Crohn’s Disease

Understanding Crohn’s Disease

Crohn’s disease is a form of inflammatory bowel disease that causes persistent inflammation within the digestive system. This inflammation develops when the body’s immune system becomes imbalanced, leading to swelling and redness inside the digestive tract. The resulting symptoms commonly include abdominal discomfort and diarrhoea.

While Crohn’s disease can develop at any stage of life, it most frequently first appears in people during their twenties and thirties. The condition is more prevalent in Western countries, though it is becoming increasingly common in developing nations as well. Australia has one of the highest rates of inflammatory bowel disease worldwide.

Recognising the Symptoms

Common symptoms experienced by people with Crohn’s disease include diarrhoea, abdominal pain and cramping, fatigue, reduced appetite and weight loss. Additional symptoms may involve blood or mucous in the stools, mouth ulcers, fever, and pain or swelling around the anus, which may occur with or without discharge.

Symptoms tend to come and go over time, with the inflammation flaring up and then easing again in periods known as remission. The specific symptoms also depend on which area of the digestive system is affected. Not everyone with Crohn’s disease experiences the same combination of symptoms.

What Causes Crohn’s Disease?

The precise cause of Crohn’s disease remains unknown despite extensive research. Evidence indicates that genetic factors, infections and various environmental influences all play important roles. It appears that the interaction of these factors in susceptible individuals leads to the development of Crohn’s disease.

Crohn’s disease cannot spread from one person to another. Family members of people with Crohn’s disease face a slightly elevated risk of developing either Crohn’s disease or ulcerative colitis, but even when both parents have inflammatory bowel disease, their children still have more than a 60 per cent chance of not developing the condition.

Stress and dietary factors alone do not cause Crohn’s disease, although attention to both can significantly improve quality of life. Smoking increases the likelihood of developing Crohn’s disease and can worsen disease activity.

Understanding the Differences Between Crohn’s Disease and Ulcerative Colitis

Ulcerative colitis is another type of inflammatory bowel disease. These two conditions affect the digestive tract in distinct ways.

Crohn’s disease can affect any part of the digestive tract, from the mouth through to the anus. The inflammation extends through the full thickness of the bowel wall. Most commonly, Crohn’s disease affects the ileum (the final section of the small bowel), the colon, or both areas. Inflammation caused by Crohn’s disease may also affect other parts of the body, such as the eyes or joints.

Ulcerative colitis, in contrast, only affects the large bowel (the colon or rectum). The inflammation occurs only in the surface layers of the bowel lining, causing tiny open sores called ulcers to form.

Who Gets Crohn’s Disease?

Current estimates suggest that approximately 75,000 Australians are living with inflammatory bowel disease. Crohn’s disease often develops between the ages of 15 and 30, though it can begin at any age. While uncommon, diagnoses are becoming increasingly frequent.

When to See Your Doctor

Seeing your doctor if you experience any symptoms of Crohn’s disease is important. Your doctor may refer you to a gastroenterologist (a specialist doctor) for diagnosis and treatment. If you have been diagnosed with Crohn’s disease, seeing your doctor for a check-up at least every six months is recommended.

How Crohn’s Disease is Diagnosed

Diagnosing Crohn’s disease often takes time because the symptoms can be non-specific. When symptoms and signs are severe, diagnosis usually occurs promptly, but delays are common in milder cases.

Generally, unless symptoms have persisted for more than eight weeks, doctors first need to exclude bowel infections or gastroenteritis, which may result from contaminated food or following prolonged antibiotic treatment. In milder cases without rectal bleeding or weight loss, irritable bowel syndrome is often initially suspected, as it occurs far more commonly than Crohn’s disease. Any abnormal test results, however, should guide the diagnosis away from irritable bowel syndrome.

Tests that help identify Crohn’s disease include blood tests, which may reveal a low red blood cell count, raised white cell or platelet count, and elevation in CRP or ESR (markers indicating inflammation in the body). Blood tests also prove useful for identifying complications such as iron deficiency or other vitamin and mineral deficiencies. Faecal specimens may require examination to exclude infection and assess inflammation severity.

Most people require examination of part of the bowel, either through direct inspection using a flexible tube inserted through the anus (colonoscopy or sigmoidoscopy) or the mouth (gastroscopy), or through radiology imaging, which may include CT or MRI scans. During colonoscopy, small tissue samples called biopsies may be taken from inside the bowel and examined under a microscope to look for signs of disease.

