Crohn Disease

Crohn disease is a complex, long-term condition that falls under the umbrella of inflammatory bowel disease (IBD). It causes inflammation of the lining of the digestive system, which can unfortunately affect any part of the gut, from the mouth right down to the back passage. While the symptoms can vary greatly from person to person and fluctuate in severity, the impact on daily life can be significant. Living with Crohn's often involves managing uncomfortable symptoms, navigating dietary changes, and sometimes even undergoing surgery. 

Crohn disease is a chronic inflammatory condition primarily affecting the gastrointestinal (GI) tract. Unlike some other inflammatory conditions that affect specific areas, Crohn's can cause inflammation anywhere along the digestive system, though it most commonly occurs in the last section of the small intestine (ileum) and the large intestine (colon). The inflammation associated with Crohn disease tends to be "patchy," meaning there can be healthy areas of tissue between inflamed sections. This inflammation can extend deep into the layers of the bowel wall, leading to a range of symptoms and potential complications. It's a condition that can manifest differently in each individual, making diagnosis and management sometimes challenging.

While Crohn disease can affect any part of the digestive tract, it is often categorised by the primary area of inflammation. These include:

• Ileocolitis: The most common type, affecting both the ileum (last part of the small intestine) and the colon (large intestine).
• Ileitis: Inflammation is confined to the ileum.
• Crohn's Colitis (Granulomatous Colitis): Affects only the colon.
• Gastroduodenal Crohn disease: A rarer form that impacts the stomach and the duodenum (the first part of the small intestine).
• Jejunoileitis: Affects the jejunum (the middle part of the small intestine).
• Perianal Crohn disease: Involves inflammation around the anus, which can occur alone or alongside inflammation elsewhere in the gut.

The exact cause of Crohn disease remains unknown, but it's widely believed to be a result of a combination of factors, rather than a single trigger. Researchers suggest that an abnormal immune system response plays a significant role. In individuals with Crohn's, the immune system, which is designed to protect the body from harmful invaders, mistakenly attacks healthy cells in the digestive tract, leading to chronic inflammation.

Genetics are also thought to be a contributing factor, as Crohn disease can often run in families. If you have a close relative with the condition, your risk may be higher. Environmental factors are also under investigation, with theories including the impact of certain infections, diet (though diet doesn't cause Crohn's, it can influence symptoms), and even elements like air pollution. Smoking is also recognised as a significant risk factor.

The symptoms of Crohn disease can vary widely depending on the location and severity of the inflammation. They often come and go, with periods of active symptoms (known as "flare-ups" or "relapses") followed by periods of remission where symptoms are mild or absent. Common symptoms include:

• Recurring diarrhoea, often with blood or mucus
• Abdominal pain and cramping, which may worsen after eating
• Extreme tiredness (fatigue)
• Unintended weight loss and loss of appetite
• Fever
• Nausea and vomiting
• Pain around the anus due to perianal involvement

Less common symptoms can include joint pain and swelling (arthritis), skin rashes, mouth ulcers, and eye inflammation. In children, Crohn disease can sometimes lead to delayed growth or puberty.

Diagnosing Crohn disease can sometimes be a lengthy process as its symptoms can mimic other conditions. Your doctor will typically start by taking a detailed medical history, asking about your symptoms, diet, recent travel, and any family history of bowel conditions. They may also perform a physical examination, checking your pulse, blood pressure, temperature, and examining your abdomen.

Further diagnostic tests may include:

• Blood tests: To check for inflammation, anaemia, and infection.
• Stool samples: To check for blood, mucus, infection, or inflammation markers like faecal calprotectin.
• Endoscopic procedures: These involve a thin tube with a camera being passed into your digestive tract. Examples include:
  • Colonoscopy: To view the entire large intestine and the end of the small intestine.
  • Gastroscopy (upper endoscopy): To examine the oesophagus, stomach, and duodenum.
  • Capsule endoscopy: You swallow a small camera that takes pictures as it passes through your small intestine.
• Biopsies: Small tissue samples taken during endoscopy for microscopic examination.
• Imaging scans:
  • MRI scan (Magnetic Resonance Imaging): Provides detailed images of the bowel and surrounding tissues.
  • CT scan (Computed Tomography): Offers cross-sectional images of the bowel.
  • Ultrasound scan: Can sometimes identify inflammation and complications.

Currently, there is no cure for Crohn disease, but effective treatments can help manage symptoms, reduce inflammation, induce remission, and prevent complications. The treatment approach is highly individualised and depends on the severity and location of the disease.

Common treatment options include:

• Anti-inflammatory drugs:
  • Aminosalicylates (5-ASAs): Such as mesalazine, often used for mild to moderate inflammation.
  • Corticosteroids: Like prednisolone (Brands: Wysolone, Omnacortil) and Betamethasone (Brands: Betnesol), used to reduce inflammation rapidly during flare-ups. These are generally for short-term use due to potential side effects.
• Immune system suppressants (Immunomodulators): These medications reduce the activity of the immune system to decrease inflammation. Examples include azathioprine and methotrexate. They can take several weeks or months to become fully effective.
• Biologic therapies: These advanced medications target specific proteins in the immune system that contribute to inflammation. They are often used for moderate to severe Crohn disease and include drugs like infliximab, adalimumab, ustekinumab, and vedolizumab.
• Antibiotics: May be used if infections are present or to manage complications like abscesses.
• Dietary adjustments: While diet doesn't cause Crohn's, certain foods can trigger symptoms. A dietitian can help identify trigger foods and ensure adequate nutrition. Sometimes, a liquid diet (enteral nutrition) may be used to allow the bowel to rest.
• Surgery: Around 70% of people with Crohn disease will require surgery at some point. Surgery is not a cure but can be necessary to remove severely damaged sections of the bowel, address complications like strictures (narrowing of the bowel), fistulas, or abscesses, or to relieve symptoms when medication isn't effective. Common surgical procedures include bowel resection (removing the affected part and joining healthy ends) or creating a stoma (ileostomy or colostomy) in some cases.

