A type of Inflammatory Bowel Disease (IBD), Crohn’s disease is a lifelong condition that causes parts of the digestive system to become inflamed. The inflammation can cause a range of symptoms from painful cramping and diarrhoea to weight loss and fatigue.
Sometimes, one may also experience symptoms that present themselves in other areas of the body, these are called extraintestinal manifestations of Crohn’s disease. These symptoms might not initially be linked to the bowel as they are not apparent in this area of the body, as such the sufferer may not realise these are signs of Crohn’s disease.
Symptoms can be constant or sufferers may experience frequent Crohn’s disease flare-ups, often without warning or any apparent reason.
Crohn’s disease is an Inflammatory Bowel Disease which causes parts of the digestive system to become inflamed and can cause intense abdominal pain and cramping, among its many potential symptoms. The inflammation can affect anywhere along the gastrointestinal tract. The most common location, however, is the end of the small bowel called the ileum. When this part of the bowel becomes inflamed it is known as ileitis.
There is no cure for Crohn’s disease, however, treatment can reduce symptoms so life can be lived normally and reduce the likelihood of complications. With a tailored treatment plan and/or surgery, affected people can live free of Crohn’s symptoms for many years to come. Unfortunately for some patients despite the highest intensity of treatment they will still continue to have ongoing symptoms and complications of the condition.
Crohn’s can lead to secondary conditions such as bowel cancer, weak bones or a lack of iron (due to the body’s difficulty absorbing nutrients from food), and damage to the bowel that may require surgery. Therefore, it is important to receive regular follow up through a specialist gastroenterologist to ensure that the treatment plan is optimised for each individual.
First described by Dr. Burill Crohn in 1932, Crohn’s disease is an autoimmune condition where the immune cells of the body incorrectly attack the cells within the gut. However, the exact cause of Crohn’s disease is unknown. Research into Crohn’s is ongoing but as yet, a comprehensive cause for the disease is yet to be discovered.
Some evidence suggests that Crohn’s has a genetic component. It is thought that Crohn’s disease may occur following exposure to an event, such as a stomach bug, however, this is not proven at this point.
Crohn’s disease typically starts between 15-40 years, however, between 50-60 years of age there is another rise in incidence.
Smoking is believed to exasperate symptoms and smokers are actually more than twice as likely to develop Crohn’s disease. Whilst associations have been suggested for specific diets and Crohn’s disease, these are largely unproven or have weak associations.
Symptoms usually start in childhood or early adulthood and include:
Crohn’s disease symptoms in females and males tend to be the same, and the disease is equally likely to affect men as women in Western countries. However, Crohn’s disease tends to be higher in males in Asian populations. Symptoms may be continuous or come and go weekly or monthly. When people experience a recurrence of active inflammation, these are called flare-ups.
One may also experience extraintestinal manifestations of Crohn’s disease. These symptoms may present themselves before gastrointestinal symptoms become apparent. Extraintestinal manifestations may include:
No, there are not different types of Crohn’s disease, however, there are different names to describe where the inflammation is located in the gastrointestinal tract. They are:
As it shares symptoms with other bowel conditions, Crohn’s can be hard to diagnose in some individuals.
As such, unless an emergency admission is required, a GP will usually complete a thorough assessment where they will ask about:
A physical examination may also take place whereby the GP may feel and examine the stomach and/or take a blood sample. Additionally, a stool sample will often be requested which can be tested for inflammation and infections.
If a GP suspects Crohn’s disease is the reason for symptoms, they will make a referral to a gastroenterologist for tests which can determine whether or not Crohn’s is the cause. These tests may include:
Whilst there is no cure, treatment for Crohn’s disease aims to reduce episodes of active inflammation and to reduce symptoms.
There are different medications to treat Crohn’s disease and sometimes surgery is an option.
Steroids are commonly prescribed for Crohn’s in the first instance to induce remission, and reduce inflammation. They can however have side effects including weight gain, indigestion, sleep disturbance, and increased risk of infections (as they reduce the body’s immunity) and in children, can result in slower growth.
As maintenance therapy, most individuals are prescribed other anti-inflammatory agents known as steroid-sparing agents. Depending on the severity of the disease and whether the condition is resistant to first-line options there are a few different management options. Some patients may require more aggressive immunosuppressive therapies commonly referred to as biological therapies. These target a specific aspect of the immune system to reduce inflammation and as with steroids and other immunosuppressants are started by gastroenterologists.
For people with a Crohn’s diagnosis, it is also important to make changes to their lifestyle. In those who smoke tobacco, one of the most important changes they can make is to stop smoking. No specific diets have been shown to aid in the reduction of inflammation associated with Crohn’s disease, however, some individuals may need to avoid certain foods because of inflammation and scarring in different parts of the gut. Changes to diet should ideally be supported by a trained professional, such as a dietician to reduce the risk of vitamin and mineral deficiencies.
Surgical treatment may be required as an emergency or on an elective basis to treat areas of inflammation that are refractory to best medical therapy or complications such as narrowing of the bowel or the development of fistulae. However, as Crohn’s disease can affect any part of the gastrointestinal tract there is no guarantee that surgery is curative for any individual.
A specialist will discuss all possible treatments with their patient and a suitable Crohn’s treatment plan will be agreed upon together. This can be reviewed further down the line to ensure the best plan for the individual is in place.
Research into the effect of medicinal cannabis on pain associated with Crohn’s disease is limited. However, following the legalisation of cannabis for medical purposes in 2018, there has been a rise in people looking towards medical cannabis. When first-line therapies have not proved effective at reducing symptoms, medical cannabis may be considered an option for Crohn’s disease. For further information and to find out more about medical cannabis, click here to discover more about our multi-award-winning Sapphire Access Scheme. Alternatively, complete an eligibility assessment now. Once complete, one of our clinicians will review your application and advise whether you are eligible for progression to an appointment.
The disease itself is not fatal, however, complications from Crohn’s can lead to life-threatening ailments if left untreated. It is therefore very important to establish a treatment plan with a specialist upon diagnosis and to ensure that any individual has regular endoscopies and clinical follow-up.
Rather than being directly hereditary from a parent, Crohn’s disease has some genetic inheritance. This means that the disease could be in your genes as opposed to having been passed down through generations. If you have a close family member (parent, sibling, aunt, uncle, etc) with Crohn’s, you are more likely to develop the disease, but not everybody with Crohn’s disease in a first-degree relative will also get Crohn’s disease.
A specialist will test for Crohn’s disease in one or more of the following ways:
Colonoscopy: A procedure by which a small camera is inserted anally to inspect the bowel for signs of Crohn’s disease.
Biopsy: The removal of tiny parts of the bowel to check for signs of Crohn’s disease
CAT or MRI scan: A non-invasive procedure requiring the patient to drink a barium sulphate mixture to ensure the bowel shows clearly on the scan.
The symptoms of Crohn’s can be debilitating, exhausting and painful. It is a lifelong disease that, if not treated/managed, can result in several serious illnesses and/or complications. Whilst the disease itself is not considered life-threatening, complications from untreated Crohn’s can be, so it is a serious disease requiring appropriate attention.
The exact cause is unknown, research is ongoing to establish whether there is one main cause of Crohn’s. Suspected causes of Crohn’s disease include:
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