Crohn's Disease

Introduction

Crohn's disease, a type of inflammatory bowel disease (IBD), is a condition in which the lining of your digestive tract becomes inflamed, causing severe diarrhea and abdominal pain. The inflammation often spreads deep into the layers of affected tissue. Like ulcerative colitis, another common IBD, Crohn's disease can be both painful and debilitating and sometimes may lead to life-threatening complication.

While there's no known medical cure for Crohn's disease, therapies can greatly reduce the signs and symptoms of Crohn's disease and even bring about a long-term remission. With these therapies, many people afflicted with Crohn's disease are able to function normally in their everyday lives.

What causes Crohn's disease?

The exact cause is not known, but it is thought that the body's immune system overreacts to a virus or bacterium, causing ongoing inflammation in the bowel. Inflammatory bowel disease tends to run in families.

Smoking increases the risk of Crohn's disease, and it is more likely in people who eat a high-sugar, low-fibre diet.

Symptoms

The symptoms vary and depend on the severity and location of the disease.

  • Many patients only have mild symptoms for a long time and have often had the disease for several years before it is diagnosed.
  • Periods of mild fever, sometimes with blood in the stools, diarrhea, and pain in the lower right part of the abdomen.
  • Loss of appetite.
  • Unintentional weight loss.
  • Boils (cavities containing pus) and fistulas (formation of small passages that connect the intestine with other organs or the skin).
  • General malaise.

Additional symptoms that may be associated with ulcerative colitis include the following:

  • Nausea and vomiting
  • Joint pain
  • Gastrointestinal bleeding
  • Skin lesions/ rash
  • Liver diorders
  • osteoporosis
  • Kidney stones

Diagnosing Crohn's disease

The doctor will listen to a description of symptoms and carry out a physical examination. If your GP suspects you have Crohn's disease you will probably be referred to a gastroenterologist, a hospital doctor specialising in the digestive system. Your GP or gastroenterologist may recommend a range of tests. These include:

  • Blood tests - certain proteins that are present in the blood during active Crohn's can be tested for. Blood is also tested for anaemia, iron and vitamin deficiency and liver problems.
  • Stool tests - a stool sample may be tested for infections or other signs of the disease.
  • Sigmoidoscopy and/or colonoscopy - a thin telescope is inserted through the anus, to view the lining of the bowel. If any areas look like they may be affected by Crohn's disease, a small sample of the bowel lining may be taken for examination in a laboratory (biopsy).
  • Gastroscopy - a thin, flexible telescope (a gastroscopy) is inserted into the mouth and down the oesophagus into the stomach to examine the upper digestive tract.
  • X-rays - an abdominal X-ray can provide pictures of the large and small bowel and liver.
  • Barium enema - this involves filling the colon and rectum with a liquid containing barium, which shows up white on X-ray film.
  • Barium meal - the barium-containing liquid is put into the top part of the small intestine through a tube passed down the oesophagus and through the stomach.

These tests require no anaesthetic and are usually outpatient procedures. Ultrasound, CT and MRI scans may also be useful.

Treatment

Unfortunately, there is still no cure for Crohn's disease. Nevertheless, drugs and/or surgery can help reduce the inflammation and relieve the symptoms. Treatment aims to send the disease into remission during "attacks" or "flare-ups" (acute phase). To maintain remission, sometimes different treatments are used, including anti inflammatories, corticosteroids, immunomodulators, and monoclonal antibodies (anti-TNF alpha). In certain cases, antibiotics can be prescribed and surgery may be recommended. A change in diet can also lessen some of the symptoms in certain people.