Tuesday April 11, 2017
At London Doctors Clinic, we're focusing on diseases of the gut this week, as part of IBS Awareness Month 2017. Having covered the namesake's topic, we're now moving on to cover similar diseases of the gut, starting with Crohn's Disease.
What Is Crohn's Disease?
Crohn’s Disease is a form of inflammatory bowel disease, which primarily affects people aged between 15 and 30, with a smaller peak in incidence in people in their 80s. It is caused by a combination of environmental, immune, infectious and genetic factors, but the exact mechanism is unknown. This article will cover the symptoms and complications associated with Crohn’s disease, how it can be diagnosed, and current treatments for the disease.
Crohn's Disease Symptoms
People with Crohn’s disease tend to have abdominal pain, and diarrhoea, which can look “porridge-like”. People with Crohn's may also experience increased flatulence and bloating.
Sometimes blood might be present in the stool, but this is more common in other forms of inflammatory bowel disease, such as ulcerative colitis.
These symptoms may, in turn, lead to malnutrition due to defective absorption of B12, folate and iron in the bowel. Crohn’s may follow a pattern of remission and acute flares )which is a period when the disease becomes more active).
Since Crohn’s disease can affect any part of the gastrointestinal tract (from mouth to anus), it is also associated with symptoms affecting the mouth (non-healing ulcers), the oesophagus and stomach (difficulty swallowing, vomiting), and the anus (anal fistulae, abscesses and fissures) - which may lead to itchiness around the anal area, or foecal incontinence.
Crohn's disease can affect any part of the gastrointestinal tract, including the mouth.
In addition to these gastrointestinal signs, patients with Crohn’s disease may have fever, weight loss and anaemia. As well as this, they may have extra-intestinal features, which means that it can affect a wide range of organs.
Crohn's disease may cause an inflammation of the interior portion of the eye (called uveitis), leading to blurred vision and pain when exposed to light.
Some people with Crohn's also experience a tender, red rash on the shins, or swollen, stiff joints (a form of arthritis).
Crohn's Disease Complications
In most cases, Crohn's disease is well managed, with no complications. However, one important complication for Crohn's sufferers to be aware of is called "toxic megacolon", where the colon is very dilated. This can cause symptoms such as fever, and may lead to life-threatening complications such septic shock and bowel perforation (the development of a hole in the bowel).
Sometimes, people with Crohn's (particularly those who have undergone surgery on their bowel) may develop bowel strictures (narrowing of the intestine, due to scars), which can lead to bowel obstruction.
While these events are rare, it's important to be aware of such complications and be on the look-out for the red-flag symptoms, as these are considered as an emergency, and should be treated with surgery.
Finally, if Crohn’s disease lasts for a long time and involves a large portion of colon, it can increase the risk of developing bowel and colorectal cancer. Screening for colon cancer is done through colonoscopy, and it is recommended for anyone who has had Crohn’s disease for at least 8 years.
Crohn's Disease Diagnosis
The majority of cases of Crohn’s disease can be diagnosed by colonscopy - a thin, flexible tube with a camera on, used to inspect the inside of the digestive tract.
If Crohn’s is only found in the small intestine, it may be more difficult to diagnose, as a traditional colonoscopy only allows visualisation of the colon and the lower part of the small intestine. For these cases, capsule endoscopy can be used, which involves swallowing a small capsule embedded with a camera.
A procedure known as a "barium swallow" can also be conducted, which involves the patient swallowing a liquid (containing barium), while having X-Rays taken.
Sometimes, a biopsy can also be carried out to examine the cells in the GI tract.
Crohn's Disease Treatment
Crohn’s disease has no cure, but symptoms can be controlled with lifestyle changes and medication. Since Crohn’s disease has an increased incidence in the industrialised world, it may be associated with an increased intake of animal protein, polyunsaturated fats, and smoking. Lifestyle changes involve eating more vegetable protein, portion control, regular exercise and sleep.
The symptoms of Crohn's Disease can be controlled with lifestyle changes, such as partaking in regular exercise.
In flare-ups of the condition, treatment primarily involves medication. These mainly act to treat the widespread inflammation associated with the disease. The first line of treatment is oral or topical corticosteroids, non-steroidal immunosuppressants, and antibodies (known as "Biologics") which help to suppress the immune system.
Surgery For Crohn's
Crohn’s disease cannot be cured with surgery, however complications associated with Crohn’s may be treated with surgery. Sometimes, parts of affected bowel can be removed as an elective procedure, if your doctor thinks these parts may be at higher risk of developing cancer.
Living With Crohn's Disease
Despite the lack of a medical or surgical cure, patients with Crohn’s disease can achieve a normal weight with treatment, and most people can live a generally disease-free life, with a normal lifespan.
In fact, the internet is overflowing with blogs following the incredible stories of people living with Crohn's, who manage to balance their chronic disease with their very successful lives!
If you would like to discuss any suspect bowel symptoms you may have noticed, we'd recommend booking an appointment with a private doctor at London Doctors Clinic, to discuss such matters further. We can arrange for thorough investigations, such as blood tests, and can also refer you to a specialist for specialist investigation and diagnosis of your condition. Together, we can work with you to provide better management of your symptoms, as to minimise the impact of the condition on your life!
By Jennie Han