Crohn's Disease Causes: Complication, Investigation And Management

Crohn’s disease is defined as a non-specific granulomatous inflammation involving single or multiple areas of intestine.

Usually it is seen in age group of 20-60yrs and may occur in children. It is seen more in females and cause of the disease is unknown.

Involvement of both genetic and environmental factors is guessed.

Smokers are more prone to Crohn’s disease.
Infective agents- mycobacterium para-tuberculosis is isolated from some patients with Crohn’s disease.
High intake of sugar and low intake of fiber is possibly associated with Crohn’s disease.

Causes of Crohn’s Disease

Many theories exist about causes of Crohn’s disease, yet none of these had been scientifically proven.

The following are suspected to be some of the causes of the disorder:

Genes: Cases of Crohn’s disease seem to run in some families. Studies revealed that about 20 percent of people having the disease have a blood relative with other forms of inflammatory bowel disease. People of Jewish heritage are said to have greater risks of developing Crohn’s disease, while African-Americans are at decreased risks for developing the disease.
Immune System: The immune system’s abnormal response to bacteria, foods, and other substances, mistaking them to be ‘œforeign invaders’ and attacking them causes white blood cells to accumulate in the linings of the intestine, and eventually producing inflammation.
Antigens: Some scientists think that another possible cause of inflammation is the body’s reaction to foreign substances or antigens present in the environment.

Signs and symptoms depend on the site of disease.

Ileum

Colon

Symptoms resembling ulcerative colitis but rectal bleeding are less marked.

Oxalate stones may develop and inflammatory process may involve ureters leading to recurrent pyelo-nephritis, ureteric stenosis and hydronephrosis.

The common complications brought by Crohn’s disease include the following:

Thickening of the intestinal walls, swelling and growth of scar tissues, and narrowing of the passage resulting to intestine blockage.
Rectal bleeding.
Severe mouth sores.
Nutritional complications such as inadequate absorption of essential nutrients resulting to weight loss.

Other complications include:

Investigations

Barium meal shows ‘string sign’- a thin irregular shadow extending from last filled loop of ileum through area of filling defect to ileocaecal valve.
USG- may be helpful in patients with a palpable abdominal mass in order to differentiate an inflammatory mass from abscess.
CT-scan and MRI are often more useful- may show thickened loops of affected intestine and also investigating complex perianal disease.
Sigmoidoscopy and rectal biopsy-

Sigmoidoscopy may reveal patchy mucosal inflammatory change in rectum and sigmoid colon.

Rectal biopsy may show non-specific chronic inflammatory change.

Colonoscopy- with multiple biopsies helps differentiate ulcerative colitis and Crohn’s disease.

General measures

Medical Treatment

Sulphasalazine is useful in active Crohn’s disease.
Corticosteroids can be used in intravenous form in severely ill patients with Crohn’s disease.
Immuno-suppressive agents like azathioprine may be used if other therapy has failed.
Metronidazole is useful if there is associated sepsis.

Surgical Treatment

Indications:

Surgery involves limited resections, stricturoplasty or end to end anastomosis as necessary.

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