Crohn’s disease is a chronic inflammation of the entire gastrointestinal tract. The lower small intestine and the beginning of the large intestine are particularly frequently affected. How Crohn’s disease manifests itself and what treatment and diet helps.
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quick overview
definition: Crohn’s disease is a chronic inflammatory bowel disease that can affect the entire digestive tract. In general, the course of the disease is very individual.
symptoms: Signs include cramping abdominal pain, diarrhoea, fever, loss of appetite and tiredness.
Treatment: Drugs are used, in certain cases an operation may be necessary.
Nutrition: In the acute phase, a low-fat, fiber-free diet can help. In the resting phase, an anti-inflammatory whole diet is recommended.
causes: The reasons are still unclear. Genetic predisposition may play a role, as well as environmental factors such as smoking.
At a glance:
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What is Crohn’s disease?
Crohn’s disease is a chronic inflammatory bowel disease (IBD) that usually manifests itself as persistent diarrhea and abdominal pain.
The disease can lead to inflammation in the entire digestive tract, i.e. from the oral cavity to the rectum, and usually occurs in phases. The small intestine (ileum) and the large intestine (colon) are particularly frequently affected.
Crohn’s disease and IBD ulcerative colitis have many similarities and are not always easy to distinguish from one another. There are some differences though. Crohn’s disease can affect just about any part of the digestive tract, while ulcerative colitis usually affects the large intestine.
How common is Crohn’s disease?
Crohn’s disease is one of the most common chronic inflammatory bowel diseases, affecting around 100 to 200 out of 100,000 people. The disease can occur at any age. Young adults are particularly affected.
Chronic inflammatory bowel disease usually begins between the ages of 15 and 34. Men and women are equally affected, children less often.
Crohn’s disease: symptoms and signs
The main symptoms of the disease include diarrhea and abdominal cramps: often in the lower right abdomen.
Other symptoms of Crohn’s disease can include:
Some of those affected also suffer from diseases outside the gastrointestinal tract. These include psoriasis (psoriasis), spondylarthritis and inflammation of the pancreas (pancreatitis).
Complications of Crohn’s disease
Additional complications of intestinal inflammation include fistulas (connecting passages, for example, to other sections of the intestine) and constrictions in the intestine (stenoses) up to an intestinal obstruction.
Patients also have an increased risk of osteoporosis or bone loss.
Treatment for Crohn’s disease
Basically, it should be emphasized that the therapy must be individually adapted to each patient. Affected people with a longer history of illness often know very well which therapy in which dose effectively alleviates their symptoms.
In general, a distinction is made in the treatment of Crohn’s disease between relapse therapy and maintenance of remission:
In the case of an acute attack, anti-inflammatory drugs are usually prescribed to relieve the symptoms (5-aminosalicylate, budesonide, azathioprine or cortisone preparations).
Drugs to suppress the immune system (azathioprine, 6-mercaptopurine or methotrexate) or TNF-alpha blockers (infliximab) are used to maintain remission. In certain cases, the surgical removal of affected sections of intestine may be necessary, for example in the case of:
- intolerance to other forms of therapy
- an abnormal development of tissue (dysplasia)
- Intestinal narrowing (stenosis)
- fistulas or abscesses
Crohn’s disease: Adjusting diet by phase
Diet in Crohn’s disease can have a positive effect on the course of the disease. In the case of Crohn’s disease, all foods that are well tolerated are initially allowed. This is different for each individual. During a flare-up, a wholesome diet can look different than in the remission phase.
Diet in Crohn’s disease during an attack
There is no blanket recommendation for certain foods. But during a flare-up, a low-fiber, low-fat diet has proven its worth. In some cases it may be necessary to feed astronauts (high-calorie liquid food) to ensure adequate nutrient intake.
It is better to avoid raw food, heavily sugared foods, undiluted juices or carbonated drinks, as well as foods that are too salty, spicy or hot.
Feeding through a stomach tube or with the so-called astronaut cos can make sense, especially for children with growth disorders. Iron supplements can also be given if there is an iron deficiency. This should be discussed with a doctor if necessary.
Basically, the following applies to nutrition in Crohn’s disease:
No special diet needs to be followed.
A balanced diet with plenty of fresh food (not raw, but boiled or steamed) is recommended.
Refrain from alcohol.
In the remission phase, those affected best use easily digestible dietary fiber, such as extra tender oatmeal or finely ground whole grain products. Fermented milk products such as yoghurt as well as high-quality vegetable oils and protein, for example in fish and poultry, are usually well tolerated.
Carrots, parsnips and zucchini are sometimes more digestible than cabbage and legumes. A balanced diet should also be aimed for in Crohn’s disease in order to cover the body’s nutrient requirements. Secondary plant substances in fruit and vegetables also have an anti-inflammatory (anti-inflammatory) effect.
Those affected often try different diets themselves, even if no specific diet is recommended for Crohn’s disease. The carbohydrate diet, in which few carbohydrates are eaten, and the FODMAP diet are particularly popular.
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Cause of Crohn’s disease unknown
The causes of Crohn’s disease have not been clarified beyond doubt. It is clear that it is not an infectious disease. That is why Crohn’s disease is not contagious.
The currently most commonly held view is that Crohn’s disease is an autoimmune disease of the intestinal mucosa. This is justified with the good response of the disease to immune-inhibiting drugs, but specific antibodies could not be detected. An influence of environmental factors such as smoking, food allergies and intestinal pathogens is also assumed.
The proven connection between mutations in the NOD2 gene and the occurrence of Crohn’s disease speaks for a hereditary predisposition to the disease.
The risk of Crohn’s disease can also be increased
People who have close relatives with chronic inflammatory bowel disease and
treatment with antibiotics in adolescence.
In addition, psychological stress, such as stress or conflicts, seems to have a negative influence on the course of intestinal inflammation.
Diagnosis of suspected Crohn’s disease
Anyone who suffers from recurring gastrointestinal complaints should consult a doctor specializing in gastroenterology.
It can often be difficult to differentiate Crohn’s disease from other inflammatory bowel diseases. The diagnosis is a combination of several examination methods, which usually enables an unequivocal diagnosis. These include, among others:
Laboratory tests of the blood: In many of those affected, the inflammatory parameters in the blood are significantly increased, and a lack of vitamins and trace elements or anemia can also be detected in this way.
Stool examinations to differentiate from contagious inflammation of the intestine
Ultrasound examinations (sonography) to diagnose a thickened intestinal wall, abscesses or fistulas
Gastroscopy and colonoscopy
Analysis of tissue samples from the intestinal mucosa (biopsy)
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The course of Crohn’s disease varies
Crohn’s disease is a chronic disease for which there is currently no cure. Since the causes of Crohn’s disease have not been clarified beyond doubt, it is also not possible to prevent it.
The course of the disease and its extent are individual and therefore require complex diagnostics and therapy. Some sufferers suffer from permanent symptoms, while others alternate between phases of relative health (remission) and acute illness (relapse).
Although symptoms often recur, many sufferers cope well with the disease and lead a completely normal life. The exchange with other patients in a self-help group can be an important support.
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