Many people are alarmed when they hear they have been diagnosed with Crohn’s disease. After experiencing prolonged abdominal pain, diarrhoea and weight loss, one may feel both a sense of relief that the problem finally has a name, and fear for the future. What does this diagnosis mean? What tests can you expect? How can you live a full life with this condition? This article has been written to provide clear, understandable answers to these questions and to offer practical advice to help you take the first steps in living with Crohn’s disease.
Our aim is to dispel the uncertainty surrounding the diagnosis and to show that, with the help of modern medicine and a suitable lifestyle, the symptoms of Crohn’s disease can be effectively managed. Find out about the diagnostic process, treatment options and practical tips that can make your day-to-day life easier.
What exactly is Crohn’s disease?
Crohn’s disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, from the mouth right down to the anus. The inflammation most commonly affects the final section of the small intestine (the ileum) and the initial section of the large intestine. A characteristic feature of the disease is that the inflammation is not continuous; healthy sections of the bowel may alternate with affected areas (these are known as „skip” lesions). The inflammation can affect all layers of the intestinal wall, which over time can lead to complications such as intestinal strictures or the formation of fistulas.
The condition usually first appears in young adulthood, but can be diagnosed at any age. The course of Crohn’s disease is characterised by fluctuations: symptom-free, quiet (remission) periods may be followed by active, inflammatory flare-ups (relapses).
The most common symptoms are:
- Abdominal pain (often in the lower right-hand side of the abdomen)
- Persistent, non-bloody diarrhoea
- Unintentional weight loss, loss of appetite
- Elevated temperature, fever
- Fatigue, general malaise
- Problems around the anus (abscess, fistula, fissure)
The steps involved in making a diagnosis
Diagnosing Crohn’s disease is a complex process, as its symptoms can resemble those of other digestive disorders. The doctor must rule out infections, irritable bowel syndrome (IBS) and ulcerative colitis, another common inflammatory bowel disease. The diagnosis is based on a combined assessment of the results of several tests.
Medical history and physical examination
The first step is always a detailed discussion. Your doctor will ask you about your symptoms, when they started, how often they occur, your eating habits, any family history of illness and any harmful habits (e.g. smoking, which has been shown to worsen the course of Crohn’s disease). This is followed by a thorough physical examination, during which the doctor will palpate your abdomen to check for tender or painful areas or any palpable abnormalities.
Laboratory tests
Laboratory tests alone are not sufficient for a diagnosis, but they do provide important information.
- Blood test: A blood count may reveal anaemia, which can be a sign of chronic inflammation or a malabsorption disorder. Inflammatory markers, such as C-reactive protein (CRP) or an elevated erythrocyte sedimentation rate, indicate an inflammatory process taking place in the body.
- Stool analysis: This test can rule out bacterial or parasitic infections, which can cause similar symptoms. Measuring the level of a protein called calprotectin in the stool is crucial. High calprotectin levels are a sensitive indicator of inflammation in the gut and help to distinguish inflammatory bowel diseases from IBS.
Endoscopic examinations
Endoscopic (mirror-based) examinations are essential for the diagnosis of Crohn’s disease. During these examinations, a thin, flexible instrument fitted with a camera (an endoscope) is used to directly examine the inner surface of the digestive tract, and a tissue sample (biopsy) is taken if necessary.
- Ileocolonoscopy (colonoscopy): This is the most important diagnostic procedure. During the examination, an endoscope is inserted via the rectum and advanced along the entire length of the large bowel, right up to the final section of the small bowel (terminal ileum), which is one of the most common sites of Crohn’s disease. The examining doctor looks for characteristic lesions, such as aphthous ulcers, deeper, linear ulcers, swelling of the bowel wall giving a cobblestone appearance, as well as strictures or fistula openings. Histological analysis of tissue samples taken from several sites during the examination can confirm the diagnosis.
- Gastroscopy (gastroscopy of the stomach): If the symptoms (e.g. nausea, vomiting, upper abdominal pain) suggest involvement of the upper gastrointestinal tract, a gastroscopy may also be carried out to examine the oesophagus, the stomach and the initial section of the small intestine (duodenum).
- Capsule endoscopy: This is a modern, non-invasive procedure for examining the small intestine. The patient swallows a small capsule containing a camera, which travels through the digestive tract and takes several thousand images. It is recommended when conventional endoscopic examinations are negative, but there is a strong suspicion of small bowel involvement based on symptoms and other findings. As the capsule may become lodged in a potential stricture, a preliminary test (a so-called patency capsule) or an imaging examination is required beforehand to rule out intestinal stricture. The Endomedix Gastroenterology Centre Its specialists have extensive experience in performing and interpreting capsule endoscopy.
