Mr. A (36), an office worker, visited the hospital due to repeated chronic abdominal pain and diarrhea in recent months and unexplained weight loss. As a result of endoscopy and tissue biopsy, I was diagnosed with Crohn’s disease, an inflammatory bowel disease that has recently been rapidly increasing among young people.
Crohn’s disease is a chronic inflammatory disease in which abnormal inflammation repeatedly occurs within the intestinal tract. It mainly occurs in young people in their 20s and 30s. Main symptoms include chronic abdominal pain, diarrhea, weight loss, fatigue, and bloody stool. If there is small intestine stricture, symptoms such as intermittent squeezing pain after a meal, abdominal distension, nausea, and vomiting appear.
Unlike irritable bowel syndrome, which has similar symptoms, Crohn’s disease does not have repeated constipation and diarrhea, and is characterized by nighttime diarrhea, mucous stools, bloody stools, back pain, nausea, fever, loss of appetite, weight loss, and fatigue.
Professor Go Bong-min of the Department of Gastroenterology at Soonchunhyang University Bucheon Hospital said, “According to the Korean Society for Intestinal Research, the number of Crohn’s disease patients was approximately 18,000 as of 2019, which is more than double the number of patients with Crohn’s disease in 2010, which was 7,777. “Recently, the prevalence is increasing due to the influence of environmental factors, westernized eating habits, and stress,” he explained.
It is known that one-third of Crohn’s disease patients experience various extra-intestinal symptoms, including joint, skin, and eye symptoms. The most commonly observed extraintestinal symptoms include joint diseases such as peripheral neuritis, arthralgia, and back pain. Skin diseases include oral ulcers and erythema nodosum, and eye diseases include uveitis, iritis, and episcleritis, which are characterized by eye pain, glare, and redness.
Although the cause and pathogenesis of Crohn’s disease have not yet been clearly identified, it is known to occur complexly in patients with a genetic predisposition due to various environmental changes due to industrialization. 5-10% of all inflammatory bowel diseases are familial, and most of the remaining cases occur sporadically regardless of family or genetics.
For an accurate diagnosis, Crohn’s disease must be diagnosed through a comprehensive review of medical history, physical examination, blood test, stool test, endoscopy, biopsy, and imaging tests. Through endoscopy, the area of intestinal involvement is identified and a tissue biopsy is performed. Endoscopic examinations include gastroscopy, small intestine endoscopy, colonoscopy, and capsule endoscopy, and imaging tests such as CT, MRI, and gastrointestinal ultrasound are used.
The goal of treatment for Crohn’s disease is not only to relieve symptoms, but also to prevent structural intestinal damage or physical disability through healing of mucosal lesions. Treatment methods include drug treatment using 5-ASA, immunosuppressants, steroids, biological agents, and small molecules. There is surgical treatment. Customized treatment is performed for each patient, taking into account the severity of the disease, activity level, site of involvement, disease type, prognostic factors, age, concomitant diseases, and patient preference.
Drugs should be selected considering their efficacy, administration method, and side effects. In most patients, immunomodulators are used as the first treatment, and steroids may be used in acute exacerbations. Recently, patient prognosis and quality of life have been greatly improved with various biological agents. In particular, infliximab, an anti-TNF agent first approved in December 2000, has had a significant impact on improving treatment outcomes, and adalimumab, betolizumab, and usteminumab are actively used. Recently, small molecule drugs have also been developed and used.
Professor Bongmin Ko said, “It is known that dysplasia caused by repeated inflammation in Crohn’s disease also affects the development of colon cancer. However, according to domestic studies, the risk of developing colon cancer 10 years after Crohn’s disease diagnosis was reported to have dropped significantly from 2.9% in 2006 to 1% in 2014. “This is thanks to the continuous development of treatments, treatment strategies to maintain remission, and appropriate colectomy.”
To prevent Crohn’s disease, Westernized eating habits, including increased intake of refined sugars, fatty acids, artificial sweeteners, fast food, and meat, and decreased intake of fiber, fruits, and vegetables, which are reported to be associated with the development of inflammatory bowel disease, and reduction of infectious diseases And you need to be careful about air pollution.
For Crohn’s disease patients, a balanced diet, sufficient fluid intake, and regular exercise are recommended. A low FODMAP (Fermentable, Oligosaccharide, Disaccharides, Monosaccharides And Polyols) diet is recommended during the active stage of Crohn’s disease, such as diarrhea or abdominal pain. It is best to drink plenty of water and eat small, frequent meals. You should reduce your intake of processed foods and quit drinking and smoking. Excessive stress and heavy physical work can also worsen symptoms, so caution is required.
Professor Bongmin Ko said, “There is a misconception that Crohn’s disease is fatal, but if you control the symptoms through appropriate treatment and management, you can maintain a normal life. However, if the timing of treatment is missed due to incorrect information and fibrosis develops into a chronic condition, surgical treatment may be necessary. Therefore, if you have any suspicious symptoms, it is best to quickly visit a medical institution to receive an accurate examination and customized treatment,” he advised.