• Genetics: Having a family history of Crohn disease or other IBD.
• Smoking: Significantly increases the risk of developing Crohn's and experiencing flare-ups.
• Age: Most commonly diagnosed between ages 15 and 40, but can occur at any age.
• Ethnicity: More common in Caucasian populations, particularly those of Ashkenazi Jewish descent.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Can worsen symptoms or trigger flare-ups.
• Oral contraceptives: May slightly increase risk in women who smoke.
• Geographic location: More prevalent in developed countries and urban areas.
• Previous infections: Some research suggests a link between prior stomach bugs and increased risk.
• Appendectomy: Having the appendix removed in recent years may slightly increase risk.

• Bowel obstruction (strictures): Narrowing of the bowel due to inflammation or scarring.
• Fistulas: Abnormal tunnels between parts of the bowel or between the bowel and other organs/skin.
• Abscesses: Painful collections of pus, often near the anus or in the abdomen.
• Anal fissures: Small tears in the lining of the anus, causing pain and bleeding.
• Ulcers: Open sores in the digestive tract.
• Malnutrition: Due to poor nutrient absorption and reduced appetite.
• Anaemia: Often caused by blood loss from inflammation or poor iron absorption.
• Increased risk of bowel cancer: Especially if the colon is affected for many years.
• Osteoporosis: Weakening of bones due to inflammation, malnutrition, or steroid use.
• Extraintestinal manifestations: Inflammation affecting other body parts like joints, skin, and eyes.
• Kidney stones: Increased risk due to changes in fluid absorption.

Living with Crohn disease can be challenging, but with the right strategies, you can significantly improve your quality of life.

• Manage Stress: Stress doesn't cause Crohn's, but it can certainly aggravate symptoms and trigger flare-ups. Incorporate stress-reducing activities like yoga, meditation, deep breathing exercises, or hobbies you enjoy into your daily routine.
• Understand Your Dietary Triggers: Keep a food diary to identify specific foods that worsen your symptoms. While there's no universal "Crohn's diet," many find certain foods like spicy dishes, high-fibre foods during a flare, or dairy products to be problematic. Work with a dietitian to ensure you're still getting adequate nutrition.
• Prioritise Sleep: Adequate rest is crucial for your body to recover and for your immune system to function optimally. Aim for 7-9 hours of quality sleep each night.
• Stay Active (as tolerated): Regular, moderate exercise can boost energy levels, improve mood, and support overall gut health. Listen to your body and adapt your activity levels during flare-ups.

"Crohn disease is the same as Irritable Bowel Syndrome (IBS)." 

This is a significant misconception. While both conditions affect the digestive system and share some symptoms like abdominal pain and diarrhoea, they are fundamentally different. Crohn disease is an inflammatory bowel disease (IBD) that causes chronic inflammation and damage to the GI tract, whereas IBS is a functional bowel disorder that affects muscle contractions in the colon and does not cause inflammation or permanent damage. The treatments for each are distinct.

"Bad eating habits or a poor diet caused your Crohn disease." 

This is false. There's no scientific evidence that specific foods or dietary habits cause Crohn disease. While certain foods can trigger or worsen symptoms in individuals, the underlying cause is complex and involves genetic, immune, and environmental factors.

"Crohn disease only affects adults." 

This is also incorrect. Crohn disease can affect people of all ages, including children and teenagers. In fact, a significant percentage of diagnoses occur before the age of 20, and childhood onset can sometimes lead to complications like delayed growth or puberty.

If you experience persistent changes in your bowel habits or any of the following symptoms, it's crucial to see your GP:

• Ongoing abdominal pain
• Diarrhoea lasting more than seven days
• Blood or mucus in your stool
• Unexplained weight loss
• Persistent fatigue
• Fever
• Any concerns about your child's growth or development

Seek urgent medical help if you experience severe abdominal pain, high fever with shaking, or if your stool is black or dark red (indicating significant bleeding).

• What specific part(s) of my digestive system are affected by Crohn disease?
• What are the long-term treatment goals for my Crohn disease?
• What are the potential side effects of the medications I'm taking, and what should I do if I experience them?
• Are there any specific dietary recommendations or restrictions I should follow, and should I see a dietitian?
• What are the signs of a flare-up, and when should I contact you if my symptoms worsen?
• What lifestyle changes, such as exercise or stress management, can help me manage my condition?
• What screening tests for complications (e.g., colon cancer, bone density) do I need and how often?

• Learn about Crohn disease, its varying symptoms, and its impact. The more you understand the condition, the better equipped you'll be to offer meaningful support and recognise their needs.
• Sometimes, your loved one just needs to talk about their feelings, frustrations, or fears without judgment. Offer a listening ear and validate their experiences. Avoid downplaying their symptoms or saying, "It could be worse."
• During flare-ups, simple tasks can be exhausting. Offer to help with groceries, cooking, childcare, or household chores. If they have appointments, offer to drive or go with them for support.

Crohn disease is a challenging and lifelong condition that impacts hundreds of thousands of people across the UK. While there is currently no cure, significant advancements in understanding and treatment mean that many individuals can achieve long periods of remission and maintain a good quality of life. By understanding the nature of the disease, its symptoms, and available treatments, and by adopting supportive lifestyle changes, those living with Crohn's can better manage their condition. Remember, open communication with your healthcare team and a strong support network are vital tools in navigating the complexities of Crohn disease.