Crohn’s disease

Crohn’s disease is an inflammatory disease of the entire digestive tract, probably caused by an autoimmune reaction. The immune system produces antibodies against the patient’s own bowel wall structures and causes inflammation at the site. The whole digestive tract from the esophagus to the anus can be involved. In most patients inflammatory changes occur in the small and large bowel.

Mostly the disease starts at a young age (15-30 years) and many times the first diagnosis of Crohn’s disease is made after an appendectomy. In other cases chronic abdominal pain and persistent diarrhea lead to further investigations (colonoscopy, biopsy, CT scan) before the diagnosis of Crohn’s disease is made. Persistent anal fistula is another form of early presentation of Crohn’s disease. 

Treatment is mainly conservative, using medication to stop the inflammatory process. Drugs with a local (inside the bowel) anti-inflammatory effect like Salofalk, Claversal or Entocort (locally active cortisol), systemic immune suppressants like cortisol, Azatioprin etc. and monoclonal antibodies are prescribed. Even alternative herbal medications like incense have been tested in clinical studies for potential effectiveness. 

Surgery comes in only after all these medical treatments have failed, e.g. when severe chronic stenosis after repeated attacks of acute inflammation or when abscesses or fistulas complicate the course of the disease. Surgical strategy aims for an operation as limited as possible, trying to preserve as much bowel as possible. The chances that further surgery will be necessary during a lifetime with Crohn’s disease are very high. Many of these operations are performed laparoscopically.

The area most frequently involved is the junction of small and large bowel (iliocecal area). Massive stenosis resulting in crampy pain in the lower right abdomen makes a normal life impossible. This problem can be solved by a limited resection of this segment of bowel. The laparoscopic procedure leaves few scars and does not burden the patient much. (A prominent example for such a procedure is the American pop singer Anastacia)