Inflammatory Bowel Disease: Conditions
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Crohn's Disease

November 11th, 2008 by Stephen Doogan

Published by Bupa's health information team, February 2008

What is Crohn's disease?

Crohn's disease is due to inflammation of the wall of your bowel. It can affect any part of your digestive system, from your mouth down through your stomach and bowel to your anus. However, it's most common in your small bowel or the first part of your large bowel. It may affect more than one section leaving unaffected areas in-between.

If you have Crohn's disease, you will have inflammation and swelling in affected areas of your bowel and ulcers may form. These are raw areas of the bowel lining which can bleed. Your bowel wall will be thickened and this may cause blockages.

Illustration showing the areas of the bowel commonly affected by Crohn's disease
The areas of the bowel commonly affected by Crohn's disease

Symptoms

Crohn's disease is a chronic condition. This means that it lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not to how serious a condition is. Crohn's disease is characterised by flare-ups of symptoms. These alternate with periods of no symptoms at all - this is called remission. Usually there is no obvious trigger for the symptoms coming back (a relapse). When you have symptoms, the disease is said to be active. Symptoms include:

  • diarrhoea - it may contain blood, pus or mucus
  • a painful and swollen abdomen (tummy)
  • loss of appetite
  • weight loss
  • fever
  • rectal bleeding - this may lead to anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood)
  • tears, ulcers or abscesses (pus-filled areas) around your anus

Active Crohn's disease may cause other problems such as:

  • mouth ulcers
  • joint pain
  • eye inflammation
  • rashes
  • ulcers on your skin
  • fertility problems and, in women, an increased risk of miscarriage

Complications

With severe, long-term inflammation, you may develop complications. These include:

  • a fistula - an abnormal connection between two parts of the body, most commonly between your bowel and your skin
  • an abscess in your abdomen
  • a stricture (narrowing of the bowel) - this can be caused by scar tissue that builds up after inflammation and may block your bowel
  • a slightly increased risk of developing bowel cancer if you have had Crohn's colitis (Crohn's disease of the colon - your colon is part of your large bowel) for more than eight to 10 years

Causes

The exact reasons why you may develop Crohn's disease are not fully understood at present. However, it's thought that you are more likely to have Crohn's disease if your immune system (your body's defence system) overreacts to bacteria within the bowel leading to ongoing inflammation. Crohn's disease tends to run in families and researchers have identified genes associated with it.

Certain lifestyle factors, such as smoking, mean you are more likely to develop Crohn's disease. The role of diet in causing Crohn's disease isn't fully understood. However, it's possible that you are more likely to develop the condition if you eat a diet that is high in sugar and low in fibre.

Diagnosis

Your GP will ask about your symptoms and examine you. He or she may refer you to a gastroenterologist, a doctor specialising in conditions that affect the digestive system. You may have further tests including:

  • blood tests
  • faeces (stool) tests
  • sigmoidoscopy and/or colonoscopy - you will be sedated and a thin telescope inserted through your anus and into your bowel to view the lining. If any areas look affected by Crohn's disease, a small sample of your bowel lining may be taken - this is a biopsy and will be sent to a laboratory for testing
  • X-rays to provide images of your large and small bowel
  • barium enema X-ray - this involves placing a fluid containing barium (a substance which shows up on X-rays) into your bowel via the rectum. X-ray images of your abdomen then show the inside of your bowel more clearly
  • barium meal X-ray - this involves swallowing a drink containing barium. X-ray images of your abdomen then show the inside of your bowel more clearly
  • CT scans (these use X-rays to make a three-dimensional picture of your bowel), MRI scans (using magnets and radiowaves to produce images of the inside of your body) and ultrasound may also be useful

You won't need to have a general anaesthetic for these tests and they are usually carried out as out-patient procedures. This means you have the test in hospital, but you won't need to stay overnight.

Diet

If you have Crohn's disease it's important that you eat a healthy, balanced diet with a high fibre content, unless you are prone to blockages. This is especially true when your symptoms flare up, as you will need to replace lost nutrients, although you may not feel like it. If you can eat a normal diet, you should continue to do so. However, you may find that certain foods disagree with you or that you need to eat more of particular types of food such as starchy carbohydrates (eg potatoes, bread and pasta).

When your Crohn's disease is active, your doctor may recommend that you have a liquid diet, made up of simple forms of protein, carbohydrates and fats. This is called an elemental diet and is commonly used to treat children.

Surgery

You may need surgery to treat complications or if medicines aren't controlling the disease. Your surgeon will aim to remove as little of your bowel as possible and expand any parts that have become narrowed.

Living with Crohn's disease

Some people with Crohn's disease have frequent flare-ups, whereas others have only one or two attacks during their lifetime. Flare-ups are unpredictable, but with good management your symptoms can be controlled. You are likely to be able to enjoy a normal lifestyle.

