CONDITIONS
Crohn’s Disease
What is Crohn’s disease?
Crohn’s disease is a long-lasting inflammation of the gastrointestinal (digestive) tract.
Crohn’s disease commonly affects the small intestine and the beginning of the large intestine. Still, it can potentially impact any part of the digestive system, extending from the mouth to the anus.
What are the risk factors for Crohn’s disease?
Risk factors include:
- Genetics: Family history plays a significant role. If a close relative has Crohn’s disease, the risk is higher.
- Environmental factors: Certain environmental factors, such as smoking, diet (including high intake of fats and processed foods), and stress, may contribute to the development of Crohn’s disease or exacerbate its symptoms.
- Location where one resides: There is a higher incidence of Crohn’s disease in developed and urban areas than in developing countries and rural areas.
- Age: While Crohn’s disease can occur at any age, it is more commonly diagnosed in adolescents and young adults (before age 30), but it can also affect people in their 50s, 60s, 70s, or even later in life.
- NSAID use: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) [medications used to reduce pain, inflammation, and fever] may increase the risk of developing Crohn’s disease or exacerbating its symptoms in susceptible individuals.
What are the types of Crohn’s disease?
There are five types of Crohn’s disease, based on which part of the gastrointestinal tract is affected.
- Crohn’s (granulomatous) colitis: Affects the colon only.
- Gastroduodenal Crohn’s disease: Affects the stomach and duodenum (the first part
- of the small intestine).
- Ileitis: Affects the ileum.
- Ileocolitis: The most common form of Crohn’s disease affecting the colon and terminal ileum (the last section of the small intestine).
- Jejunoileitis: Produces patchy areas of inflammation in the jejunum (upper half of the small intestine).
What are the symptoms of Crohn’s disease?
The common symptoms of Crohn’s disease include:
- Abdominal pain or cramps
- Frequent diarrhoea
- Bloody stools
- Tiredness that does not improve with rest
- Unexplained weight loss
- Mouth ulcers
The individuals sometimes experience non-intestinal symptoms, which include:
- Arthritis or joint pains
- Pericholangitis is inflammation of the tissues around the bile ducts
- Rashes
- Eye inflammation, such as uveitis and episcleritis.
- Kidney stones
- Fistulas around the anal areas.
Children with Crohn’s disease may fail to develop or grow properly.
The symptoms can vary in intensity, ranging from mild to severe. Due to the chronic nature of Crohn’s disease, individuals will undergo periods of disease flare-ups, during which symptoms become active. However, in between these flare-ups, individuals may not experience any symptoms at all. These symptom-free periods, referred to as “remission,” can last for months or even years, although symptoms usually recur at some point.
How is Crohn’s disease diagnosed?
Diagnosing starts with obtaining a comprehensive medical history of an individual and their family, which includes detailed information about the symptoms. Additionally, a physical examination is conducted. As several other conditions can manifest similar symptoms to Crohn’s disease, the doctor relies on various medical tests to eliminate other potential causes for the symptoms, such as infection. These tests may involve:
- Stool tests: These are utilized to rule out infection or identify inflammation (fecal calprotectin test measures inflammation in the intestines).
- Blood tests: Can identify the presence of inflammation, abnormal antibodies, anaemia, or deficiencies in nutrition/vitamins. An elevated count of white blood cells can suggest the presence of inflammation or infection. Conversely, a decrease in red blood cell levels is indicative of anaemia, which is frequently associated with Crohn’s disease. Active inflammation may increase the C-reactive protein (CRP), a protein produced by the liver, which is checked by blood tests.
Imaging scans: Cross-sectional imaging involves utilizing computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to assess the intestinal tract and nearby structures for signs of inflammation or issues like strictures, fistulae, or abnormal fluid collections.
Endoscopy: A gastroenterologist may be consulted for the following procedures:
Balloon-assisted enteroscopy. This test utilizes balloons that inflate and deflate to maneuver a flexible tube known as an endoscope through the small intestine. A tiny camera on one end provides a visual of the interior of the guts. It is one of the nonsurgical techniques for examining the entire length of the gastrointestinal tract.
