Crohn's Disease (CD)

CD is a chronic inflammatory intestinal disease that can affect any part of the digestive tract.

 

Overview:

CD is, together with Ulcerative colitis, one of the most significant chronic inflammatory bowel diseases. 1 CD often follows a relapsing course and is characterized by transmural inflammation of any portion of the gastrointestinal tract. Typical symptoms include abdominal pain, diarrhea, fever, and fatigue. 2 The chronic inflammation, which often begins at a young age, can significantly impact daily life. 3

 

Epidemiology in Switzerland

  • Prevalence: CD is widespread in Switzerland, with a prevalence of approximately 100–105 cases per 100,000 inhabitants. 4
  • Incidence: In Switzerland, the annual incidence of CD is approximately 2.2 new cases per 100,000 inhabitants, based on population-based data from the Canton of Vaud. 5
  • Age of onset: CD can affect individuals of any age, from children to the elderly. 6
  • Gender distribution: The overall gender distribution is approximately equal, although some studies report a slight female predominance. 6

 

Pathogenesis

The development CD is thought to result from a dysregulated crosstalk between commensal microflora and the gut mucosal‑associated immune system. The interplay between environmental factors and genetic predisposition can compromise the intestinal mucosa and epithelial barrier. The accelerated influx of antigens and microorganisms into the lamina propria of the gut is associated with amplification of the innate immune response and a persistent adaptive immune response.7

A typical feature of CD is the frequent alternation between active disease flares and periods of remission. 2 Symptoms vary individually, but commonly include abdominal pain, diarrhea, urgency to defecate, fatigue, and fever. 8

Complications such as strictures, fistulas, or abscesses that may occur during the course of the disease often require surgical intervention. 8 Whether an aggressive disease course is likely can often be predicted based on certain factors such as active smoking, young age at onset (<40 years), or involvement of the upper gastrointestinal tract. 2

Approximately 20–40% of patients develop extraintestinal manifestations (EIMs), which can affect various body regions, including the eyes, joints, skin, or vascular system. In general, the frequency of such EIMs increases with disease duration. 2,6

 

Diagnosis

CD involves patchy inflammation that can impact any part of the gastrointestinal tract, with extent and location differing by individual. Diagnosis relies on symptoms, disease progression, and endoscopic, histological, imaging, and laboratory results. 6

 

Therapy

The choice of therapy depends on several factors, such as disease activity, pattern of involvement, presence of extraintestinal manifestations or other complications, and age at onset. Patient preference and previous treatments should also be considered in the treatment decision. 6

 

Drug classes available for the treatment of CD include: 6

  • Corticosteroids
  • Conventional immunosuppressants such as thiopurines and methotrexate
  • Biologics
    • Integrin antagonists
    • TNFα antagonists
    • IL-12/23 antagonist
    • IL-23 antagonists
  • Small molecules
    • JAK inhibitors

Integrin Antagonist 

Learn more about the mode of action of the integrin antagonist:

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References

  • 1. Podolsky DK et al. Inflammatory Bowel Disease. New England Journal of Medicine. 2002;347:417-429.

  • 2. Roda G et al. Crohn’s Disease. Nature Reviews Disease Primers. 2020;6(1):22.  

  • 3. Ng SC et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390:2769–2778.

  • 4. Schoepfer A et al. Epidemiologie und sozioökonomische Aspekte der chronisch entzündlichen Darmerkrankungen in der Schweiz.Therapeutische Umschau. 2019; 75(5):255-259.

  • 5. Pittet V, Juillerat P et al. Inflammatory bowel disease incidence trends in the Canton of Vaud, Switzerland, 1991-2005: a population-based cohort study. Eur J Gastroenterol Hepatol. 2010;22(10):1170-1176.

  • 6. Gordon H et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment. Journal of Crohn's and Colitis. 2024;18(10):1531–1555.

  • 7. Bamias G et al. Exploring the Early Phase of Crohn's Disease.Clin Gastroenterol Hepatol. 2021;19(12):2469-2480.

  • 8. Cushing K, Higgins PDR. Management of Crohn Disease: A Review. JAMA. 2021;325(1):69–80.