Crohn's Disease: Everything You Need to Know About the Growingly Common Illness

What is Crohn's Disease?

Crohn's disease is a chronic illness characterized by episodes of diarrhea and abdominal pain and sometimes also symptoms outside the intestine, such as weakness, joint pains, mouth sores (aphthous ulcers), and skin rashes.

When Does Crohn's Disease First Appear?

Crohn's disease usually appears at a relatively young age (ages 15-30), during a critical period for personal, relational, familial, and occupational development, but it can appear at any age, from childhood to old age.

What Causes It?

No single cause of the disease has been identified. The current hypothesis is that the disease is caused by a combination of genetic and environmental factors. Firstly, Crohn's disease has a significant genetic basis: 20% of patients have a relative who also suffers from the disease. Additionally, those with a first-degree relative with Crohn's have a much higher risk of developing the disease compared to those without family cases. In the past, the disease was particularly common among Ashkenazi Jews, although today it is also prevalent among other populations in Israel and around the world, including the non-Jewish and non-Ashkenazi populations in Israel, and among other nations in the Far East, for example.

The most significant environmental factor contributing to the disease's onset and severity is cigarette smoking. However, the increase in the prevalence of Crohn's disease in recent decades and the significant correlation found between its prevalence and the socio-economic level of patients have led to the conclusion that other environmental factors also play an important role in the disease's onset. One current theory links the composition of gut bacteria, which can regulate immune system activity, such that in an environment not exposed to bacteria, or where multiple antibiotics are used, we might lose bacterial populations that could prevent the disease.

What Are the Symptoms of the Disease?

The common symptoms of Crohn's disease include diarrhea, abdominal pain, fatigue, decreased appetite, weight loss, fever, and the appearance of mouth sores. In some cases, symptoms can also appear outside the gastrointestinal system, such as joint pain and arthritis, skin rashes, or eye inflammation. Some of these symptoms can even appear before the typical complaints of Crohn's disease. In children, growth delay, short stature, and more can be observed. These signs can even be the sole expression of the disease.

How Is the Disease Diagnosed?

Diagnosis is based on a combination of typical symptoms and laboratory tests indicating the presence of chronic inflammation in a digestive system evaluation through tests called colonoscopy and gastroscopy. During the evaluation, the doctor takes biopsies from intestinal tissue for microscopic examination to determine if the type of inflammation is consistent with Crohn's disease. Additionally, evidence of the disease's presence can be obtained through gastrointestinal imaging (CT, MRI) or by swallowing a small camera called a video capsule.

How Is the Disease Treated?

It is recommended that patients with inflammatory bowel diseases be treated and monitored at specialist centers in hospitals specializing in these diseases. This way, a broad response to symptoms and patient complaints from several important disciplines can be provided. Besides the gastroenterologist, it is important for the patient to receive dietary consultation, psychological support, and monitoring by nurses and dermatologists, hepatologists, and rheumatologists, as needed. Treatment is not only directed at the patient's complaints but also aims to prevent disease-related damage, such as various infectious diseases - hence it is recommended to vaccinate patients, metabolic diseases - hence it is advised to check for absorption disruptions and supplement vitamins, and of course, there are the treatments affecting the immune system, primarily biological drugs including TNF inhibitors. A TNF inhibitor binds to the TNF protein and prevents its activity, thus reducing inflammation. The goal of such drugs is to eliminate the attacks, and essentially, to achieve a symptom-free state and improvement in blood tests, resembling a pre-disease outbreak condition. There are additional drug groups that act against other inflammatory mediators, such as anti-integrins and anti-IL-12/23, and of course, steroids and thiopurines. Apart from drugs, special nutrition can also be used to treat the symptoms of the disease, which might be suitable for some patients.