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ID: 133
Category: Inflammation
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createdon: 05 Feb 2023
updatedon: 05 Apr 2023

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Author: Khoa Tran
Published Feb 05, 2023
Updated Apr 05, 2023

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Crohn's Disease

History of Crohn's Disease

The disease was first described in 1932 by American gastroenterologist Burrill B. Crohn and his colleagues, Dr. Leon Ginzburg and Dr. Gordon Oppenheimer.

Prior to the discovery of Crohn's disease, it was believed that inflammatory bowel disease was a single condition. In the early 20th century, physicians recognized that some patients with bowel inflammation did not fit the typical profile of ulcerative colitis, which was the most commonly diagnosed form of inflammatory bowel disease at the time. These patients had a distinct set of symptoms, including inflammation that affected the entire thickness of the bowel wall, rather than just the surface, as seen in ulcerative colitis.

Using endoscopy, a technique that allows physicians to view the inside of the digestive tract, Crohn and his colleagues observed that the affected areas had a distinct appearance, including inflammation, scarring, and thickening of the bowel wall. They also noted the presence of areas of healthy tissue between the affected segments, which was different from ulcerative colitis, where inflammation is continuous.

Based on these observations, Crohn and his colleagues described the disease as a distinct entity and named it "regional enteritis" a term that has since been replaced with the current name, Crohn's disease.

Difference between Crohn's disease and inflammatory bowel disease

Crohn's disease is a type of inflammatory bowel disease (IBD), which also includes ulcerative colitis. While both Crohn's disease and ulcerative colitis share some similarities, there are several key differences that distinguish Crohn's disease from other forms of IBD. One of the main differences is the location and distribution of inflammation in the gastrointestinal tract. Crohn's disease can affect any part of the digestive tract, from the mouth to the anus, and can involve multiple segments of the bowel with areas of healthy tissue in between. In contrast, ulcerative colitis is limited to the colon and rectum, and the inflammation is continuous and does not involve healthy tissue. Another difference is the depth of inflammation in the bowel wall. In Crohn's disease, inflammation can involve the entire thickness of the bowel wall, whereas in ulcerative colitis, it is limited to the innermost layer. Symptoms of Crohn's disease can also be more severe and can include abdominal pain, diarrhea, weight loss, and malnutrition. In some cases, complications such as fistulas and abscesses can also develop.

Modern Understanding of Crohn's Disease

Crohn's disease is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the digestive tract. The exact cause of Crohn's disease is not known, but it is thought to be a combination of genetic, environmental, and lifestyle factors. The inflammation can occur anywhere in the digestive tract, from the mouth to the anus, but it most commonly affects the small intestine and colon.

Symptoms of Crohn's Disease

The symptoms of Crohn's disease can vary in severity, and may come and go over time. Some of the most common symptoms of Crohn's disease include:

1. Abdominal pain: This is one of the most common symptoms of Crohn's disease. The pain is often described as crampy and may be accompanied by bloating, gas, and diarrhea.
2. Diarrhea: People with Crohn's disease may experience frequent bouts of diarrhea, which may be bloody or contain mucus.
3. Weight loss: Chronic inflammation in the digestive tract can lead to poor nutrient absorption, which can result in unintended weight loss.
4. Fatigue: Chronic inflammation and frequent diarrhea can cause fatigue and a general feeling of weakness.
5. Fever: Some people with Crohn's disease may experience low-grade fevers, especially during periods of active inflammation.
6. Mouth sores: Sores or ulcers in the mouth may occur in some people with Crohn's disease.
7. Reduced appetite: Chronic inflammation in the digestive tract can cause a loss of appetite.
8. Anal fissures: Fissures or small tears in the lining of the anus may occur in people with Crohn's disease, causing pain and discomfort.
9. Joint pain: Some people with Crohn's disease may experience joint pain and stiffness, especially in the hands, feet, and knees.
10. Skin rashes: Skin rashes or lesions may occur in some people with Crohn's disease.

