Crohn’s disease

Crohn’s disease was named in 1932 by Dr. Burrill B. Crohn, when he published the first paper on the disease. It belongs to the Idiopathic Inflammatory Bowel Diseases (IBD), along with Ulcerative Colitis. Both cause a chronic inflammation. Ulcerative colitis only affects the large intestine and Crohn’s disease affects the entire digestive system.

The exact etiology of the two diseases remains unknown. Recently, several markers have been found on human chromosomes that indicate a predisposition to these diseases, in combination with other factors such as viruses and bacteria, smoking, food preservatives, changes in dietary habits, stress, anti-rheumatic drugs and improper functioning of the body’s immune system.
Although these diseases are not classified as hereditary diseases, first-degree relatives are 3 to 20 times more likely to develop the disease compared to relatives of people without this history.

Both diseases have symptoms such as fatigue, nausea, anorexia and sometimes fever. Symptoms from the bowel include bloody, usually diarrhea and abdominal pain. Some people experience nausea or vomiting. Many patients may experience symptoms in other organs of the body such as: mouth sores, rashes, joint pain and redness in the eyes. Crohn’s disease has been classified into 4 forms:

• Chronic inflammatory form- the chronic inflammatory syndrome is the most common form of the disease. It is the most common type chronic inflammation.
• Obstructive form- patients have colic abdominal pain, flatulence (bloating) and increased intestinal sounds.
• Syringogenic form- in 20 to 40% of patients, fistulas, which are communication pathways between the intestinal tubules (enteroenteric), or between the intestine and the skin (enteroepidermal), develop.
• Perianal disease- approximately 20 to 30% of patients with an affection in the small or large intestine will develop perirectal disease manifested by anal fissures, fistulas and abscesses.

In addition to the symptoms mentioned above, there are certain extra-intestinal manifestations that Crohn’s disease exhibits and the following are indicative:

• Skin and mouth- nodular erythema, foam ulcers, necrotizing vasculitis
• Musculoskeletal system- hypertrophic osteoarthropathy, osteopenia or osteoporosis, polymyositis, osteomalacia
• Liver-biliary- cholelithiasis, inflammations such as autoimmune chronic active hepatitis,, portal fibrosis and cirrhosis of the liver. Also, metabolic diseases such as fatty liver and gallstones associated with Crohn’s disease ileus.
• Eyes- corneal ulcers, neuritis, keratopathy
• Metabolic diseases- impaired development in children and adolescents, delay in sexual maturation
• Blood and blood vessels- leukocytosis and thrombocytosis, thrombophlebitis, arteritis, arterial occlusion, cutaneous vasculitis
• Kidneys- nephrolithiasis and amyloidosis
• Neurological diseases- peripheral neuropathy, myelopathy, vascular brain disorders
• Respiratory system and lungs- pulmonary fibrosis, vasculitis, bronchitis, sarcoidosis
• Heart- pericarditis, myocarditis, endocarditis, cardiomyopathy
• Pancreas- acute pancreatitis

The Crohn’s disease can cause deficiencies in various nutrients, which in turn lead to other clinical manifestations of the disease and these symptoms can be:

• enteropathic acrodermatitis (due to zinc deficiency)
• urticaria (due to vitamin C and K deficiency)
• glossitis (due to vitamins B deficiency)
• hair loss and weak nails (due to protein deficiency)
• anemia (due to deficiency of iron, folic acid, vitamin B12)

The most common treatment of Crohn’s disease is achieved by administering one, or a combination of medications, targeting specific symptoms and providing appropriate nutritional support orally, or if not possible, parenterally. Because it affects the small intestine, it reduces appetite, reduces and alters nutrient intake (malnutrition) and ultimately causes malnutrition and weight loss.

The risk of developing Crohn’s disease have been found to increase when a patient has low levels of vitamin D, when their diet includes an increased intake of animal protein and when they consume a lot of processed foods. On the contrary, the risk is reduced when the patient follows the Mediterranean diet, especially when the diet is rich in fish, fibre, potassium and zinc.

Experts suggest that the diet should be restored during four stages:

1st stage: it is good to eat easily digestible foods, high in carbohydrates (such as oats, rice) and low-fat soups.
2nd stage: white bread, jam, honey, boiled fruit, diluted fruit juices, boiled soft vegetables (e.g. carrots, spinach), boiled lean meat with low fat, rice, mashed potatoes, pasta, porridge, porridge, and finally low-fat milk can be added to the diet. Several small meals (at least five each day) are also recommended.
3rd stage: the diet can be enriched with dairy products with 1.5% fat, lean meat and fish, low-fat baked foods and vegetables (e.g. cauliflower, courgettes). It is recommended not to eat raw vegetables or raw fruit.
4th stage: “light full diet”, always with caution. It is recommended to avoid cabbage, legumes, fatty and fried foods, fruits with hard skins (prunes, gooseberries, etc.), vegetables cut into large pieces and juices from acidic fruits. 2-3 eggs per week, cooked as scrambled or soft boiled, are allowed.

Attention to the products made for diabetics contain a large amount of fructose which can aggravate diarrhea. Foods containing sugar substitutes such as xylitol, sorbitol or isomaltose are not recommended. Those who suffer from inflammatory bowel disease and are in remission can eat foods that are high in fiber but whole foods made from fine grains are better absorbed.

There’s no cure for Crohn’s disease, but medications and lifestyle changes can help manage the condition. This is why it’s crucial to identify the disease in its earlier stages. Untreated Crohn’s can lead to further complications of the GI tract, some of which may become permanent.

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• Fletcher J, Cooper SC, Ghosh S, Hewison M. (2019). The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management. Nutrients,11(5):1019.
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