What are the first symptoms of Crohn’s disease?

Crohn’s disease is a chronic inflammatory disease that can affect all segments of the digestive tract “most of the time terminal ileum, anus, colon” explains Dr. Axel Balian, gastroenterologist and hepatologist. It was first described in 1932 by an American doctor, Burril B Crohn. In France, 150,000 people have Crohn’s disease. Its incidence continues to increase. THE Nord Pas de Calais is one of the most affected regions.

What are the digestive symptoms of Crohn’s disease?

Crohn’s disease mainly causes digestive symptoms:

• Abdominal pain.
• Chronic diarrhea accompanied by mucus and sometimes blood.
• damage to the anal region (fissure, fistula, abscess).

It progresses in outbreaks interspersed with periods of remission and calm. during which the patient shows no symptoms. A deterioration of general condition often accompanies flare-ups: fatigue (asthenia), lack of appetite (anorexia), weight loss, fever. He is impossible to predict their frequency.

• Extra digestive symptoms (articular, cutaneous, ocular) can also be observed.
• Hepatobiliary manifestations may also occur such as steatosis, cholelithiasis, primary sclerosing cholangitis.
• Other more exceptional violations: pancreatitis, renal, urological, pulmonary pathology or a thromboembolic disease (arterial thrombosis or deep vein thrombosis, etc.)

Symptoms on the skin?

“5% of patients are bothered by rheumatism”

Skin lesions are not always specific and may resemble other skin pathologies. It’s about :

• ofmouth ulcers,
• erythema nodosum (nodules, sort of bluish, painful lumps under the skin located on the front of the legs, which disappear when the flare-ups are treated).
• or pyoderma gangrenosum (ulcerations localized in the lower limbs, buttocks and face).

Rheumatism?

Two forms of rheumatism can be associated with Crohn’s disease:

• peripheral joint rheumatism (such as the knees or wrists), whether or not the progression is correlated with the flare-up
• or axial rheumatism of the sacroiliitis type or ankylosing spondylitis, of chronic evolution

“Rheumatism can occur at the cervical, dorsal, lumbar, sacroiliac joints, elbows, wrists, heels, knees, or ankles.. 5% of people with Crohn’s disease are bothered by this rheumatism.specifies the specialist. The pain has an inflammatory rhythm (different from that of osteoarthritis) with onset at the end of the night and morning pain. which are accompanied by a stiffness of affected joints. They then disappear during morning rust removal. Pain can occur during progressive digestive flare-ups and sometimes even precede the digestive flare-up by a few days and then disappear with treatment of the digestive disease. It sometimes happens that the pain continues after digestive flare-ups.

Ophthalmological symptoms?

The ophthalmological symptoms are often not specific to this pathology: pain, tearing, blurred vision, photophobia, redness, etc. In the event of loss of vision, treatment must be considered in order to avoid the onset of blindness. It is strongly recommended to consult an ophthalmologist when the diagnosis of Crohn’s disease is made.
The majority of ocular manifestations occur during digestive flare-ups. Uveitis, Scleritis and episcleritis may appear.

Anemia and iron deficiency due to Crohn’s disease

Among the hematological symptoms: anemia, most often due to deficiencies (sometimes associated, iron, folate, vitamin B12), or inflammatory, accompanied by thrombocytosis.

“Confirmation of the diagnosis of Crohn’s disease is carried out with biopsies”

What causes Crohn’s disease?

THE Causes of the disease are not clearly defined. We do not yet know what factor(s) trigger this abnormal immune reaction at the intestinal level and what modifies its evolution over time. A genetic predispositionfactors linked to the environment as well as an abnormality of the immune system could constitute contributing factors. Crohn’s disease is not a “hereditary” disease in the true sense of the term, explains the association AFAbut there is a genetic factor of predisposition to the disease, the NOD2 or CARD16 gene on chromosome 16 of the human genome. There would also be a link with abnormalities of the intestinal immune system linked to an imbalance in the intestinal flora (dysbiosis). This microbial flora (microbiota) is less diverse and thedepletion of certain bacterial strains is one of the characteristics of Crohn’s disease. “We know, however, that it is not a contagious disease” adds the AFA and “It’s not about not a “psychosomatic” illness either even if psychological factors can modulate its evolution. Finally, “THE smoking is a major risk factor to develop the diseasewarns the gastroenterologist.