- Capsule endoscopy. A pill-sized camera is swallowed to allow the doctor to examine the small intestine closely.
- Upper endoscopy. This procedure is performed to examine the oesophagus, stomach, and duodenum. A flexible, illuminated tube is inserted through the mouth, passing through the oesophagus, reaching the stomach, and extending down to the duodenum, the initial segment of the small intestine.
- Colonoscopy or sigmoidoscopy. These procedures allow the doctor to examine the colon, the terminal portion of the large intestine, by introducing a flexible, illuminated tube through the anus.
What is treatment for Crohn’s disease?
The appropriate treatment for Crohn’s disease varies for each individual. The treatment plan will be determined based on symptoms, underlying cause, and the severity.
There are effective treatments available that can manage Crohn’s disease and potentially lead to remission. These treatments work by reducing the abnormal inflammation in the gastrointestinal system, promoting healing, and relieving symptoms like diarrhoea, rectal bleeding, and abdominal pain.
Medication
- Antibiotics fight infections and promote healing in the digestive system caused by Crohn’s disease.
- Aminosalicylates are anti-inflammatory medicines mainly used for ulcerative colitis but also benefit individuals with Crohn’s disease.
- Corticosteroids are prescribed for short-term anti-inflammatory relief.
- Immunomodulators help control or suppress the body’s immune system response, thereby reducing inflammatory activity, although their effects may take several months to become noticeable.
- Biologics, derived from living cell proteins, are reserved for individuals with moderate to severe Crohn’s disease. These medications are antibodies that stop certain proteins in the body from causing inflammation. They are currently offered in an injectable form or intravenous form.
- Loperamide can be used to manage diarrhoea, but consultation with a doctor is recommended before starting treatment.
Surgery
Despite receiving appropriate medication and following a strict diet, a significant percentage of individuals diagnosed with Crohn’s disease may need to undergo surgery at some point in their lifetime. Although surgery cannot completely cure Crohn’s disease, it can help preserve parts of the gastrointestinal tract and improve overall quality of life. Surgery becomes a viable option when medications are no longer effective in managing symptoms or when complications such as fistulas, fissures, or intestinal obstructions arise. Typically, surgical intervention involves removing the affected portion of the bowel (resection) and reconnecting the healthy segments (anastomosis). While these procedures may provide relief from symptoms for an extended period, it is common for Crohn’s disease to recur in the future.
How can one prevent Crohn’s disease?
Preventing Crohn’s disease is not possible. However, some strategies may help ease the symptoms and reduce flare-ups include:
- Stopping smoking
- Avoiding medications that can trigger flare-ups
- Managing stress
- Maintaining good nutrition
In summary, Crohn’s disease is a chronic gastrointestinal condition causing symptoms like abdominal pain, diarrhoea, and fatigue. Its exact cause is uncertain but involves genetic, environmental, and immune factors. Diagnosis includes a medical history review, physical exams, and imaging tests. Treatment aims to manage symptoms and inflammation through medications, dietary changes, and sometimes surgery. Good nutrition is essential for those with Crohn’s disease as symptoms like diarrhoea can hinder the absorption of important nutrients like protein, fat, carbohydrates, water, vitamins, and minerals.
References
- Cleveland Clinic. Crohn’s Disease. Available from: https://my.clevelandclinic.org/health/diseases/9357-crohns-disease. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs . Accessed on May 13th, 2024
- Crohn’s Disease: Symptoms, Causes, Treatment. Available from: https://www.webmd.com/ibd-crohns-disease/crohns-disease/digestive-diseases-crohns-disease . Accessed on May 13th, 2024
- National Institute of Diabetes and Digestive and Kidney Disease. Crohn’s Disease. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts. Accessed on May 13th, 2024
- CROHN’S & COLITIS FOUNDATION. What is Crohn’s Disease? Available from: https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-crohns-disease. Accessed on May 13th, 2024