Diagnosis of Crohn's Disease

Diagnosing Crohn's disease can be challenging, as the symptoms can be similar to those of other digestive disorders. In order to make a diagnosis, a doctor will typically conduct a thorough physical examination, take a medical history, and order a variety of diagnostic tests. Some of the most common tests used to diagnose Crohn's disease include:

1. Blood tests: Blood tests can help to identify markers of inflammation in the body, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Blood tests can also be used to check for anemia or nutritional deficiencies.
2. Stool tests: Stool tests can help to identify the presence of blood, mucus, or bacteria in the stool. These tests can help to rule out other digestive disorders, such as infections or inflammatory bowel disease.
3. Colonoscopy: A colonoscopy is a procedure that allows a doctor to examine the lining of the colon and rectum using a flexible tube with a camera attached. During a colonoscopy, a doctor can take biopsies of the intestinal tissue, which can be examined for signs of inflammation.
4. Imaging tests: Imaging tests, such as CT scans or MRI scans, can help to identify inflammation in the digestive tract and rule out other conditions that may be causing symptoms.
5. Capsule endoscopy: Capsule endoscopy is a procedure in which a small, pill-sized camera is swallowed, allowing doctors to take pictures of the digestive tract.
6. Double-balloon endoscopy: Double-balloon endoscopy is a procedure in which a flexible tube is inserted through the mouth or rectum and slowly advanced through the digestive tract. This allows doctors to examine hard-to-reach areas of the small intestine.

It is important to note that not all of these tests may be necessary for every person suspected of having Crohn's disease, and the diagnostic process may vary depending on the individual's symptoms and medical history.

Causes of Crohn's Disease

The exact cause of Crohn's disease is unknown, but it is thought to be a combination of genetic and environmental factors. Here are some potential causes of Crohn's disease:

1. Genetics: Crohn's disease has a strong genetic component, with about 20-25% of people with the disease having a close relative who also has the condition. Researchers have identified several genes that may play a role in the development of Crohn's disease, including genes involved in the immune system and inflammation.
2. Abnormal immune response: Crohn's disease is thought to result from an abnormal immune response in which the body's immune system attacks the lining of the digestive tract. This can lead to chronic inflammation and damage to the intestinal walls.
3. Environmental factors: Environmental factors such as diet, smoking, and infections may also play a role in the development of Crohn's disease. For example, people who consume a diet high in refined sugars and saturated fats may be more likely to develop Crohn's disease, while those who consume a diet high in fruits, vegetables, and whole grains may be at lower risk. Smoking has also been linked to an increased risk of Crohn's disease, while infections with certain bacteria or viruses may trigger the development of the disease in susceptible individuals.
4. Gut microbiome: The gut microbiome, or the collection of bacteria and other microorganisms that live in the digestive tract, may also play a role in the development of Crohn's disease. Research has shown that people with Crohn's disease have an altered gut microbiome compared to healthy individuals, with a decrease in beneficial bacteria and an increase in harmful bacteria.
5. Stress: While stress does not cause Crohn's disease, it can exacerbate symptoms and may play a role in the development of the disease. Stress can disrupt the gut microbiome and trigger inflammation in the digestive tract, potentially leading to the development of Crohn's disease in susceptible individuals.

Treatments for Crohn's Disease

The treatment of Crohn's disease typically involves a combination of medication and lifestyle changes. Some of the most common treatment options for Crohn's disease include:

1. Medications: There are several types of medications that can be used to treat Crohn's disease. Anti-inflammatory drugs such as corticosteroids and aminosalicylates can help reduce inflammation in the intestines and relieve symptoms. Immunosuppressive drugs, such as azathioprine and methotrexate, can help suppress the immune system and prevent inflammation. Biologic drugs, such as infliximab and adalimumab, target specific proteins involved in the immune response and can help reduce inflammation.
2. Nutritional therapy: Nutritional therapy may be recommended as part of the treatment plan for Crohn's disease, especially during flare-ups. This can involve a special liquid diet or the use of nutritional supplements to help reduce inflammation and provide the body with necessary nutrients.
3. Surgery: In some cases, surgery may be necessary to manage Crohn's disease. This can involve removing damaged portions of the intestine or creating a temporary or permanent ostomy to divert waste away from the damaged area. Surgery is typically considered when other treatments have not been effective or if there are complications such as a blockage or fistula.
4. Lifestyle changes: Making certain lifestyle changes can also be helpful in managing Crohn's disease. This can include reducing stress, getting regular exercise, and avoiding foods that trigger symptoms. It is also important to quit smoking, as smoking can worsen symptoms and increase the risk of complications.
5. Complementary therapies: Some people with Crohn's disease may find complementary therapies such as acupuncture, massage, or hypnotherapy helpful in managing symptoms. It is important to discuss these options with your doctor before starting any complementary therapies.
6. Clinical trials: There are ongoing clinical trials investigating new treatments for Crohn's disease. Participating in a clinical trial may be an option for people who have not responded to other treatments.

Symptoms

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Anal fissures
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Skin rashes
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Abdominal pain
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Stomach cramps
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Joint pain and stiffness
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Diarrhea
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Loss of appetite
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714
Fatigue
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715
Fever
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Mouth sores
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717
Weight loss

Confirmation Tests

- Colonoscopy
- Enteroscopy
- Upper endoscopy

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