Summary
Crohn’s disease is a chronic inflammatory bowel condition characterised by periods of flares and remissions. It affects the entire gastrointestinal tract, with a predilection for the distal ileum. Triggering factors include complex interactions between environmental, genetic, immunological factors and changes in the microbiome. There are several types of the disease, each with specific manifestations. In addition to its effects on the digestive system, it can affect other parts of the body. Malnutrition is common, affecting up to 75% of patients, underlining the importance of addressing both inflammatory and nutritional aspects. Deficiencies of nutrients such as vitamin D, iron, magnesium, zinc, folic acid and vitamin B12 are common and can have serious consequences. The role of fibre and prebiotics in gut health is also crucial.
Introduction
Crohn’s disease is a chronic condition of the gastrointestinal tract with periods of activity and remission. Although its general clinical aspects are known, its underlying biological mechanisms and its relationship to nutrition remain areas of active research.
Aetiology and pathogenesis
Crohn’s disease is the result of a complex interaction between genetic, environmental and immunological factors. A genetic predisposition has been identified, with a higher incidence in first-degree relatives of affected patients. In addition, environmental factors such as diet and smoking may play a role in its development.
Intestinal inflammation in Crohn’s disease is characterised by a dysregulated immune response, involving innate lymphoid cells and proinflammatory cytokines. Innate lymphoid cells, such as ILC1 and ILC3, are involved in the pathogenesis of the disease and are found in greater numbers in certain areas of the intestine affected by the disease. Dysregulation of the immune system, especially of these specific cells, plays a key role in the development and progression of the disease.
Types and Clinical Manifestations
Crohn’s disease can manifest in various forms, including gastroduodenal disease, ileocolitis, ileitis or jejunoileitis, Crohn’s colitis and perianal disease. In addition to gastrointestinal symptoms, it can affect other parts of the body, such as the joints, skin, eyes and internal organs.
Nutrition and Crohn’s disease
Malnutrition is common in patients with Crohn’s disease, affecting a large proportion of them. Loss of appetite, nausea, vomiting and malabsorption contribute to this condition. It is essential to address the nutritional requirements of these patients, especially during periods of disease activity.
Nutritional deficiencies
Patients with Crohn’s disease may be deficient in several nutrients, including vitamin D, iron, zinc, magnesium, folic acid and vitamin B12. These deficiencies can have serious health consequences, including osteoporosis, anaemia and neurological disorders.
Role of Nutritional Supplements
Supplementation with specific nutrients, such as vitamin D and iron, can be beneficial for patients with Crohn’s disease, especially during periods of disease activity. However, it is important to regularly monitor serum levels of these nutrients and adjust supplementation as needed.
Importance of Fibre and Prebiotics
Fibre and prebiotics play a crucial role in gut health by promoting bacterial diversity and the production of butyrate, a fatty acid essential for maintaining the integrity of the intestinal barrier and regulating inflammation. The inclusion of fibre-rich foods and prebiotics in the diet may help to improve symptoms and quality of life in patients with Crohn’s disease.
Conclusions
Crohn’s disease is a complex condition that affects both the gastrointestinal tract and other parts of the body. Malnutrition and nutritional deficiencies are common in these patients and can have serious health consequences. It is crucial to address both the inflammatory and nutritional aspects of the disease to provide comprehensive treatment and improve patients’ quality of life.
Sources:
1- Crohn’s and Colitis Foundation of America http://www.ccfa.org/
2- National Institute of Diabetes and Digestive and Kidney Disorders http://www.niddk.nih.gov/
3- Harvard education https://www.health.harvard.edu/a_to_z/crohns-disease-a-to-z
