Crohn's disease: the advice of the specialist doctor

Interview with Pr Yoram Bouhnik, Head of Gastroenterology, IBD and Nutritional Assistance at Beaujon Hospital, Clichy.

Crohn's disease, when you know what it is, means incurable disease. Is this really the case?

We must relativize things. Much has been said about the severe forms of the disease. But, in the majority of cases, fortunately, the evolution is more benign. The arrival of the new anti-TNF drugs and the better knowledge of their handling have made it possible to unblock situations that were once very serious, or only mutilating surgeries or prolonged nutritional treatments could be proposed, and also to aspire to new objectives, such as rapid and complete healing of the lesions, which seems to be an extremely important factor to better control the medium-term evolution of the disease.

The possible surgical interventions are also more targeted ...

Surgery has also made significant progress, with the majority of procedures now being performed under laparoscopy, that is to say, without major abdominal scar, but which still remains, for complicated forms, the prerogative of expert centers. in colon surgery and laparoscopic surgery.

So we have made progress, even if we still have to make some ...

Research is extremely active in this field, with a major support in France from the François Aupetit association (AFA), which funds basic, clinical and therapeutic research programs, in addition to its work of informing and supporting patients. to their loved ones. All this brings immense hope. Admittedly, we can not yet speak of cure of the disease, in the strict sense of the term, that is to say, durable remission without any clinical, biological or endoscopic sign and no treatment, but we can allow a majority of patients to have a normal quality of life or almost.

What advice could you give to patients?

Patients are often very much afraid of having to undergo surgery or even a stoma (artificial anus), and are worried about the unpredictability of the disease and the risk of thrust, hindering them in their personal life plans, family and professional.
We must remind them that once in two, the disease is quite benign and does not even require major treatments. Pregnancy is quite feasible, with appropriate surveillance, and the risk of transmission of the disease to the child is relatively low.

And regarding the risk of cancer?

The risk of intestinal cancer in the long term is now almost halved, thanks to simple treatments and regular endoscopic surveillance. As for the sexual life, it must be remembered that it is normal in the vast majority of cases, except perhaps when there are active lesions in the perineal region. In short, we must play down this disease, which, admittedly, can be disabling in severe cases, but remains benign and well controlled in the majority of cases.

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