What are the tests to diagnose Crohn’s disease?

The diagnosis of Crohn’s Disease is made on the accumulation of several elements “but it is mainly endoscopy with biopsies and the anatomopathological analysis which confirm the diagnosis”. What can guide the diagnosis:

• the questioning and history of the illness,
• clinical examination,
• blood tests (search for signs of inflammation, vitamin deficiency indicating malabsorption, anemia, antibodies specifically increased in Crohn’s Disease).
• radiological examinations.
• THE morphological examinations (highlighting the specific lesions of Crohn’s Disease)
• MRI to identify fistulas, possible complications of Crohn’s disease.
• A proctological examination to identify lesions characteristic of Crohn’s disease such as fissures, simple or complex fistulas, or ulcerations.
• A video capsule examination allows, when other tests are not positive, to confirm the diagnosis of Crohn’s disease whose site is located in the small intestine. “It is necessary to be sure beforehand that there is no stenosis of the small intestineotherwise the capsule could become blocked and cause occlusion of the small intestine.notes the specialist.

Colonoscopy and fibroscopy to analyze the gastric sphere

Colonoscopy allowsexamination of the mucosa of the colon and the terminal part of the small intestine. “Confirmation of the diagnosis of Crohn’s disease is carried out by performing biopsies on lesions visible macroscopically, at the ileal, colonic and rectal level”, specifies the specialist. There esogastroduodenal fibroscopy allows visualization of the esophagus, stomach and duodenum, first part of the small intestine. This examination is carried out using a flexible tube fitted with a light and a camera which is inserted into the mouth.

What are the treatments for Crohn’s disease? During push-ups?

Treatment of Crohn’s disease allows treat disease flare-ups and prevent relapses and complications. “In all patients, it is absolutely necessary obtain a complete and definitive cessation of tobacco consumption (which aggravates the progression of Crohn’s disease)”, insists Dr. Balian. A nutritional treatment may be recommended in order to overcome malnutrition. Feeding can thus be enteral, by nasogastric tube or parenteral by venous route. For pain, analgesics can be prescribed. THE Antidiarrheal medications may be advised. Finally, the antispasmodic drugs helps relieve abdominal pain. Permanently stopping smoking, an aggravating factor in the disease, remains one of the most important measures. During flare-ups, drug treatments following are recommended:

• 5-ASA orally and/or rectally.
• mesalazine, 1 to 4 g/day.
• corticosteroids : Corticosteroids used for short periods are prescribed during outbreaks of the disease. They absolutely do not constitute a preventive treatment.
• antibiotics : Antibiotics are prescribed in several situations, notably in cases of sudden worsening or suspicion of intestinal infection, also in cases of abscess, in the form of quinolone and/or metronidazole.

What is surgical treatment for Crohn’s patients?

Surgical treatment is considered if the disease progresses, when complications appear and when drug treatments prove ineffective. The surgical procedure involves removing the affected area(s) of the intestine. “Surgery must be as economical as possible, recurrences that may occur in the anastomotic areas“, explains the gastroenterologist. Surgery consists of excision of inflammatory lesions, drainage of abscesses and treatment of occlusions or peritonitis. When removing part of the intestine, it is sometimes considered a surgical procedure to create an artificial anus by connecting the colon to the wall of the abdomen in order to divert the stools outwards into a bag that is regularly changed. This stoma is often temporary.

What diet should you choose in case of Crohn’s disease?

Unlike other diseases like diabetes, there is no real nutritional strategy for Crohn’s disease because recommendations vary depending on each patient’s tolerance. You should know that no food can trigger or prevent a flare-up, but certain dietary measures can make digestion more pleasant.

► During a flare-up: raw fruits and vegetables, dairy products and alcohol are strongly discouraged.

► Outside these periodswe can consume white starchy foods, easier to digest than whole foods, as well as fish, eggs and meat for protein intake. It is also important to drink water throughout the day because Crohn’s disease can cause water malabsorption and dehydration must absolutely be avoided. Finally, it is best to eat in peace to promote digestion.

Thanks to Dr. Axel Balian, gastroenterologist and hepatologist. Source: Crohn’s disease, Afa Association, 2020.