What is Crohn’s Disease?

It is estimated that there are at least 1 in 323 people in the UK living with Crohn’s disease. It is a long-term, medical condition of the gut that causes painful swelling and ulceration.

Crohn’s disease causes sufferers to experience symptoms ranging from stomach cramps, diarrhoea and tiredness to anaemia, fever and weight loss.

Symptoms most commonly present early in life, with the majority of sufferers being diagnosed before the age of 30 and over 20% of people with Crohn’s finding out that they have the condition by the age of 21.

What is Crohn’s disease?

Crohn’s disease affects the gut and digestive system. It is a lifelong condition that can usually be managed, but it causes some painful and uncomfortable symptoms.

When people have Crohn’s, parts of their digestive system become inflamed. Their immune system starts to attack their own body which results in swollen tissue and ulcers.

Crohn’s can cause problems anywhere in the digestive system. The digestive system is the system of organs in the body responsible for chewing, swallowing, breaking down and processing our food as well as removing waste products.

Any part of the gut can be affected by Crohn’s symptoms including the:

• Mouth.
• Oesophagus.
• Stomach.
• Bowels.
• Colon.
• Anus.

The layers of the gut can be affected to varying degrees by Crohn’s symptoms. Sometimes only small parts are affected with healthy tissue remaining in between the inflamed areas. If the inflammation penetrates the middle and outer layers, an abscess or fistula can develop.

What causes Crohn’s disease?

The exact cause of the disease is still being studied by doctors and scientists, but it is thought that a mix of genetic factors and environmental triggers are involved.

Those with an impaired immune system may also be at a higher risk of developing Crohn’s or another form of Inflammatory Bowel Disease (IBD) such as Ulcerative Colitis. IBD is not the same as irritable bowel syndrome (IBS).

People suffer from the symptoms of Crohn’s disease differently. Sometimes, sufferers can go for long periods without any symptoms, then suddenly the condition becomes active again and they start to experience problems.

What are the risk factors for Crohn’s disease?

Although a single factor has not yet met the requirements to be labelled as a major ‘cause’ for the condition.

Some risk factors are thought to be associated with developing Crohn’s disease:

• AGE – Crohn’s disease can affect people of all ages but it is more common for symptoms to start early in life, either during childhood, adolescence or early adulthood.
• SMOKER STATUS – Studies indicate that the risk of developing Crohn’s is increased for smokers/nicotine users.
• FAMILY HISTORY – Many studies have identified a genetic element in developing Crohn’s.
• MEDICINE – Some prescribed drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics may affect symptoms and flare-ups.
• GASTROENTERITIS – After an incident of infectious gastroenteritis the risk of developing Crohn’s increases by four times, especially in the first year.
• GUT FLORA – Some research suggests that Crohn’s sufferers have less of the healthy bacteria living in their gut/stomach lining than non-sufferers and that some of the helpful bacteria they should have is not there at all.

Although you cannot safeguard yourself from getting Crohn’s disease, it might help your body if you adopt a healthy lifestyle. You should also ensure that any changes in your health or worrying symptoms you experience are investigated quickly.

What are the signs and symptoms of Crohn’s disease?

Some of the primary symptoms associated with the condition are:

• Diarrhoea.
• Stomach pain/aches.
• Abdominal cramps.
• Blood in stools.
• Tiredness/fatigue.
• Lack of appetite.
• Weight loss.

Other less common symptoms include:

• High temperature.
• Nausea/sickness.
• Mouth ulcers.
• Areas of painful, reddened and sore skin (often affecting the legs).
• Joint pains.
• Red/sore eyes.

Children with Crohn’s sometimes grow more slowly than their peers. Some of the medication prescribed for the condition can also affect growth in children.

For some sufferers, the symptoms of Crohn’s are constant and consistent. Others will experience flare-ups where they have periods without any symptoms, then they suddenly start up again. This can happen every few weeks or even months.

Does Crohn’s disease affect someone’s life?

