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In this section you can find out more information regarding Crohn's Disease (CD)

Crohn's disease is a type of chronic inflammatory bowel disease (IBD) that leads to the development of inflammation in the digestive system.

It can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.

CD affects people of all ages. The symptoms usually start in childhood or early adulthood. The main symptoms of CD are diarrhoea, stomach aches and cramps, blood in stools, tiredness (fatigue) and weight loss. The symptoms may be constant or may come and go every few weeks or months.

In the UK, 400 in every 100,000 people have been diagnosed with Crohn's disease – this is equivalent to >270,000 cases in the UK.

What is Crohn's Disease (CD)?

References
1. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304 Accessed October 2022
2. CDC. What is inflammatory bowel disease (IBD)? Available at https://www.cdc.gov/ibd/what-is-IBD.htm Accessed October 2022
3. NHS. Crohn's Disease - Overview. Available at https://www.nhs.uk/conditions/crohns-disease/ Accessed October 2022
4. Crohn's and Colitis Care in the UK - The Hidden Cost and a Vision for Change. April 2021
5. King D, et al. Aliment Pharmacol Ther. 2020;51(10):922-934

Causes

The exact cause of CD is unknown. It's thought several things could play a role.

In a person with CD, there is a problem with the immune system (the body's defence against infection). The body attacks the digestive system causing inflammation.

There is no evidence to suggest a particular diet causes Crohn's disease.

Risk Factors

Factors that may increase the risk of CD include:

Genetics

CD tends to run in families.

Gut bacteria

An abnormal balance of gut bacteria.

Smoking

Evidence suggests that people who smoke have an increased risk of developing CD. Smoking has also been shown to make symptoms worse and can lead to greater risk of needing surgery.

References
1. NHS. Crohn's Disease - Overview. Available at https://www.nhs.uk/conditions/crohns-disease/ Accessed October 2022
2. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304 Accessed October 2022

Signs and symptoms of CD can range from mild to severe. They usually develop gradually over time, but can suddenly come and go - a flare-up is when symptoms come back.

The symptoms will vary from person to person, over time and will depend where Crohn's is in the gut.

The main symptoms of CD are:

  • Diarrhoea - which may come on suddenly
  • Stomach aches and cramps - most often in the lower-right part of the abdomen
  • Blood in stools / rectal bleeding
  • Tiredness (fatigue)
  • Loss of appetite and weight loss

Some people with CD also experience symptoms outside the gut during a flare-up such as:

  • A high temperature
  • Joint pain and swelling
  • Skin rashes
  • Mouth ulcers
  • Swelling in the eyes

What are the symptoms of CD? 1

What are the symptoms of CD? 2

References
1. NHS. Crohn's Disease - Overview. Available at https://www.nhs.uk/conditions/crohns-disease/ Accessed October 2022
2. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304 Accessed October 2022

CD can be difficult to diagnose because there is no definitive test for the condition. There are also quite a few conditions that have the same symptoms.

A diagnosis of CD is made by a doctor, assessing symptoms experienced, an examination, procedures, scans and blood tests. If CD is suspected, a referral to a specialist (gastroenterologist) is made.

Blood Tests

No blood test can definitively prove or rule out a diagnosis of CD. However, several tests can show possible signs of the condition.

Main blood tests used include:

  • Liver Function Test (LFT) - to see how well the liver is working
  • C-reactive protein (CRP) - measures inflammation levels
  • Full blood count - to check for anaemia (a lack of red blood cells making the blood unable to carry enough oxygen). Anaemia is common in people with CD although having anaemia does not confirm CD

Stool Tests

  • Tests for hidden (occult) blood or organisms, such as infection-causing bacteria.
  • Measures the level of calprotectin (a protein contained in white blood cells) to detect active inflammation in the intestine.

Procedures

  • Colonoscopy - examination of the colon (large intestine). Colonoscopies are often used to diagnose and to assess the extent and severity of CD. A narrow, flexible tube, long enough to examine the whole of the colon, and, if necessary, the lower end of the small intestine as well. It is inserted through the anus, into the rectum and then on into the colon.
  • A biopsy (tiny pieces of the bowel ) may be removed during a colonoscopy and checked for signs of CD.

Scans

  • Magnetic Resonance Imaging (MRI) scans - use magnets to look at what is happening inside the body and thickness of the bowel wall.
  • Computerised Tomography (CT) scans - use x-rays and a computer to create detailed images of the inside the body (sometimes called a CAT scan). These may be done with contrast material to improve the detail of the small intestine (involves drinking a liquid).

References
1. NHS. Crohn's Disease - Diagnosis. Available at https://www.nhs.uk/conditions/crohns-disease/diagnosis/ Accessed October 2022
2. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309 Accessed October 2022
3. Crohn's and Colitis UK. Tests and Investigations. Available at https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/healthcare/tests-and-investigations Accessed October 2022

There are a variety of treatments available for CD. There is no cure, but treatments can help control or reduce the symptoms and help them from coming back. The main treatments are medicines; however, surgery is sometimes required.

There are three main ways to treat CD:

  1. Medications
  2. Diet
  3. Surgery

Medications

There are three main groups of medications that are used to treat CD:

  1. Steroids – can relieve symptoms by reducing inflammation in the digestive system.

  2. Immunosuppressants – can be used to relieve symptoms if steroids on their own are not working. Immunosuppressants can also include biologics which target and suppress inflammation in the gut. Biologics can slow, modify or stop the disease.

Diet

A liquid diet (enteral nutrition) may be recommended to help reduce symptoms. This can improve overall nutrition and allow the bowel to rest, reducing inflammation in the short term.

Surgery

Advances such as biological medications have produced increasingly effective medical therapies for Crohn's disease. There have also been changes in the way surgery for Crohn's is managed. However, surgery remains an important treatment option, often in combination with medical therapies. Up to 8 in 10 people with Crohn's will need to have surgery at some point in their lives – but this number is reducing for some types of surgery. The main operation for CD is called resection – removing a small inflamed section of the bowel and stitching the healthy parts of the bowel together.

References
1. NHS. Crohn's Disease - Treatment. Available at https://www.nhs.uk/conditions/crohns-disease/treatment/ Accessed October 2022
2. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309 Accessed October 2022
3. Crohn's and Colitis UK. Surgery for Crohn's Disease. Available at https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/surgery-and-complications/surgery-for-crohns-disease Accessed October 2022

CD can be life changing. However, treatments can enable good control over symptoms and prevent long-term problems.

Lifestyle changes can help with managing CD and include:

Exercise – regular physical exercise maintains muscle and bone condition. However, it is important to keep a good balance between rest and exercise.

Healthy eating – there is no specific diet for patients with CD, however a balanced, nutritious diet will help to maintain a healthy weight. It is also important to drink enough fluids to avoid dehydration. Some patients make small changes to their diet to improve symptoms, for example avoiding high-fibre or spicy foods. A food diary can help identify if certain foods make symptoms worse.

Keeping well – keeping up to date with vaccinations and resting during a flare-up.

Medication – it is important to take medication as prescribed, even if symptoms reduce. Medication can help prevent flare-ups and reduce the risk of joint damage.

References
1. NHS. Crohn's Disease – Living with Crohn's disease. Available at https://www.nhs.uk/conditions/crohns-disease/living-with/ Accessed October 2022
2. Mayo Clinic. Crohn's disease. Available at https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309 Accessed October 2022

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