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In segments and through all wall layers — hence narrowings and fistulas, and hence the calprotectin counts more than how one feels.
Also known as: Crohn’s disease · inflammatory bowel disease (IBD)
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Crohn’s disease is a chronic inflammation of the digestive tract that can in principle appear anywhere — from the mouth to the anus. Most often it strikes the junction between small and large bowel. Two peculiarities explain almost everything else. First, the inflammation affects the bowel in segments, with healthy stretches in between. Second, it goes through all layers of the wall, which is why narrowings, fistula tracts and abscesses can form — that separates it from ulcerative colitis, which involves only the topmost layer of the large bowel. Typical are abdominal pain, often in the lower right, diarrhoea over weeks, tiredness, weight loss and, in children, falling behind in growth. Blood in the stool belongs more to the other picture. Not rarely the illness first shows itself at the anus, with a fistula or an abscess. Outside the bowel too it makes itself felt: in joints, eyes, skin and bile ducts. Two things matter for everyday life: the calprotectin in the stool shows the inflammation even when one feels well — and smoking clearly worsens the course of this illness.
The aim of today’s treatment is a healed lining and not only freedom from complaints. A rising value in a quiet phase is the best moment to act.
In this illness smoking is linked with more flares, more operations and more relapses after surgery. It is the most effective step one can take oneself.
In quiet phases a varied, plant-rich diet does good. With a known narrowing or cramping pain after eating the opposite applies — then low-fibre and finely chopped.
A large share of the tiredness can be explained and corrected this way. With an inflamed bowel, iron is often better given through the vein than through the stomach.
It ends a flare but does not keep it away. Anyone needing cortisone more than twice a year needs a treatment that changes the course — and in between an eye on the bones.
There only the large bowel is affected, continuously and only superficially, with blood and mucus in the stool. The distinction determines treatment, course and the question of surgery.
Inflammation, cortisone and the poorer uptake of calcium and vitamin D all work in the same direction. A bone density measurement belongs earlier than most assume.
Anyone who has ever lived in the tropics or subtropics can carry a threadworm unnoticed for decades. Under cortisone or a treatment with antibodies it can multiply massively. So this question belongs before the treatment starts — checked with antibodies in the blood and the eosinophils.
A threadworm can stay silent in the gut for decades and, under cortisone, biologicals or other immune suppression, flood lung and bloodstream. Anyone who ever went barefoot in the tropics or subtropics is looked for beforehand with a blood test — one effort, and it prevents the worst course this worm has.
Cortisone settles the flare and is not a long-term solution. Immunomodulators and biologics hold the remission. Today the aim is a healed mucosa, not only freedom from symptoms — the two often diverge.
About two to three in a thousand people are affected, with a peak between fifteen and thirty. One to two years pass on average before the diagnosis. The course comes in waves over decades; the length of the quiet periods depends more on treatment than on diet.
The commonest picture, for years often read as a sensitive bowel. The difference lies in the duration, in the weight and in the fact that it also wakes at night.
A fistula, an abscess or a deep, badly healing tear can be the first sign — sometimes years before the bowel draws attention. It belongs mentioned, uncomfortable as it is.
In children and teenagers a break in the growth or weight curve can be the first and for a long time the only sign, even before abdominal pain.
Together with a bloated belly, nausea and the feeling that nothing is moving on, this speaks for a narrowing. Coarse fibre is then exactly wrong — the diet is adjusted.
Aching joints, a red painful eye, tender red lumps on the shins or itching skin with raised liver values belong to the same picture and are often treated separately.
The most useful value for following the course. It separates true inflammation from an irritable bowel and often rises before complaints return — so it is measured in quiet phases too.
Indicates a flare, but in some people stays normal despite active inflammation. A good value alone therefore proves no quiet.
Iron shortage is the commonest accompaniment of all. Careful: with inflammation the ferritin is falsely high — so the transferrin saturation belongs alongside.
The anaemia explains a good share of the tiredness and is often put down to the illness itself, although it is readily treatable.
The last stretch of the small bowel takes up B12. If it is inflamed or has been removed, B12 is permanently lacking — then injections are needed, not tablets.
Is taken up less well when the small bowel is inflamed and, together with courses of cortisone, is the reason the bones are looked after early.
The single most important hint of worms in the blood. They are raised with worms that travel through tissue — not with giardia, threadworms and amoebae, which stay in the bowel. A normal value therefore rules nothing out.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
No diet cures Crohn — nutrition is individual and supportive.
Much studied in inflammatory bowel disease; in relapse prevention the results stayed behind expectations.
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