Crohn’s disease is not curable at the moment. However, when managed correctly, Crohn’s disease is a condition that most people are able to live a full life with.

Many people find that the regular check-ups, medical appointments and unexpected flare-ups can cause significant disruption to their lives and routines.

This includes:

• Work or education.
• Family life/relationships.
• Social life.
• Hobbies.

Sufferers of Crohn’s will usually learn to live with the condition in their own way, adapting their lifestyle as they need to. Finding what works for you can be a case of trial and error, especially at first.

It is important that the friends, family, employers and teachers of someone with Crohn’s are understanding – plans might have to change last minute, physical performance can sometimes be limited and periods of time off to rest may be required. This is the reality of living with this kind of condition.

Some sufferers of Crohn’s may require the help and support of those around them. Others may prefer some space and alone time to process their diagnosis or manage their symptoms privately.

It is not a condition with a ‘one size fits all’ solution as there can be many factors at play. If you know someone who is being affected by Crohn’s disease, try to be empathetic and understanding and allow them to let you know what they need.

Other issues caused by Crohn’s

Crohn’s sufferers can also develop additional issues, both inside and outside the gut as a result of the condition.

These include:

• Fistulas – Around 1/3 of people diagnosed with Crohn’s will develop a fistula. This is when an abnormal tunnel develops and connects two organs that should not be connected. In Crohn’s sufferers, fistulas often develop between the bowel and other organs such as the anus, bladder or vagina. Surgery or medication is usually offered to repair the fistula.
• Strictures – This is where portions of the gut get narrower as a result of a cycle of inflammation and healing that causes scar tissue to form. Strictures can disrupt the ease in which food is passed and in extreme cases can cause a blockage. This can cause pain, nausea, bloating and constipation. Treatment includes surgery using a type of endoscopy to widen the affected area or medicine.
• Perforation – This is uncommon, affecting approximately 2% of those with Crohn’s. A perforation happens when a hole is made in the wall of the bowel meaning that the contents of the bowel leak through. Although rare, it is considered a medical emergency and requires immediate treatment.
• Osteoporosis – People with Crohn’s are at a greater risk of developing weak bones or osteoporosis. This can be the result of poor calcium and vitamin absorption, dietary restrictions (especially if dairy is a known trigger), steroid use or bouts of inflammation. Vitamin and calcium supplements can help with this as well as reducing prolonged steroid use.
• Cancer – Having Crohn’s can increase the risk of developing bowel cancer. The risk is relatively low but it increases the longer you have the condition. Those who require it should be offered bowel screening as part of their ongoing care plan by their doctor or specialist.

How is Crohn’s disease diagnosed?

If you have concerns about your health or you have noticed any unusual changes, you should make an appointment to see your GP immediately.

You will need to give your doctor information about your general health and recent activities, such as:

• Any symptoms you have been experiencing.
• When and how often you have had symptoms and how severe they are.
• Any recent travel abroad (infections and parasites can present similar symptoms to Crohn’s disease).
• Any medicine you take (prescribed, over the counter or herbal medicine).
• Any family history of Crohn’s or IBD that you know of.
• Your diet.
• Your general health and if you smoke.

It can be difficult to diagnose Crohn’s disease initially as the signs and symptoms of the condition overlap with many other illnesses and causes.

During your initial appointment, your doctor may need to examine your abdominal area for any tenderness or swelling, take blood to be sent for testing and ask you to provide a stool sample. Blood and stool samples can be checked for signs such as inflammation which can indicate Crohn’s disease (or other causes such as an infection).

If doctors suspect you have Crohn’s disease, they may also want to run some other tests to check for other problems or complications, such as:

• Blood tests to check for anaemia, B12 deficiency, vitamin D levels.
• Liver function tests.
• Electrolyte testing for dehydration.

You may also be referred to a specialist called a gastroenterologist for additional testing.

