CROHN S DISEASE. The term "inflammatory bowel disease" includes Crohn's disease and the other related condition called ulcerative colitis.

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2 CROHN S DISEASE What does it consist of? Crohn s disease is an inflammatory process that affects mostly to the intestinal tract, although it can affect any other part of the digestive apparatus from the mouth to the anus. The most frequently affected region is the distal part of the small bowel (ileum) and/or the large intestine. Crohn's disease is chronic and the patient can suffer several recurrences along their life. Some people can present long remission periods (that can even last for years) in which there are no symptoms of the disease. It is not possible to predict when the patient will begin a remission state or when the symptoms will be present again. Which symptoms does Crohn's disease present? The symptoms can be very different from one patient to another because the condition can affect any part of the intestine. The most frequent are stomach cramps, abdominal pain, diarrhea, fever, weight loss, and abdominal distension. Not all patients experiment all these symptoms, and some do not even suffer any of them. Other possible symptoms are anal pain, cutaneous injuries, rectal abscesses, fissures, arthralgia, or arthritis. Which people can be affected? This condition can appear at any age, but it is more frequent in young adults aged 16 to 40, both men and women. In certain cases the disease runs in families: 20% of the patients with Crohn's disease have a first-degree relative with some type of inflammatory bowel disease, normally a brother or a sister, although it can also be their parents or their children. The term "inflammatory bowel disease" includes Crohn's disease and the other related condition called ulcerative colitis. Causes for Crohn's disease Nowadays the exact reason for this disease is unknown, although there are several explicative theories. The most recent ones are based on the influence of the immune system (the protective system of our organism) and/or bacterial agents. It is not contagious, although there is certain genetic predisposition.

3 Crohn's disease and colorectal cancer The relative risk of small bowel cancer in patients with Crohn's disease is higher than in the general population, but in spite of this a total risk is very unlikely. The problem is more worrying in the case of the colon, and that is why these patients must go under monitoring programs in order to detect early precancerous injuries (screening). Treatment for Crohn's disease There is no curative treatment for this illness. The initial treatment is medic in most cases, and is based on administering one or several medicines at early stages in order to relieve the symptoms and to remit any outbreak of the illness. The most used drugs are corticoids (prednisone and methylprednisolone) as well as other types of antiinflammatory analgesics. Less frequent medicines include immunosuppressives such as 6- mercaptopurine and azathioprine. Metronidazole is an antibiotic that also affects the immune system, and is very efficient in the treatment of patients with an anal condition. Nowadays, inmunomodulators are being used for Crohn's disease and the results so far are quite encouraging. Advanced or complicated cases may require surgery. It is performed urgently under certain circumstances such as intestinal perforation, intestinal obstruction, and massive intestinal bleeding. Surgery is also indicated in less urgent cases such as abscesses, fistulae (abnormal connection between the intestine with nearby structures), severe anal illnesses, or persistence of the condition despite a correct medical treatment. Not all patients that present these or any other complications need surgery. The best treatment for most patients requires the participation of a multidisciplinary team including gastroenterologists and colorectal surgeons. Should surgery be avoided by all means? Even though the chosen procedure at early stages of the disease is the medical treatment, we must take into account that every three out of four patients will require surgery at some point. Many patients have suffered unnecessarily due to the

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