Introduction regarding Chrohn’s disease
First of all, about 80% of all cases of Crohn’s Disease, an inflammatory bowel disease occur preferentially in the last part of the small bowel (called ileum). Furthermore, 20% develop in the first part of the right sided colon (also called “ascending colon”). The reason that distinction is important is that another inflammatory bowel disease, ulcerative colitis (see below), likes to confine itself solely to the colon and this becomes important for diagnostic purposes.
More detail about Crohn’s disease
There are several distinctions between these two diseases, so proper diagnosis in the beginning is crucial. Crohn’s disease is associated with small ulcerations in the lining of the bowel wall with associated inflammatory changes in the wall, which are called granulomas. On biopsy (small bowel biopsy, colon biopsy) these have a very distinct pathology, which helps for the diagnosis of Crohn’s. Unfortunately these granulomas are also the ones that have given Crohn’s the bad name, as they can melt together leading to complications such as fistula formation or bowel perforation. This in turn is responsible for acute flare-ups of Crohn’s, fistula formation to neighboring bowel loops, the bladder, the rectum, the vagina or the skin.
With the chronic progression of these changes there can be a narrowing of the opening of the bowel eventually leading to a stricture or bowel obstruction. Next, another complication can be an intra-abdominal abscess, when a granuloma perforates the bowel and the bowel contents enter into the abdominal cavity. Crohn’s has a spotty presentation with areas of bowel having been skipped (” skip areas”). To put it differently, this is an important finding on X-rays to support the diagnosis of Crohn’s.
Future more specific anti-inflammatory medication for Crohn’s disease
Lately there are some specific anti-inflammatory treatment modalities that have been developed. The newest classes that have been tested in Crohn’s and ulcerative colitis are the human cytokines (interleukin-11) and the anti-cytokine antibodies (anti-tumor necrosis factor or anti-TNF). Ref. 22-25 deal with interleukin-11. Ref. 26 describes among other medications the use of infliximab, a chimeric antibody targeting the anti-TNF, which has done very well in preliminary clinical trials and early postmarketing experience. However, additional clinical trials are needed to show long-term safety and adverse effects of the medication, but it likely will improve treatment of Crohn’s.
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