A B C D E F G H I J K L M N O P R S T U V W

CROHN'S DISEASE

What is Crohn's Disease ?

Crohn's disease is a condition involving inflammation in the bowel. It can affect any part of the gut from mouth to anus. However, it most commonly affects the small bowel near the appendix and the colon near the rectum (back passage. The main function of the small bowel is to absorb food, minerals and vitamins. When this part of the bowel is inflamed, absorption fails and various deficiencies may eventually occur. The colon's function is to absorb water from the bowel contents and form the more solid stools (faeces). When this part of the bowel is inflamed, liquid stools (diarrhoea) occur. The main symptoms of Crohn's disease are abdominal pain, diarrhoea, weight loss and generally feeling ill. The pain varies from mild discomfort to colicky pain, usually after food. The stools may be pale and float, due to all the fat which cannot be absorbed. Sometimes they contain blood, if the lower colon or rectum is affected.

How does Crohn's Disease occur ?

The cause of Crohn's disease is unknown. There are unproven theories that it is due to infection. The condition causes small ulcers in the gut which may penetrate deep into the tissue. The ulceration is not continuous. An area of normal bowel is often found between a couple of abnormal areas. Parts of the bowel may become narrowed by scarring, or loops of bowel can stick together from the inflammation. Both these problems can cause blockage of the bowel which causes pain and sometimes vomiting.

Why does Crohn's Disease occur ?

Crohn's disease occurs most commonly in early adult life and is becoming commoner. About 1 person in 4000 is affected. There is an increased incidence in some families. It is not known if this is due to factors which are inherited or in the environment.

Treatment Involved for Crohn's Disease

Certain tests will be performed to confirm the diagnosis. A barium meal involves swallowing liquid which outlines the stomach and small bowel while x-ray pictures are taken. A barium enema will show similar details in the large bowel. A sigmoidoscopy or colonoscopy consists of passing a narrow tube into the large bowel through the anus. It permits a piece of tissue to be taken (biopsy). This is examined under the microscope to confirm the diagnosis. Diet is part of the treatment. A well balanced high-fibre diet is advisable, unless there are narrowings or blockages of the bowel. Crohn's disease is usually treated with oral steroids (cortisone-like) drugs until improvement occurs. These drugs act by damping down the inflammation. Doctors try to avoid using steroids on a long-term basis, but sometimes it is necessary to control severe disease. Sulphasalazine or mesalazine tablets are used in Crohn's disease to help control the disease process and reduce the amount of steroids required. Azathioprine is a drug which dampens auto-immunity. Its use also allows the dose of steroids to be reduced. Antibiotics are occasionally needed to treat bowel infections. Vitamin B12 injections and other supplements are needed if absorption of vitamins is decreased. Anti-diarrhoeal drugs such as loperamide or codeine phosphate may be helpful if diarrhoea is a problem. It may be necessary for you to have an operation at some stage of the disorder in order to remove narrowed areas of bowel (strictures) and drain abscesses around inflamed bowel. Occasionally an operation may be needed to create an external opening of the small bowel through the skin for a short period of time (colostomy/ileostomy). Surgery is generally avoided where possible because the disease can recur even after all evidence of disease has been removed at the time of the initial operation. New classes of powerful drugs which act on the immune system are being used to treat some patients with Crohn’s disease but their use is confined to patients with specific complications not responding to other treatments.

During Treatment for Crohn's Disease

Crohn's disease responds to treatment, but sometimes very slowly. Prolonged courses of steroids and other treatment may be needed. Steroids can lead to water retention (swelling) and some increase in weight. Some people develop diabetes or a raised blood pressure. Steroids should not be stopped suddenly without medical advice: the body's own cortisone supply may not be able to deal with this change and a collapse could occur. Azathioprine can cause an increase in infections, anaemia and liver inflammation. Patients on this drug need regular blood tests. Sulphasalazine can cause nausea, skin rashes and anaemia. Mesalazine is less likely to do so.

After Treatment for Crohn's Disease

This is a disease which comes and goes. Many patients remain well, taking only medical treatment. However, as time passes, you may need an operation. Complications of longer-term Crohn's disease include arthritis, eye inflammation, rashes and kidney stones. Any unexpected symptom needs to be reported to the doctor quite quickly. A change of treatment may be needed.

If Crohn's Disease is Left Untreated

Without treatment, short-term wellbeing may not be affected. Some patients do get better themselves after mild flare-ups. Untreated the disease can be disabling whilst with effective treatment the aim is for patients to lead as near normal a life as possible.

Effects on Family of Crohn's Disease

People close to you will need to understand that the disorder waxes and wanes. Unpredictable flare-ups could easily interfere with plans that have been made. Crohn’s disease leads to reduced energy and may impact upon relationships within the family.