What is Crohn’s disease?
Crohn’s disease falls into a family of conditions known as inflammatory bowel diseases, along with another condition, called ulcerative colitis.
Crohn’s effectively causes swelling or inflammation of the digestive system and bowels. In Crohn’s disease, any part of the digestive system can be affected it is more common for parts of the lower intestine (small bowels) to be affected. However, given that the digestive tract is essential one very long tube, starting from the mouth, and finishing at the bottom (anus), any part can potentially be affected.
Crohn’s Disease is a long term or chronic condition. This means it is a life-long condition. However, there are excellent treatments that can keep your Crohn’s at bay, and help to ensure you have few or no symptoms. From time to time, you may experience a flare-up but most can be managed with the help of your GP.
What are the Symptoms of Crohn’s disease?
Crohn’s disease symptoms can range from:
- Mouth ulcers
- Abdominal pains (pain in the tummy)
- Loose stools or diarrhoea
- Bloody stools
- Children may fail to gain weight or grow slowly
- Low blood count (anaemia) may be noted on blood tests
- Mucous in the stools
- Unexplained loss of weight
You may have one or more of Crohn’s disease symptoms, you do not need to have all the symptoms for your doctor to diagnose you with Crohn’s disease
Who gets Crohn’s disease?
Anyone may develop Crohn’s disease at any age. However, we tend to see most people diagnosed as young adults between 15 and 40. Crohn’s is more common in those who have a family history of inflammatory bowel disease. Whilst Crohn’s may affect any ethnic group, it can be seen more commonly in patients of Ashkenazi Jewish descent. Men and women are equally as likely to develop Crohn’s disease.
How do we diagnose Crohn’s disease?
If you have any symptoms suggestive of Crohn’s, then you should see your GP. They will take a full and comprehensive history of your symptoms and perform an examination of your tummy. They may ask you to perform a stool sample called faecal calprotectin, which is readily available from your private GP. This test helps to risk-stratify patients with possible Crohn’s disease.
Your GP will refer you to see a specialist Gastroenterologist (gut & bowel doctor). They are likely to complete a camera test to look inside the digestive tract. This is known as an endoscopy. This allows them to take picture of the bowel, and take a sample, or biopsy, which can be examined under the microscope to determine if you do have Crohn’s disease.
Are there any other signs of Crohn’s disease?
Crohn’s disease may also give symptoms outside of the digestive tract/bowels. We refer to these as the extra-gastrointestinal symptoms.
These may include:
- A skin rash (erythema nodosum)
- Joint Pains
- Red and painful eyes (Scleritis & Uveitis)
What are the treatments available for Crohn’s disease?
Steroid treatment
Crohn’s disease has several treatment options, all of which aim to reduce the inflammation that is occurring with the digestive tract, with the purpose of reducing your symptoms.
One of the most commonly used treatments are steroids, such as prednisolone. Prednisolone is typically taken as tablets, and work quickly to reduce inflammation. Steroids may also be given intravenously, by drip, and this may be necessary if you are having a severe flare-up of your symptoms.
Steroids can also be administered by enema, which is a highly effective way of delivering these powerful medications exactly where they are needed.
Non-steroidal treatment
Because steroids are not typically taken on a long-term basis, we will aim to switch people to non-steroid based medications.
In Crohn’s disease, we tend to use medications such as:
- Methotrexate
- Ciclosporin
- Mercaptopurine
These medications are very good at controlling the symptoms of Crohn’s.
Where these medications have failed to provide adequate symptom control, we may utilise newer medications. These are often referred to as biological treatments. They include drugs such as Infliximab and adalimumab (Humira). These are specialist medications, often given by injections, that help to keep Crohn’s symptoms under control.
Surgery
In some instances, surgery to remove affected parts of the bowel may be necessary. This is usually performed when medical treatments have failed to control symptoms, or when there have been complications of Crohn’s. Complications occur as a result of long periods of swelling of the bowel, the swelling and inflammation can cause narrowing, known as strictures, or complete blockage, known as obstruction. If the bowel is obstructed for a long period of time, this can result in a perforation of the bowel.
When to see a GP
To help avoid the development of any of these complications, it is key that you see your GP if you have any of the symptoms of Crohn’s, so you can be tested and treated as soon as possible. You can see a private GP at London Doctors Clinic on the same day if you are worried or presenting with any of the symptoms.
Article written by Dr Daniel Fenton, General Practitioner & Clinical Director at London Doctors Clinic
Published: October 2018
Review date: October 2021