What is Crohn's Disease?

Crohn’s disease is a chronic illness which causes severe inflammation of the digestive tract.  It is known for abdominal pain, diarrhoea and affecting the persons quality of life.  It is characterised by alternating between flare ups and remissions.  It was named after the person who first described the disease back in 1932, Dr Burrill B Crohn.

Crohn’s disease is included within a larger group of illnesses known as inflammatory bowel diseases (IBD).  It can appear anywhere along the gastrointestinal tract from the lips to the anus.  However, it is mainly found in the distal small bowel and colon.  Due to it developing anywhere within the intestinal tract it can make diagnose and treatment slightly difficult.

Over time, ulcerations can develop and extend through the layers of the intestinal tract. This can cause severe complications such as:

·         Strictures (intestinal narrowing)

·         Fistulas (abnormal tunnelling)

·         Anal fissures (painful tears in the skin around the anal area)

·         Ulcers of the gastrointestinal tract

·         Malabsorption

What Causes Crohn’s Disease?

The cause of Crohn’s disease is unknown. It’s an autoimmune disorder. That means that a combination of genetics and environment cause your immune system to attack your own intestinal cells.  At the moment there is research into the different fungus and bacteria which live within our bodies in our digestive track to see if there are any differences in how they work within our body to a person who has not got Crohn’s disease.

• What about age?
Crohn’s disease most affects people between the ages of 15 and 35.  But with all the new technologies within the hospitals there are children as young as 6months old being diagnosed with Crohn’s disease and Ulcerative Colitis.

• Family History?
Those with a family history of Crohn’s disease unfortunately are at a higher risk of having the illness.  Unlike myself I happened to be the first of many generations who had been diagnosed with Crohn’s Disease.  With me having it, there is a chance of 10-15% of my children having but if they are not diagnosed with it they can be a carrier just like all the other genetic illnesses out there.

• History of Autoimmune Disorders?
If other autoimmune disorders are present within the family or within yourself (such as rheumatoid arthritis and fibromyalgia) you have a higher risk for developing Crohn’s disease.

• Race/Ethnicity?
Although people of all races have the disease, Crohn’s is found more often among people from Eastern Europe and American Jews of European descent.

Symptoms

What Are the Symptoms of Crohn’s Disease?

Symptoms of Crohn’s vary depending on the severity of the disease and the location of the inflammation. The most common symptoms, however, are severe abdominal pain, bloating and cramping during a severe episode. Other symptoms can include weight loss, diarrhoea that may or may not contain blood or mucus, fever, and fatigue.

Because it involves the immune system, symptoms of Crohn’s disease can also be found outside of the gastrointestinal tract. The disease can also include arthritis, skin rashes such as; erythema nodosum, sores inside of the mouth such as; mouth ulcers or canker sores, osteoporosis, and kidney or gallstones.

How Is Crohn’s Disease Diagnosed?

Crohn’s disease is difficult to diagnose because the symptoms can mimic many other diseases, such as a parasitic infection, diverticulitis, a common disease found in the large intestine, Coeliac disease and colon cancer. Another reason that Crohn’s is difficult to diagnose is that there is no specific blood test to identify the disease.

A doctor will consider a variety of factors in diagnosing Crohn’s disease. These include:

· History and Physical Exam

Your doctor will begin with a detailed history of your symptoms and any ask about a family history of autoimmune disorders.

· Abdominal X-ray

This is done to check for any intestinal narrowing or obstruction, which can be a medical emergency.

· Ultrasound

An ultrasound will rule out diseases of other abdominal organs such as the liver, gall bladder, or pancreas.

· CT Scan or MRI

These imaging methods are used to determine any complications of the disease such as fistulas or abscesses.

· Colonoscopy

This is the gold standard for diagnosis of Crohn’s disease. A colonoscopy enables a doctor to see the inside of the intestinal wall and remove a tissue sample for further examination.

How Is Crohn’s Disease Treated?

Due to no known cure as yet for Crohn’s disease doctors can only try to prevent complications and control inflammation. Since the disease alternates between periods of remission and flare-ups, treatment focuses on helping you avoid any flare ups. Treatment varies based on the site and severity of disease as well.

Some treatment options include:

Medications

Many different medications are used to manage Crohn’s disease. They may be used alone, or in combinations.

· Corticosteroids can be used to control inflammation and quiet the immune system. Because of the side effects of chronic use, steroids are often prescribed for a short-term during a flare-up.

· Aminosalicylates are anti-inflammatory drugs that treat mild to moderate symptoms and help keep you in remission.

· Immunosuppressive agents are prescribed to help you maintain remission by calming an over-active immune system.

· Antibiotics are prescribed to prevent and treat infection or decrease the overgrowth of bacteria in the gastrointestinal tract.

· Biologic agents are similar to drugs used in chemotherapy and are given for more severe cases. These medications may be given orally, intravenously, or by self-injection.

Surgery

Depending on the location and severity of the condition, it may be necessary to remove a diseased portion of the intestine. Unfortunately, this doesn’t cure the disease. Crohn’s is a chronic illness that often will reoccur later in life. There are also times when it is necessary to remove an ulceration or blockage in the digestive tract.

Surgery is done cautiously and every attempt is made to preserve as much intestine length as possible to avoid further complications.

Nutrition

People with Crohn’s disease are often underweight because intestinal inflammation interferes with the absorption of food. Nutritional counselling and dietary supplements may be used to try and prevent malabsorption.

Stress Management

Stress can increase the frequency and severity of flare-ups. Stress management and emotional support are important to a successful treatment plan.

Can a Crohn’s Flare-up Be Prevented?

Crohn’s flare-ups cannot be prevented. Certain lifestyle changes, however, can decrease the severity of a flare-up:

· Dietary Changes

A low fibre diet can decrease bowel frequency and help reduce diarrhoea. Many Crohn’s patients find that diarrhoea and flatulence improves by limiting gas-producing foods such as beans, cabbage, broccoli, raw fruits, and juices. Limiting dairy has also been helpful in managing the condition. A dietitian may also recommend six small, frequent meals per day instead of three large ones.

· Stress

Limiting stress and learning to manage it with exercise and relaxation techniques can help decrease symptoms.

· Smoking

Recent studies have shown that even light or occasional smoking can increase the intensity of flare-ups.

· Compliance

Patients who have Crohn’s must take their medications exactly as prescribed and follow their treatment plan in order to prevent complications and hospitalisations.

Crohn’s disease can be a lifelong challenge. Following your doctor’s advice and sticking with your diet and treatment plan can greatly improve your quality of life.