(Health Korea News / Kim Yu-i) There are some people who suffer from frequent stomachaches. They have frequent stomachaches, and when they are severe, they go to the bathroom several times a day. When this happens, irritable bowel syndrome comes to mind, but recently, the number of people being diagnosed with Crohn’s disease is increasing.
Crohn’s disease is still an unfamiliar disease to the general public. However, it has gradually become known as several famous celebrities have recently revealed that they are battling the disease. Crohn’s disease is a typical chronic inflammatory bowel disease along with ulcerative colitis. Inflammatory bowel disease is a chronic inflammatory disease that occurs in the intestines due to various factors such as genetics, individual immune response, composition of intestinal microorganisms, and environment, and is largely divided into Crohn’s disease and ulcerative colitis.
The name Crohn’s disease comes from the first report by American doctor Burrill Bernard Crohn in 1932. It is also called CD by taking the first letters. The incidence was high mainly in the West, but the incidence in Korea has been rapidly increasing recently due to changes in eating habits. It is especially prevalent among the young.
Inflammatory bowel diseases, including Crohn’s disease, are rapidly increasing, with a 2.5-fold increase in the number of children and adolescents in Korea over the past 10 years. The most important cause is a change in eating habits. In particular, children and adolescents with Crohn’s disease may have poor nutrient absorption, which can lead to growth disorders such as low weight or short stature.
◇Increased 2.1 times faster in the past 10 years… Half of patients are under 20 years old
The number of patients with Crohn’s disease in Korea is rapidly increasing. According to the Health Insurance Review & Assessment Service, the number of patients who visited hospitals with Crohn’s disease in Korea last year (2023) was 30,3238, a 2.1-fold increase from 10,6138 in 2013. By age group, those in their 20s were the largest at 31.2%, followed by those in their 30s at 25.1%, those in their 40s at 15.3%, and those in their teens at 15.1%, with those in their 20s or younger accounting for nearly half.
The typical symptoms of Crohn’s disease are abdominal pain, diarrhea, and weight loss. If these symptoms persist for more than two weeks, Crohn’s disease may be suspected. Along with these symptoms, bloody stool, fever, fatigue, pain or discharge around the anus, a fistula that does not heal, vomiting, nausea, pain in the mouth, growth retardation, and anemia may also appear.
It is sometimes compared to ulcerative colitis with similar symptoms, but there are differences in the location, range, and characteristics of the lesions. Ulcerative colitis occurs only in the large intestine, and the inflammation is shallow and continuously distributed. On the other hand, Crohn’s disease can occur anywhere in the digestive tract from the mouth to the anus, but it mostly occurs in the small intestine and large intestine, and the inflammation is deep and scattered.
Up to 10% of patients with Crohn’s disease will develop extraintestinal symptoms, including oral, skin, joint, liver, and eye symptoms, within 1 year of diagnosis, and up to 20-30% will develop symptoms within 1 year of diagnosis. The full-thickness inflammation of the intestinal wall can cause fibrosis and strictures of the intestine, leading to intestinal obstruction, abscess formation, and microscopic perforations or fistulas, which may require surgical treatment.
◇Representative symptoms are abdominal pain, diarrhea, and weight loss… Immune system changes are believed to be the cause
The cause of Crohn’s disease is still not well known. However, it is presumed that genetic factors, breastfeeding, Westernized diet, antibiotic abuse, smoking, drugs, stress, and other environmental and social factors cause changes in the immune system. Clinical manifestations change with age. In particular, in the case of Crohn’s disease where genetic abnormalities are found, it occurs at a very young age, and the prognosis is usually very poor at this time.
The intestinal microbiota environment is also considered one of the causes. Intestinal microbiota plays a very important role in our body. They defend against harmful substances that enter from the outside and synthesize necessary substances that our body cannot synthesize from food.
However, if the intestinal microbes are out of balance, the barrier is damaged, the number of beneficial bacteria decreases, and the protective role against harmful substances is lost, which can cause various diseases. Recently, research on intestinal microbes has been actively conducted in various fields, including diabetes, obesity, and ADHD (attention deficit hyperactivity disorder), in addition to intestinal diseases.
In the case of Crohn’s disease, the intestinal microflora changes, resulting in a decrease in beneficial bacteria and an increase in relatively harmful bacteria, which causes the intestinal microflora to lose its balance. This damages the intestinal barrier and increases intestinal permeability, allowing toxic substances or harmful bacteria to penetrate the intestines, which can cause inflammation.
◇Treatment is centered on drug therapy… With continuous treatment and management, normal life is possible
If Crohn’s disease is suspected, stool tests including various serological tests, fecal calprotectin tests that reflect the intestinal inflammation status, and stool culture tests to rule out the possibility of bacterial infection are performed. Then, MRI (magnetic resonance imaging) or capsule endoscopy is performed to check for small intestine invasion, and the mucosa is observed and tissue examination is performed using colonoscopy and upper gastrointestinal endoscopy.
Imaging tests for diagnosing Crohn’s disease are different from general CT (computed tomography) or MRI tests in that they are for checking the small intestine. The small intestine is usually not inflated and is attached, but in order to indirectly check for lesions such as fistulas and strictures in the small intestine, contrast agents are administered before the MRI test to inflate the intestinal lumen. Through this, narrowed areas of the small intestine, fistulas, and swelling of the intestine can be indirectly checked.
Treatment is usually carried out with medication. In particular, treatment of Crohn’s disease in children and adolescents aims to alleviate symptoms, maximize growth, and minimize the toxicity of treatment drugs to improve the quality of life. Treatment is divided into two stages: at the time of initial diagnosis or during the active stage when the disease worsens.
In the active phase, remission induction treatment is performed to induce remission, a state in which symptoms are reduced. Unlike adults, children undergo exclusive enteral nutrition for mild and moderate cases, in which they consume beverages with finely chopped nutrients for 8 weeks to provide the required calories. Once remission is induced through this, anti-inflammatory drugs or immunomodulators must be taken consistently depending on the condition of the disease to maintain the remission.
Depending on the patient’s condition, medications are divided into three stages: mild, moderate, and severe, and are divided into remission induction treatment and remission maintenance treatment. In general, total enteral nutrition is used to induce remission, but in severe cases where symptoms are severe from the beginning, or total enteral nutrition fails or relapses, steroids and biological agents are used to induce remission. After that, anti-inflammatory agents, immunomodulators, and biological agents are used to maintain remission.
However, when Crohn’s disease is first diagnosed, remission induction is essential even if the drug level continues to increase. In some cases, the disease worsens during maintenance treatment, and then remission induction treatment is performed again, and maintenance treatment is planned again after remission is induced. In general, Crohn’s disease rarely remains active, but in cases of frequent relapse, complications such as strictures may occur.
Crohn’s disease occurs frequently in children and adolescents, so when diagnosed, not only the children but also their parents are often confused and upset by the unfamiliar name and the burden of having to take medication for the rest of their lives. It is important for family, school teachers, and friends to understand and be considerate of the disease.
There is no specific preventive method for pediatric and adolescent Crohn’s disease because the cause or pathogenesis has not yet been identified. However, it is estimated that it can be prevented to some extent through exclusive breastfeeding, healthy eating, and refraining from overusing antibiotics. In principle, Crohn’s disease is not a disease that can be cured at present, but it should be noted that it is possible to live a life close to normal with continuous and thorough treatment and management. (Written by Kim Yu-i, Professor of Pediatrics and Adolescent Medicine, Incheon St. Mary’s Hospital, Catholic University of Korea)
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Source: www.hkn24.com
