but the costs of such treatment are, unfortunately, very high.

There are interesting attempts to treat CD using probiotic bacteria, i.e. good bacteria, which can sometimes help soothe the inflammation in your gut. The research results, however, are not unequivocal here and need to be continued.

Surgical intervention is the last resort and consists in removing the diseased parts of the gastrointestinal tract.

Crohn’s disease is a chronic disease of unknown etiology (ie the cause). Fortunately, it is often possible to keep the disease in check and prevent its exacerbation, as long as the patient is under the supervision of an experienced gastroenterologist and has access to the latest therapies and diagnostic methods. Unfortunately, medicine does not yet allow for an effective cure, although scientific works are ongoing and their results give hope for a change in this state of affairs.

Text: Tomasz Gosiewski, MD, PhD