Here, you may have:

• A colonoscopy – This is a test to check inside the bowels. It is done by inserting a camera up the anus. The camera is on a long, thin, flexible tube and films images so that doctors can get a picture of what is going on inside your body. It can check for inflammation, swollen and irritated tissues, growths, polyps and other signs of abnormalities or disease.
• A biopsy – This involves removing small pieces of tissue from the bowel to be examined under a microscope and checked for signs of Crohn’s disease.
• An MRI or CT scan – These are special scans that use different types of technology to produce detailed images of parts of the body. They can be used to help diagnose and also monitor different conditions.

How is Crohn’s disease treated?

Your doctor or specialist will be able to advise you on the best treatment options if you are diagnosed with Crohn’s disease.

Common treatments to help manage the condition include:

• Medication.
• Surgery.
• Dietary changes.

Some sufferers of Crohn’s find that particular foods can trigger flare-ups. It may also help Crohn’s sufferers if they limit high residue foods. This might mean reducing fibre and limiting dairy. People with Crohn’s can learn to make sensible swaps so that they can still enjoy a varied diet containing the foods that they enjoy but without the increased risk of a nasty flare-up.

Once Crohn’s disease has been diagnosed, you can expect your doctor or primary care team to follow up with further support and treatment.

This may include:

• Assessments on how the symptoms are affecting day-to-day life.
• Help with stopping smoking.
• Offering information, resources or signposting you to support groups.
• Arranging a follow-up with a gastroenterology specialist.
• Prescribing and monitoring medication to manage the condition.
• Assessing relapse/flare-ups.
• Advice about vaccinations (as some medication can lower the immune system).
• Advice about contraception/family planning (the contraceptive pill may not be suitable for sufferers and some Crohn’s medication is not advisable during pregnancy).

Common medications used to treat Crohn’s include steroids. These are usually taken in tablet form or can be taken as an injection. They are effective at relieving symptoms by reducing inflammation, although long-term use can cause additional problems and side effects.

For youngsters with Crohn’s a liquid diet can be helpful. A doctor will prescribe drinks that are fortified with all of the nutrition that a patient requires, which can be used as a meal replacement for short-term use.

If steroids alone are not working as they should, some people with Crohn’s have to take immunosuppressant drugs. They reduce the activity of the immune system and can be used long term to reduce the risk of symptoms coming back.

When other medicines fail to work appropriately, some people have to take stronger medicines known as biological medicine. These are given intravenously as an injection or through a drip every 4–8 weeks.

In some cases, surgery may be required. A common operation performed on Crohn’s sufferers is called a resection. This is where small, inflamed sections of the bowel are removed using keyhole surgery and the healthy parts of the bowel are stitched back together.

How to prevent Crohn’s disease

There is no way to prevent Crohn’s disease.

Adopting a healthy lifestyle might help to reduce the impact of symptoms and help with flare-ups, such as:

• Stopping smoking.
• Eating a healthy, balanced diet (avoid any foods that you have identified as ‘triggers’).
• Reducing stress.
• Self-care (regular exercise, adequate amounts of sleep and staying hydrated).

There is currently no cure for Crohn’s disease or a way to prevent it although there are options including medication and surgery to help sufferers to alleviate and control their symptoms.

Having a condition that causes pain and discomfort, especially one that can flare up at any moment, can have an impact on a person’s emotional and mental health as well as affect them physically. If Crohn’s diagnosis is getting you down, try to take advantage of any help and support that is offered to you including local support groups and charities.

If you find that you are feeling anxious or depressed due to having Crohn’s, you are not alone. Talk to your GP if you feel anxiety or depression is impacting your life. They may offer talking therapies or medication.

For milder cases, there are some healthy coping mechanisms you can try at home such as:

• Gentle exercise and fresh air.
• Yoga or meditation.
• Mindfulness.

Your Crohn’s diagnosis is nothing to be embarrassed or ashamed about. Some people may feel that digestive problems are a taboo subject, but Crohn’s disease is a medical condition with no defined cause – it is not something you could have prevented. Try to be open and honest with those around you about the help that you require, take time out when you need to and practise self-care whenever possible.

If you have any concerns about your health, you should always make an appointment to see your doctor immediately.