Dr Tina Mehta, Consultant Gastroenterologist, speaks to us about Crohn’s Disease and how the condition is treated at Circle Bath.
Crohn’s disease, a form of Inflammatory Bowel Disease, is an auto-immune condition and is life-long. The commonest age of onset is between your teens and your early forties. It is considered to be a painful condition, with symptoms potentially presenting in any part of the gut, from your mouth to your anus. This can include:
- Mouth ulcers,
- Indigestion symptoms,
- Small bowel disease (causing weight loss, abdominal pain, nausea or vomiting),
- Large bowel disease (causing diarrhoea and the passing of blood, perhaps with a sense of urgency),
- General ill health such as lethargy, weight loss, anaemia, and loss of appetite.
These symptoms may change, depending on the severity of the condition, its location and its extent. If it presents in a mild form, you may experience abdominal pain and a subtle change in bowel habit, with the occasional presence of blood in your stool. When severe, you could undergo weight loss, significant abdominal pain, anaemia, and it may feel like you have a mass within your abdomen.
Inflammation through the gut can sporadically flare up in various places along the bowel. This may be in a section as small as a few centimetres but at other times could extend right through the bowel over a long distance.
Crohn’s disease is usually diagnosed with a combination of colonoscopy and an MRI of your small bowel. For your gastrointestinal tract to show up well in the MRI, you will most likely be required to take a ‘contrast agent’ orally. It is a good idea to drink lots after the scan to flush your system of the liquid.
If you are aged 25 or under, you might have an endoscopic test as well to examine your upper gut (as Crohn’s disease in the upper gut is more common if you are young). This involves passing a thin, flexible tube through your mouth, into the oesophagus (food pipe) and into your stomach and the upper part of your small intestine. The tube has a light and camera within the end, which allows me to examine for any inflammation of the upper gastrointestinal tract.
Treatments for the condition are largely with medication, starting as tablets and steroids as the mildest form of treatment. If these are ineffective, we can consider immune suppressing medications, progressing to immune suppressing injections for severe cases.
Most people who have Crohn’s disease will have periods of remission where they have no symptoms and feel healthy, and this is what I aim towards with my treatment plans. Each person experiences a different frequency and severity of flares where there is an escalation of symptoms, and you may have a period of feeling unwell again. Each person may recognise their own symptom pattern such as weight loss, diarrhoea, or abdominal pain that are signs that their condition is flaring and this allows rapid assessment and treatment.
Crohn’s disease is not curable with surgery, and usually is managed with medical therapy. Surgical treatment is indicated in a minority of persons, and is becoming less frequent as new medications have become available. I offer a personalised treatment plan to help with your symptoms. Throughout your care, I will be assessing your condition at regular intervals, allowing me to respond quickly if any new symptoms or complications arise. Inflammatory Bowel Disease can affect you in many ways, and I will often consult with colleagues from other specialties, if appropriate. This multi-disciplinary approach ensures that every aspect of your general health is taken into account.
It should be noted that Crohn’s disease gets significantly worse with smoking so I actively encourage all my patients to stop smoking. A healthy lifestyle in general is recommended, with a balanced diet and regular exercise contributing to good mental and physical health.
A controlled diet can be helpful in some cases, particularly in young adults, where normal meals can be replaced by food supplements, taken orally, to give the bowel a chance to rest. Nutritional therapies such as this can be effective for certain patients, and we can discuss this at greater length in a consultation to see if this is a good option for you.
As a chronic condition, a diagnosis of Crohn’s disease can seem disheartening. Whilst there is no outright cure, there are fortunately a number of treatments to help manage your condition. At Circle Bath, I am available to talk through your symptoms, take a medical history, and refer you for a variety of tests to rapidly respond to a flare up, as waiting times are short. After an initial diagnostic scan or procedure such as a colonoscopy to confirm the severity of the disease, I can develop a personalised treatment plan suited to your needs. With this personalised care backed up by a healthy lifestyle, many patients can go on to lead positive, fulfilling lives, unrestricted by their condition.