No single test can reliably diagnose all cases of Crohn’s disease, and many people need several different tests. Depending on symptom severity, it can take six to eighteen months from first symptom onset until diagnosis is confirmed. In most cases, this delay does not lead to additional complications.

Treatment Approaches

Treatment goals focus on controlling inflammation, easing symptoms and correcting nutritional deficiencies when needed, all aimed at healing the gut. Treatment options involve medications, surgery, nutritional supplements or a combination of therapies, depending on disease location and severity.

Medications

Medications play a crucial role in achieving and maintaining remission, meaning freedom from symptoms and gut healing. The response to each medication differs between individuals, and many people require a combination of different drugs working together.

Various types of medications are available to address different aspects of Crohn’s disease. Some medications work by reducing inflammation directly in the bowel lining, helping to heal damaged tissue and prevent further deterioration. These anti-inflammatory treatments form the foundation of medical management for many people with Crohn’s disease.

Other medications work by modulating the immune system’s response. Since Crohn’s disease involves an imbalanced immune reaction, these medicines help to dampen the overactive immune response that drives the inflammation. Some of these immunosuppressive treatments take several months to reach their full effect, but they play an important role in maintaining long-term remission.

For people with moderate to severe Crohn’s disease who have not responded adequately to other treatments, advanced targeted therapies are available. These sophisticated medications work by blocking specific proteins or cells involved in the inflammatory process. Because they target inflammation very precisely, they can often induce gut healing more quickly. These treatments typically require injection, either under the skin or into a vein, and government subsidies may not be available for all patients. Many new therapies are currently under research and will hopefully become available in the near future.

Additional medications may be prescribed to manage specific symptoms or complications. Antibiotics help prevent or treat infections that can arise from disease complications. Medications to control diarrhoea may be helpful during flare-ups, though these should only be used for short periods. For pain management, paracetamol can be used safely, but certain pain relievers such as anti-inflammatory drugs and strong opioid medications should be avoided as they can worsen the disease.

The choice of which medications to use depends on the location and severity of your Crohn’s disease, how you respond to treatment, and whether you have experienced any side effects. Your gastroenterologist will work with you to find the most effective treatment approach for your individual situation.

The Importance of Taking Medications Regularly

Medications need to be taken regularly for the long term to control inflammation. If you don’t take medications as prescribed, even though you may feel briefly well, significant symptom flares and complications can result, affecting quality of life in the long term. However, some patients can have their dose reduced or be weaned off medications if disease is under good control, the bowel has healed, and after consultation with your treating specialist.

If you feel unwell while taking medications, rather than simply stopping them, talk to your specialist about ways to reduce side effects. Most medications are safe to take during pregnancy and breastfeeding, but this should be discussed with your specialist.

Surgery

Medication helps many patients, but for some it is not enough to relieve symptoms. Surgery for Crohn’s disease is sometimes needed to remove or widen sections of the bowel that are badly affected by the disease. The healthy ends of the bowel are usually reconnected to each other.

Sometimes a stoma (an artificial opening in the abdomen that diverts faeces into a bag outside the body) is needed. A stoma can be temporary or permanent. It is normal to feel uneasy about the idea of living with a stoma, but many people find it greatly improves their quality of life.

Nutritional Therapy and Diet

Nutritional therapy such as exclusive enteral nutrition for active Crohn’s disease or supplemental enteral nutrition generally is important to maintain remission and provide nutritional support. These consist of liquid nutritional supplements, some of which are dairy-free.

Most people with Crohn’s disease do not need dietary restrictions and can eat a healthy balanced diet. Good nutrition is very important. Some foods can trigger symptoms for different people, so certain dietary changes may help improve symptoms. For example, spicy or fatty foods and foods with high fibre content (such as some fruits, vegetables, nuts and wholemeal grains) can worsen symptoms. Speaking to your specialist or dietician about what nutritional steps would be best for you is recommended.

When active disease is present, sometimes particular nutrients are difficult for the inflamed gut to absorb. After blood tests, some people may need to take vitamin tablets or require vitamin B12 injections or an iron infusion.

Emotional Support

As with other illnesses, stress may worsen symptoms, so stress management and emotional support may help in combination with medical treatment. Speaking to your doctor, psychologist or psychiatrist about what management would be best for you is worthwhile. Joining inflammatory bowel disease support groups locally or through online communities may also prove helpful.

