Crohn’s Disease

Crohn’s disease is a condition that causes inflammation of the gastrointestinal tract (gut). The gut consists of the esophagus (gullet), stomach, and small and large intestine.

Crohn’s disease can affect any part of the gut. However, it most commonly occurs at the lower end of the small intestine, known as the ileum. Typical symptoms include pain, ulcers, and diarrhoea. Daily medication can be taken to relieve the symptoms but sometimes, surgery to remove part of the gut may be required.

This disease is not as common as ulcerative colitis in India but still very underreported. It affects females slightly more than males

The majority of people experience moderate symptoms from time to time and most (80%) will require surgery at some point. Rare complications, such as a perforated gut, can be life-threatening.

The symptoms of Crohn’s disease occur when the wall of the affected part of the gut becomes inflamed. The inflammation often causes one or more of the following symptoms:

The reason why these other symptoms occur is not fully understood. However, it is thought that they may be triggered by the immune system as a reaction to the inflammation of the gut.

The exact cause of Crohn’s disease is unknown. It is thought that there may be a genetic link because there is some evidence that it runs in families. One in ten people with the condition has a close relative who also has it.

A bacterium or virus (germ) may be a factor in the cause of Crohn’s disease. Some scientists think that in people who are genetically prone to the condition, a germ may trigger the immune system to cause inflammation in parts of the gut.

Crohn’s disease is more common in smokers and in women who use the combined oral contraceptive pill.

As well as weight loss and ill-health, there are a few physical signs that may indicate that you have Crohn’s disease. Sometimes, a mass can be felt in the abdomen when loops of inflamed bowels are stuck together. There may also be fatty stools.

A number of tests can be carried out to diagnose Crohn’s disease, and which ones are used will depend on the part of your gut that is affected. Tests that can be used include:

Medicines or steroids, to reduce inflammation in your gut, are commonly used to treat Crohn’s disease when it first develops. They are usually taken in oral tablet form, or as an enema (a tablet inserted into your anus), if the rectum or lower part of the colon, are affected

Steroids

If the symptoms of Crohn’s disease are severe, a course of steroids (corticosteroids) may be recommended for a few weeks. In most cases (70%), the symptoms improve within four weeks of starting steroids. Once the symptoms improve, the dose is gradually reduced, and then stopped. As steroids can cause side effects, they are not usually used as a long-term treatment.

5-aminosalicylate medicines

5-aminosalicylate medicines can be used as an alternative to steroids, to treat mild to moderate symptoms of Crohn’s disease. They include sulfasalazine, mesalazine, of salazine, and balsalazide. However, they do not always work and you may need to switch to steroids if your symptoms are severe.

Antibiotics and immunosuppressants

Some people with Crohn’s disease do not respond well to steroids or 5-aminosalicylate medicines. In such cases, a specialist may advise that you use antibiotics to combat infection, immunosuppressive medicines,such as methotrexate, antibody therapy (infliximab), or a combination of these treatments.

Diet

If you have particularly bad symptoms, which cannot be controlled using medicines, you may be given a strict diet to follow. In most cases, after sticking to the diet for a few weeks, the symptoms improve and a normal diet can be gradually resumed. The reasons why this works are not fully understood, but it is thought that some foods, such as dairy products, may trigger the symptoms of Crohn’s disease and that resting the gut may help.

Surgery

As a last resort, if other treatments do not work, surgery may be required to remove the affected part of your gut. The affected part is removed and the two ends are sewn together. Surgery may also be required to treat complications such as obstructions, abscesses, or damage to your gut.

Laparoscopic surgery

This is now commonly done for segmental resections and is ideal for crohns patients as most crohns patients need 4-5 surgeries in their lifetime and keyhole surgery helps patients to undergo future without risk of severe adhesions and difficulties of redosurgery

Other measures

Anti-diarrhoeal medicines can be taken to firm up your stools, and painkillers may be needed at times when your symptoms are particularly bad. If your symptoms are really severe, you may need to go to hospital to receive fluid intravenously (by a drip).

You may be prescribed iron tablets if you develop anaemia. Also, if your gut is not absorbing food properly, you may need to take vitamin supplements. If you smoke, giving up will often decrease the frequency of your symptoms

Complications arising from Crohn’s disease may occur, particularly if symptoms are frequent and severe. Complications that require surgery include:

Other complications of Crohn’s disease include iron deficiency, and problems with food absorption, due to scarring in the intestine, or because its length is reduced following a number of operations.

People with Crohn’s disease also have a slightly higher risk of developing bowel cancer compared with those who do not have the condition.