Crohn's disease is a chronic inflammatory bowel disease; chronic meaning the condition is ongoing. Nobody knows exactly what causes Crohn's disease. It can affect any part of the gastrointestinal tract, so could involve developing mouth ulcers, inflammation and narrowing of the small bowel, or inflammation and narrowing in the large bowel. It’s one of the two main forms of Inflammatory Bowel Disease (IBD). The other is Ulcerative Colitis.
The symptoms of Crohn's disease can be anything from mild to severe. At the mild end of the spectrum, it can simply involve abdominal pain and a change in bowel habits. A patient may occasionally get blood in their stools and lose some weight. At the severe end of the spectrum, symptoms may include significant abdominal pain, a feeling of a lump within the stomach, a dramatic loss in weight, anaemia, and a shortage of protein. This can have particularly serious consequences if the patient is in their teens as it may affect their growth spurt.
Areas of inflammation can be patchy with parts of normal gut in between inflamed areas. A part of the inflammation may also be small, measuring only a few centimetres, or extend quite a distance along part of the gut. As well as affecting the lining of the bowel, Crohn’s disease may also go deeper into the bowel wall.
Nobody knows what causes Crohn's disease. Over the years there has been a substantial amount of research undertaken to attempt to identify the causes of the disease. Research has shown that whilst people can inherit a gene that allows the person to develop Crohn’s disease, it does not necessarily mean that it will cause the condition. It is also thought that there is a disorder in the immune response to something that is triggering the disease and there is an over activity of the immune system that attacks the bowel.
It can occur at any age, and in any ethnic group. However, the most common age group to develop the disease is late teens and twenties, although children and people over 60 can equally show signs of the condition.
The type of treatment for people with Crohn's disease depends on where it is within the gastrointestinal tract and how severe the condition is. If it has developed to the more severe end of the spectrum, the patient will normally start on a steroid, either prednisolone or one of the newer forms because these are the fastest-acting treatments.
If the patient comes under control with steroids, as does happen for the majority of those with Crohn's disease, they will then be prescribed a drug called azathioprine which turns down the volume on the immune system but takes two to three months to kick in and the patient will have to undergo regular blood tests. This is the usual treatment for the majority of people with Crohn's disease. The patient will also be advised very strongly to stop smoking if they do smoke. Quitting smoking has a highly beneficial effect on the gut and this simple act can be as strong as some of the medications prescribed.
If there is any narrowing in the bowel, then a fairly low residue diet might be recommended. The option for more severe Crohn's disease includes a group of medication called biologic therapy which mimics some of the antibodies that are produced in our blood and helps reduce the inflammatory response. If this does not work or there is substantial narrowing in the gut, then surgery may have to take place, but this is always reserved as the last resort for those who are extremely unwell.
The aim of treatment is to make the patient as healthy as possible and able to enjoy their life. As there is no cure for Crohn's disease, the only option is to manage the condition. Through treatment, the patient would hopefully get back to a normal lifestyle, both at work and in leisure, and the symptoms would be eliminated. Since treatment has advanced over the years, physicians now aim to try and turn the disease off altogether so that there is no possibility of the condition persisting under the surface, thereby improving the long-term health of patients.
Physicians discourage the use of steroids as a form of treatment in the long-term, and are usually prescribed for short term use. For example, a well-known drug is azathioprine and side effects can include a reduction in white blood cells which can lead to infections. However, this is usually well monitored, not only by regular blood tests but also at the start of treatment to make sure that an individual patient is not given too much of the drug.
The side effects of biologics may include skin irritation at the treated area, and rarer side effects may include neurologic disease, congestive heart failure, lung fibrosis, and liver toxicity. But side effects are rare, and the physician will go through this with the patient before any treatment is prescribed.
The majority of patients with Crohn's disease would be diagnosed, treated and under regular follow up by a medical gastroenterologist. Patients may be referred to a surgeon only if necessary.
What should the patient expect and what preparations should they take before undergoing treatment?
The physician will first explain the diagnosis to the patient which may come as a shock. Trying to get the patient used to the idea that there is no cure for the disease, and that it can only be managed in order to make their life as comfortable and normal as possible, can sometimes be a difficult process psychologically.
In terms of the treatment, it is encouraged that patients do their own research, through web sites like Crohn's & Colitis UK that explain the medications and the disease in more detail, and the Inflammatory Bowel Disease Service which will respond to queries either by e-mail or phone so that people who have issues or worries regarding their medication can receive quick and reliable advice.
Patients with Crohn’s disease should immediately stop smoking. They should take normal healthy living advice with regular exercise and a good balanced diet. It is also important to avoid foods that very obviously upset their digestive system.
While the general medical opinion is foods do not on the whole cause Crohn's disease, certain foods can cause symptoms and make the symptoms worse, either because the foods are getting caught up in a narrow area of the bowel or the patient is not allowing their bodies to rest enough. In addition to receiving medical treatment, a patient should consider psychological support if they feel they need it.
This very much depends on the severity and the position of the Crohn's disease within the body. The outlook for the vast majority of people is very good, but for a minority of people it is a chronic, debilitating disease that can cause major long term issues.