Crohn’s disease

Crohn’s disease is a persistent condition that is caused by inflammation of the lining of the gut. It is one of two conditions known as inflammatory bowel disease, with the other condition being ulcerative colitis. Crohn’s disease usually causes the ileum and the colon to become irritated, but other parts of the digestive system can also be affected. Over the course of time Crohn’s disease can cause damage to the digestive system, which can produce severe symptoms and increase the risk of complications.

Crohn’s disease is most common among young adults but can also affect older people and young children. The disease is not common, affecting around 1 in every 1,000 people in the UK. Crohn’s disease tends to run in families and it is estimated that one fifth of people diagnosed with Crohn’s disease have a family member with the condition.

What causes Crohn’s disease?

The precise cause of Crohn’s disease is unknown, but many experts believe the immune system’s response to bacteria in the gut plays an important part. The immune system is the body’s form of defence, and it is believed that in people with Crohn’s disease, the bacteria in the gut trigger an inflammatory response. Genetics also plays a part, which explains why the disease often runs in families. Other risk factors include environmental factors, previous infection and smoking.

How is Crohn’s disease diagnosed?

If you have symptoms similar to those associated with Crohn’s disease, your doctor will question you on your medical and family history and perform an examination. This involves feeling your tummy to check for inflammation and looking for signs of illness, such as being pale or losing weight. Your GP will also check your pulse, heart rate, BMI and they may also take your temperature. If they deem there to be a chance of you having Crohn’s disease, they will refer you to a specialist for further tests.

The most frequently used test for Crohn’s disease is a colonoscopy, which enables a doctor to view the lining of the intestine and look for signs of swelling. Blood and stool samples are also usually ordered prior to the colonoscopy. The blood sample is then evaluated for signs of inflammation, infection and anaemia.

A colonoscopy involves inserting a slender, flexible tube known as an endoscope into the back passage and up into the digestive system. The procedure may be a little uncomfortable but it should not be painful. The endoscope may be fitted with instruments to remove a tissue sample (this is called a biopsy). If the colon and other parts of the digestive system look completely normal, it is very unlikely that you have Crohn’s disease.

Symptoms of Crohn’s disease

The main symptoms of Crohn’s disease are:

• Diarrhoea.
• Abdominal pain.

If the lower part of the digestive system is affected, there may also be blood and mucus in the faeces. Symptoms can vary from mild to severe and you may also experience symptoms such as:

• Weight loss.
• High temperature.
• Vomiting.
• Joint pain.
• Rashes on the surface of the skin.
• Irritated eyes.

When should I see a doctor?

You should see a doctor if your symptoms persist, you experience pain, you lose weight without any explanation or notice blood in your stools. Diarrhoea can be associated with several other health conditions and so could be nothing to worry about, but it is important to see your GP if your symptoms persevere or you identify blood in your urine or faeces.

Treating Crohn’s disease

The intention of treatment is to reduce inflammation in the intestine and ease symptoms. If you are diagnosed with Crohn’s disease, you will be cared for by a multi-disciplinary team who will create a treatment plan for you. Treatments for Crohn’s disease include:

• Medication: medications, including steroids, antibiotics and aminosalicylates, may be used to treat Crohn’s disease. Steroids and aminosalicylates reduce inflammation, while antibiotics can help to reduce the presence of bacteria in the gut, which will help to temper the inflammatory response. Immunosuppressants may also be prescribed to prevent the inflammatory response.
• Dietary therapy: you may be advised to make changes to your existing diet and follow an eating plan that is designed to ease pain and reduce symptoms.
• Surgery: in some cases, when medication does not have the required effect, surgery may be required. Around 80 percent of people with Crohn’s disease will need surgery at some point. However, surgery will not cure Crohn’s disease, but it will help to prevent symptoms and many people find that they do not experience symptoms for several years after surgery.
• Self-help: there is no evidence to suggest Crohn’s disease is caused by issues related to diet, but changing your diet may help to ease symptoms. Experts recommend eating five to six small meals per day, rather than three large portions, and many people find that avoiding certain foods helps to reduce symptoms. Common foods that are believed to make symptoms worse include milk and other dairy products, fatty foods, alcohol and foods that are high in fibre.

Living with Crohn’s disease

Crohn’s disease is a chronic condition with no cure, but many people with the disease live normal lives. Having surgery for Crohn’s disease may worry people because of the prospect of having to use a stoma bag; however, most people do not need to use stoma bags and those who do usually only need them on a temporary basis. Some people worry about Crohn’s disease having an adverse effect on fertility but there is no evidence to suggest that the disease affects fertility.

Preventing Crohn’s disease

There is no means of preventing Crohn’s disease, though giving up smoking may help to reduce your danger of developing the condition.