Living Well with Crohn’s Disease

The vast majority of people with Crohn’s disease lead normal lives, even though they need to take medications. When their disease is in remission, they feel well and are usually free of symptoms. People with Crohn’s disease can marry, engage in sexual activity and have children. They can hold down jobs, care for families and enjoy sport and recreational activities. With current medical treatment, life expectancy is normal.

Special Considerations

Pregnancy

Crohn’s disease has no direct effect on fertility in either males or females. The single most important factor for a successful pregnancy and delivery is having your Crohn’s disease under control before attempting to become pregnant and during pregnancy. Poor outcomes usually result from active disease, not from medications. Therefore, discussing with your specialist before attempting pregnancy and continuing your medications, unless a decision is made with your doctor to cease them, is important.

Travelling

Whether going on a short or long trip, travelling with Crohn’s disease can present special challenges such as risk of flare, infections and travelling with certain medications. Sometimes medications can suppress your immune system, so caution is required when travelling to places with high infection risks. Talking to your doctors and planning ahead is essential.

Vaccination

People with Crohn’s disease may face increased risk of infection because of immune suppressive medications. Some of these infections are preventable with timely vaccination, such as flu vaccination. However, live vaccinations should be avoided. Talking to your doctor about vaccination if you are not already up to date with your vaccination schedule is recommended.

Screening for Cancer

Being more diligent with cancer screening compared with the general population is important. Ensuring you are up to date with skin checks and cervical screening is advisable.

Smoking

Smoking can worsen symptoms considerably in Crohn’s disease. Giving up smoking is as beneficial as taking a medicine and reduces the risk of flare by up to 65 per cent.

Other Considerations

When starting new medications or undergoing any invasive procedures or surgery unrelated to your Crohn’s disease, letting your doctor know is important.

When to Seek Urgent Medical Attention

Severe abdominal pain, persistent vomiting accompanied by constipation, significant or new rectal bleeding, drastic changes in bowel movements, high temperature, severe fatigue or tiredness, weight loss, red itchy eyes, sores in the mouth, swollen and painful joints, or bumps or lesions on the skin all warrant urgent medical attention.

Preventing Flare-ups

While you cannot prevent Crohn’s disease from developing, you can reduce your risk of flare-ups by quitting smoking, taking your medicines as prescribed and maintaining a healthy lifestyle. Regular follow-up with your doctor or specialist can help keep your symptoms under control.

Possible Complications

Dietary Deficiencies

It is possible to develop vitamin or mineral deficiencies or become malnourished. Your doctor or dietitian can advise you on managing these.

Risk of Osteoporosis

People with inflammatory bowel diseases often have many risk factors for developing osteoporosis, including poor nutrition, low body mass index, chronic inflammation and treatment with corticosteroids. To manage your risk, your doctor may recommend screening for osteoporosis with regular bone density scans.

Bowel Obstruction

Crohn’s disease can cause bowel obstruction. This is a medical emergency requiring hospital treatment. Symptoms of bowel obstruction include increasing abdominal pain and cramping that comes and goes, as well as vomiting.

Other Gut Complications

Crohn’s disease can cause complications anywhere in the gut. Complications around the anus can include abscesses (boils), flaps of thickened skin and anal fissures.

Fistulas are another possible complication. Fistulas are tunnels that connect the bowel to other parts of the gastrointestinal tract, to other organs or to the outer skin surface. Fistulas usually develop in areas of severe scarring and ulceration.

Inflammation in Other Parts of the Body

Some people with Crohn’s disease can develop inflammation in other parts of the body, such as the liver, skin, joints or eyes.

Support and Further Information

Our Brisbane-based Gastroenterologists have extensive experience in diagnosing and managing Crohn’s disease. We provide comprehensive care tailored to each patient’s individual needs, working closely with your GP to ensure the best possible outcomes.

For additional support and information, Crohn’s and Colitis Australia provides valuable resources and can be contacted on their IBD helpline (phone 1800 138 029). The Gastroenterological Society of Australia also offers patient education resources. For information about living with a stoma, the Australian Council of Stoma Associations provides support. To find an accredited practising dietitian, the Dietitians Association of Australia can help.

If you are experiencing symptoms or have concerns about Ulcerative Colitis, please contact our rooms to arrange a consultation with one of our gastroenterologists.

This information has been sourced and adapted from education resources developed by Health Direct Australia and GESA.