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  • Ashley

    The 5 Type of Crohns Disease
    September 14th, 2009 by Ashley L
    The 5 Types of Crohn’s Disease
    Along with ulcerative colitis, Crohn's disease is part of a group of diseases known as inflammatory bowel disease (IBD). There are five different types of Crohn's disease, each with its own set of symptoms. Here is information about Crohn's disease and the five types that you can use to help you discuss symptoms and treatment options with your doctor.

    What is Crohn's disease?
    Crohn's disease is a chronic illness in which the intestine, or bowel, becomes inflamed and ulcerated, or marked with sores.

    Crohn's disease most commonly affects the lower part of the small intestine (ileum) and the colon. It can, however, occur in any part of the large intestine, small intestine, or stomach. It can affect people at any age but is most common in people who are between the ages of 15 and 35.

    Crohn's disease can disrupt the normal function of the bowel in a number of ways. The bowel tissue may:

    Swell, thicken, or form scar tissue, leading to blockage of the passageway inside the bowel
    Develop ulcers that can involve the deep layers of the bowel wall
    Lose its ability to absorb nutrients from digested foods, a condition called malabsorption
    Develop abnormal passageways known as fistulas from one part of the bowel to another part of the bowel, or from the bowel to nearby tissues such as the bladder or vagina
    What are the five types of Crohn's disease?
    The five types of Crohn's disease with their symptoms are:

    Ileocolitis: Ileocolitis is the most common type of Crohn's disease. It affects the small intestine, known as the ileum, and the colon. People who have ileocolitis experience considerable weight loss, diarrhea, and cramping or pain in the middle or lower right part of the abdomen.
    Ileitis: This type of Crohn's disease affects the ileum. Symptoms are the same as those for ileocolitis. In addition, fistulas, or inflammatory abscesses, may form in the lower right section of the abdomen.
    Gastroduodenal Crohn's disease: This form of Crohn's disease involves the stomach and duodenum, which is the first part of the small intestine. People with this type of Crohn's disease suffer nausea, weight loss, and loss of appetite. In addition, if the narrow segments of bowel are obstructed, they experience vomiting.
    Jejunoileitis: This form of the disease affects the jejunum, which is the upper half of the small intestine. It causes areas of inflammation. Symptoms include cramps after meals, the formation of fistulas, diarrhea, and abdominal pain that can become intense.
    Crohn's (granulomatous) colitis: This form of Crohn's disease involves only the colon. Symptoms include skin lesions, joint pains, diarrhea, rectal bleeding, and the formation of ulcers, fistulas, and abscesses around the anus.

    (continued)
    What causes Crohn's disease?
    The cause of Crohn's disease is unknown. It is likely that Crohn's is at least partially an inherited disease that causes an abnormal response of the immune system in the gastrointestinal tract.

    Recently, the first gene associated with Crohn's disease was identified. This gene is called the NOD2 or CARD15 gene. Abnormalities in the gene are found in up to one out of every five patients with Crohn's disease.

    People who have a relative with Crohn's disease are 10 times more likely to develop the disease themselves. If the affected relative is a sibling, the risk jumps to 30 times more likely to develop Crohn's disease. Jewish people of European descent also have a greater risk for developing Crohn's disease.

    How is Crohn's disease treated?
    Treatment for Crohn's disease depends on the type and how severe the disease is. Because the disease can sometimes go into remission on its own, it is not always possible to determine whether a specific treatment has been effective. When Crohn's disease is active, treatment is aimed at relieving symptoms, controlling inflammation, and correcting nutritional deficiencies.

    Medications are generally the first step in treating Crohn's disease. Some of these medications include anti-inflammatories, antibiotics, corticosteroids, antidiarrheals, and immune-suppressing medications. For those patients experiencing nutritional deficiencies, supplements are often prescribed.

    Even though surgery cannot cure Crohn's disease, it is sometimes needed for patients whose symptoms do not respond to medications. Surgery can be performed to correct perforations, blockages, or bleeding in the intestine. Unfortunately, Crohn's disease often returns to the area next to where the inflamed part was removed. It is therefore important that you discuss with your doctor all possible options before deciding upon surgery.

    What can I do to manage Crohn's disease?
    In managing Crohn's disease, it is very important to maintain a healthy lifestyle. This is important even when the disease goes into remission for long periods of time. You can maintain a healthy lifestyle by exercising regularly and eating a healthy diet. Abstaining from smoking can also help prevent symptoms from recurring. Studies have shown that smokers are at a higher risk of developing Crohn's disease than nonsmokers and the smokers with Crohn's tend to have a more severe course than nonsmokers with Crohn's. People with Crohn's disease are usually able to lead healthy and active lifestyles.

    Like many other disorders, understanding and being educated about Crohn's disease are the most important tools with which to manage it and prevent complications. The following organizations can provide more information about Crohn's disease CCFA.org

    11 months ago

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