Everything you need to know about Crohn’s disease

Learn the facts about this chronic inflammatory bowel disorder.

Crohn’s disease: signs, symptoms, treatment
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If you’ve been suffering with chronic, long-lasting gut problems, including diarrhoea and abdominal pain, as well as fatigue, you could be feeling the effects of Crohn’s disease.

Dr Ray Shidrawi, consultant gastroenterologist at The Wellington Hospital, part of HCA Healthcare, looks at Crohn’s disease signs, symptoms, treatments and dietary options:

What is Crohn’s disease?

Crohn’s disease is a chronic inflammatory bowel disorder. This means it’s a long-term condition that involves inflammation of the gut. If you have Crohn’s disease you will experience periods of inflammation of the bowel (flare-ups), followed by periods of remission. It can develop at any time and affect any part of the digestive tract, from the mouth to the anus.

Intestines and pills, probiotics, antibiotics. Gut protection, recovery from illness and treatment
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Crohn’s disease causes

What causes Crohn’s disease? Crohn’s disease is an auto-immune condition – a condition in which your immune system attacks your own body. It develops in genetically susceptible individuals and is triggered by unknown environmental factors.

Crohn’s disease signs and symptoms

People with Crohn’s disease can present with various signs and symptoms, depending on the severity of the condition. Some patients have minimal symptoms, while others may have a severe form of the condition requiring surgery or lifelong medication.

Crohn’s disease common symptoms include:

• Abdominal pain

Due to the inflammation of the last part of the small intestine (or terminal ileum), some people will suffer from abdominal pain and cramping, which can sometimes mimic acute appendicitis.

• Weight loss

Where larger parts of the small intestine are affected, people may show signs of weight loss and malabsorption of dietary nutrients.

• Diarrhoea

The malabsorption of nutrients can lead to diarrhoea and recurrent fevers.

• Pain around the anus/chronic perianal infections

This can be the result of the inflammation from a tunnel into the skin, medically known as ‘fistulas’.

Crohn’s disease less common signs and symptoms include:

  • Erythema nodosum: painful red nodules over the shins.
  • Pyoderma gangrenosum: chronic ulcer over the ankle.
  • Scleritis and uveitis: inflammation causing red eyes.
  • Arthritis: in large joints and the spine.

    Crohn’s disease signs and symptom in children include:

    • Delayed growth
    • Delayed sexual development

      Both of the above can be indicators of the disease.



      Crohn’s disease risk factors

      Who is most likely to suffer with Crohn’s disease? Crohn’s disease is more common in the developed world and continues to rise as standards of public hygiene improve.

      Anyone can be affected by Crohn’s disease. However, there’s a particularly high incidence among people with Eastern European Ashkenazi Jewish ancestry. A family history of the condition also suggests an increased risk of developing the condition.

      Crohn’s disease is more common in the developed world and continues to rise as standards of hygiene improve.

      While most Crohn’s patients experience symptoms early in childhood or young adulthood, it can present for the first time much later in life. Those with the disease who smoke tobacco are three times as likely to develop complications and are less likely to respond to treatment than non-smokers, so it’s essential that people diagnosed with Crohn’s disease stop smoking.



      Crohn’s disease diagnosis

      When being tested for Crohn’s disease, your doctor will initially look to see if you’re presenting symptoms, such as chronic abdominal pain, weight loss and diarrhoea.

      Blood tests can be taken to test for indications of the disease. Your doctor will look out for low levels of iron, vitamin B12 and folic acid, as well as raised ESR, CRP and platelet count.

      If your doctor suspects Crohn’s disease, they may send you for a CT or MRI scan, to help identify which areas of your gut are involved. Sometimes, they may refer you for a colonoscopy to confirm the diagnosis, by looking for signs in the colon and terminal ileum.



      Crohn’s disease treatment

      There is no cure for Crohn’s disease, although it can be controlled with treatment.

      Very mild forms of the disease may be controlled with simple medication that is safe for long-term use. More severe inflammation may require steroids, either in tablet form or by intravenous injection and targeted biologic therapy. This type of therapy works specifically to interrupt the inflammation and reduce Crohn’s disease activity with minimal side effects.

      There is no cure for Crohn’s disease, although it can be controlled with treatment.

      In more severe cases of the disease, surgery may be required, particularly if there’s abscess formation.

      Crohn’s disease is a lifelong, chronic condition, with periods of activity alternating with periods of remission, so long-term monitoring is therefore essential.



      Crohn’s disease lifestyle tips

      Many people with Crohn’s disease find lifestyle changes can be helpful in maintaining their symptoms and minimising flare-ups. These can include:

      ✔️ Regular exercise

      ✔️ Managing your diet

      ✔️ Reducing stress levels

      ✔️ Quitting smoking

      Furthermore, with the advent of the internet and the free flow of information, patients can now become well informed about their condition. New apps on mobile phones allow patients to monitor their condition at home and communicate with their specialists.



      Crohn’s disease dietary changes

      Diet plays an important role in the management of Crohn’s disease. People who suffer from the disease are sometimes recommended to adopt a neutropenic diet. This aims to help people reduce the amount of bacteria they consume in foods, which can help to settle the disease.

      People who suffer from Crohn’s disease are sometimes recommended to adopt a neutropenic diet.

      A neutropenic diet encourages avoiding fresh fruit and vegetables, and instead replacing them with frozen or cooked fruits and vegetables. This is particularly useful in children with the condition, as some treatments are associated with restricted growth, so it’s preferable to manage symptoms with diet where possible.

      Adults are advised to avoid smoking and adhere to a healthy, well-balanced diet, avoiding processed and preserved foods, such as pickled meat and vegetables and canned goods. Some patients find these diets very helpful.



      Crohn’s disease complications

      The gut plays a central role in general well-being, so diseases that affect the gut will affect patients in both obvious and subtle ways. These can vary from nutritional deficiencies, to menstrual irregularities, to diminished fertility, to mood changes.

      Deficiencies can generally be managed with the help of supplementation. Iron, vitamin B12 and folate deficiencies are easily correctable with either oral supplements or injections. Food supplements may also be necessary to reverse weight loss, while vitamin D levels need correction to help prevent osteoporosis.



      Last updated: 21-02-2020

      Consultant Gastroenterologist Dr Ray Shidrawi is a Consultant Gastroenterologist at The Wellington Hospital where he specialises in gastroenterology, sub-specialties, general gastroenterology, gastroscopy OGD, colonoscopy, flexible sigmoidoscopy, ERCP and endoscopic ultrasound.
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