- Enteroscopy (small bowel endoscopy): A specialised examination carried out using a longer endoscope, which allows access to deeper sections of the small intestine and enables tissue sampling. It is usually carried out when capsule endoscopy or another imaging technique reveals an abnormal lesion and histological confirmation is required.
Imaging studies
Imaging techniques help to assess the extent of inflammation within the intestinal wall and outside the intestinal tract, and can also detect any complications (strictures, abscesses, fistulas).
- Ultrasound: An abdominal ultrasound is a standard examination used to detect thickening of the bowel wall. A specialised ultrasound using contrast medium (CEUS) provides an even more accurate picture of the activity of inflammation in the bowel wall.
- CT- and MR-enterography: These modern imaging techniques provide detailed cross-sectional images of the small intestine. The patient is asked to drink a special contrast agent, which fills the small intestine, enabling the examination to clearly reveal any thickening of the intestinal wall, narrowings and areas of inflammation. The advantage of an MRI scan is that it does not involve X-rays, making it particularly suitable for long-term monitoring of the condition. A pelvic MRI scan is the primary method for diagnosing fistulas and abscesses around the rectum.
After the diagnosis: Practical advice for getting started
Once a diagnosis has been made, the doctor draws up a personalised treatment plan based on the activity, location and severity of the disease. The aim is to reduce inflammation, achieve and maintain remission, and prevent complications. The following advice may help you navigate the initial stages.
1. Build a relationship of trust with your GP!
Crohn’s disease is a chronic condition that requires long-term care. It is important to choose a gastroenterologist whom you trust and with whom you can communicate openly about your symptoms, fears and any questions you may have regarding your treatment. The Endomedix Gastroenterology Centre Its highly qualified specialists are committed to providing patients with comprehensive information and care based on a partnership.
2. Get your information from reliable sources!
The internet is full of information, but unfortunately also full of misconceptions. It is important to get your information from reliable sources. Ask your doctor and visit the websites of official patient organisations (e.g. the Hungarian Crohn’s and Colitis Patients’ Association – MCCBE), where you will find reliable information and a supportive community.
3. Pay attention to what you eat!
Although there is no specific „Crohn’s diet” that suits everyone, diet plays an important role in alleviating symptoms.
- During a flare-up: In such cases, easily digestible, low-fibre foods are recommended (e.g. boiled potatoes, rice, steamed vegetables, lean meats). Avoid fatty, spicy foods, raw vegetables, fruit and dairy products if you are lactose intolerant.
- During the off-season: Gradually return to a balanced, varied diet. Keep a food diary to find out which foods cause you symptoms.
- In the event of a bottleneck: Foods that are high in fibre and contain large pieces (e.g. seeds, sweetcorn, fruits with their skins on) must be strictly avoided, as they can cause blockages.
4. Give up smoking!
Smoking has been shown to increase the frequency of flare-ups, worsen the course of the disease, reduce the effectiveness of medication, and increase the need for surgery. Giving up smoking is one of the most important steps you can take for your health.
5. Exercise regularly, but in moderation!
Regular, moderate-intensity exercise (e.g. walking, yoga, swimming) improves your well-being, reduces stress and helps maintain your general health. Avoid excessively strenuous exercise, particularly during the active phase of the illness.
6. Take care of your mental health!
Dealing with a chronic illness can take a toll on your mental wellbeing. Stress does not in itself cause Crohn’s disease, but it can make the symptoms worse. Learn some stress-management techniques (e.g. relaxation, meditation), and do not hesitate to seek help from a psychologist or a support group if you feel you need it.
Summary: You are at the centre of it all
A diagnosis of Crohn’s disease brings about a new situation in life to which you will need to adapt, but it is important to know that you are not alone. Thanks to modern diagnostic procedures, effective drug therapies and a suitable lifestyle, most patients can lead full and active lives. The aim of treatment today is no longer merely to relieve symptoms, but to achieve complete healing of the intestinal mucosa and ensure long-term remission.
The most important thing is to play an active part in your own recovery process. Work in partnership with your doctor, keep yourself informed, and do everything you can to maintain your physical and mental balance. The Endomedix Gastroenterology Centre Our team is by your side every step of the way, from establishing an accurate diagnosis, through a personalised treatment plan, right through to long-term care, so that you can enjoy the best possible quality of life.
