Crohn’s disease is a chronic, inflammatory bowel disease that can affect any part of the digestive system, from the mouth right through to the anus. Patients often suffer from abdominal pain, diarrhoea, weight loss and constant fatigue, which significantly impairs their quality of life. Many people are apprehensive about the diagnosis and treatment, but it is important to know that modern medicine has increasingly effective tools for alleviating symptoms and keeping the disease under control. This article will help you understand the basics of Crohn’s disease, the diagnostic methods, and gain an insight into the latest treatment approaches on the horizon.
What exactly is Crohn’s disease?
Crohn’s disease is an autoimmune disease, which means that the body’s immune system mistakenly attacks the cells of its own digestive system, causing inflammation. This inflammation can affect the entire thickness of the intestinal wall, and a characteristic feature is that there may be healthy areas (known as „skip” lesions) between the affected sections of the intestine.
Typical symptoms and signs
Although symptoms may vary from person to person, the most common ones are as follows:
- Abdominal pain: It often occurs in the lower right-hand side of the abdomen.
- Diarrhoea: Recurrent, non-bloody diarrhoea.
- Weight loss and loss of appetite: Due to inflammation and malabsorption.
- Fatigue, fever: Signs of chronic inflammation in the body.
- Anaemia: As a result of iron and vitamin deficiency.
In some cases, patients may also notice a palpable abdominal mass, which results from the inflamed loops of the intestine sticking together.
How is Crohn’s disease diagnosed?
Diagnosing Crohn’s disease is a complex process that requires several tests to identify the exact cause of the symptoms. As the symptoms are non-specific, the doctor must rule out other conditions that cause similar symptoms. The Endomedix Gastroenterology Centre Its specialist doctors use state-of-the-art equipment to help establish an accurate diagnosis.
The steps in the diagnostic process
- Medical history and physical examination: The doctor will ask the patient in detail about their symptoms, lifestyle and any family history of illness. Palpation of the abdomen can help to identify tender areas and any abnormal masses.
- Laboratory tests: A blood test can detect markers of inflammation (such as CRP), anaemia, and vitamin and mineral deficiencies. A stool test (e.g. measuring calprotectin levels) also provides important information about the extent of intestinal inflammation.
- Endoscopic examinations:
- Colonoscopy (colonoscopy of the colon): This is the most important examination, during which the doctor inserts a thin, flexible tube through the rectum into the large bowel and the final section of the small bowel. The examination allows the doctor to view the intestinal lining, identify characteristic abnormalities (ulcers, strictures, a ‘cobblestone’ pattern) and take a tissue sample (biopsy).
- Gastroscopy (gastroscopy of the stomach): It is performed to examine the oesophagus, stomach and duodenum in cases of upper abdominal symptoms (nausea, vomiting).
- Capsule endoscopy: If conventional imaging techniques do not provide a clear result, the patient swallows a small capsule fitted with a camera, which travels through the small intestine and takes images. This is particularly useful for examining hidden sections of the small intestine. The Endomedix Gastroenterology Centre also uses this non-invasive diagnostic procedure.
- Imaging studies: MRI enterography, CT enterography or abdominal ultrasound help to assess the thickness of the intestinal wall, the extent of the disease in the small intestine, and any complications such as abscesses (collections of pus) or fistulas (abnormal connections between the intestines or other organs).
Complications of Crohn’s disease
Untreated or severe Crohn’s disease can lead to serious complications:
- Intestinal stricture (stenosis): Chronic inflammation causes scarring, which can narrow the intestinal lumen, hindering the passage of intestinal contents.
- Fistulas and abscesses: The inflammation may break through the intestinal wall, creating abnormal passages (fistulas) between the intestines, the skin, the bladder or the vagina. Inflammatory fluid may also accumulate in a localised cavity, forming an abscess.
- Perianal disease: Cracks (fissures), fistulas and abscesses may develop around the anus, which significantly impair patients’ quality of life.
- Malabsorption (absorption disorder): An inflamed small intestine is unable to absorb nutrients properly, which leads to vitamin and mineral deficiencies (e.g. iron, vitamin B12, vitamin D).
Treatment options: What might 2025 bring?
The aim of treating Crohn’s disease is to reduce inflammation, achieve and maintain a symptom-free period (remission), and prevent complications. Although there is currently no cure for the disease, modern treatments enable most patients to lead a full life.
The current range of treatments extends from anti-inflammatory drugs (5-ASA preparations, steroids) through to medicines that influence the functioning of the immune system (immunomodulators) and targeted biological therapies. Research is ongoing, and by 2025, new, even more effective and safer options may become available.
Expected new directions in therapy
- New-generation biological therapies: Alongside current anti-TNF therapies, an increasing number of drugs are becoming available that target other inflammatory pathways (e.g. blocking interleukins or integrins). These may offer an alternative for patients in whom previous treatments have not been effective.
- Small-molecule medicines (JAK inhibitors): These are oral tablets that inhibit inflammatory signalling within the cell. As they are more convenient to take, they may offer an attractive alternative to injection or infusion therapies.
- Personalised medicine: The future lies in personalised treatments. By analysing genetic data and biomarkers, doctors can predict which medicine will be most effective for a particular patient, thereby minimising unnecessary trials and side effects.
- Microbiome-based therapies: A growing body of research confirms the role of gut bacteria (the microbiome) in the development of Crohn’s disease. In future, faecal transplants or targeted probiotic treatments may also become part of the treatment, helping to restore a healthy balance to the gut flora.
The role of lifestyle in the management of Crohn’s disease
Although drug therapy is essential, lifestyle also plays a key role in keeping symptoms under control.
- Diet: There is no single „Crohn’s diet” that works for everyone. However, it is important for patients to monitor which foods make their symptoms worse. During an acute, inflammatory phase, a low-fibre diet is recommended, whilst during symptom-free periods, the aim is to follow a balanced and varied diet. In the event of a stricture, high-fibre, hard-to-digest foods (e.g. seeds, raw vegetables) should be avoided.
- Giving up smoking: Smoking has been shown to increase the risk of flare-ups and complications of Crohn’s disease. Giving up smoking is one of the most important steps a patient can take to improve their condition.
- Stress management: Stress does not in itself cause Crohn’s disease, but it can make the symptoms worse. Relaxation techniques, yoga or psychological support can be of great help.
Please feel free to consult an expert
If you or a relative are experiencing symptoms suggestive of Crohn’s disease, do not hesitate to consult a doctor. An early and accurate diagnosis, followed by the start of appropriate treatment, is essential for preventing serious complications and maintaining a good quality of life. The Endomedix Gastroenterology Centre Its highly qualified specialists and state-of-the-art diagnostic facilities ensure that you are in the best possible hands throughout your examination and treatment. As science advances, the outlook for people living with Crohn’s disease is constantly improving, and future treatments offer even greater hope for a full and fulfilling life.
