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Crohn’s disease

Crohn's disease is a bowel disease that causes inflammation and ulcers in your digestive system. It can affect any part of your digestive tract from your mouth to your anus.

Around 115,000 people in the UK have Crohn's disease.

Crohn's disease affects the wall of your bowel. It can affect any area from your mouth down through your stomach and bowel to your anus. However, it most commonly causes inflammation in the final part of your small bowel or the first part of your large bowel (colon). Crohn’s disease can affect more than one area of your bowel and leave areas in between completely unaffected.

Crohn's disease is a chronic illness. This means that it can last for a long time, sometimes for the rest of your life. The term chronic refers to how long you have the illness, not to how serious it is. However, it's usually a ‘relapsing and remitting’ condition. This means that your symptoms can disappear and then flare up again from time to time.

Crohn’s disease usually develops in teenagers and young adults, but you can get it at any age. It’s more common in women than men.

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Image showing the areas most commonly affected by Crohn's disease

Details

  • Symptoms Symptoms of Crohn's disease

    Symptoms of Crohn's disease range from mild to severe. They can also settle down in one part of your bowel and then flare up in another. There may be long periods of time when you have few or no symptoms at all.

    Symptoms of Crohn's disease include:

    • diarrhoea – sometimes with blood or mucus
    • pain in your abdomen (tummy), which can be severe
    • weight loss
    • a fever
    • tiredness

    Crohn’s disease can also cause other problems, such as:

    • mouth ulcers
    • a rash on your skin
    • red and sore eyes
    • pain and swelling in your joints

    If you have any of these symptoms, see your GP.

  • Diagnosis Diagnosis of Crohn's disease

    Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history.

    Your GP may ask for a sample of your faeces to check for a bacterial infection. He or she will take a blood test to look for anaemia and signs of inflammation.

    Your GP may refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system) for more tests. These may include the following.

    • A colonoscopy. Your doctor will insert a narrow, flexible, tube-like telescopic camera, called an endoscope, through your rectum (back passage) and into your bowel. This will enable your doctor to look inside your bowel and take samples of tissue for testing in a laboratory.
    • A capsule endoscopy. In this test, you will swallow a pill that transmits pictures as it passes through your bowel.
    • CT scan or MRI scan. These will produce images of the inside of your abdomen and are particularly useful to look for an abscess.
    • A white blood cell scan. This test looks for areas of inflammation in your bowel. You will need to give a blood sample. The white blood cells in this will be separated out and combined with a radioactive ‘tracer’ chemical that attaches to them. These will then be injected back into your body and a scanner will show where they (and the inflammation) are.
    • A barium meal or a barium enema X-ray. If you have a barium meal, you will be asked to drink fluid containing barium (a substance that shows up on X-ray images). A barium enema involves placing a fluid containing barium into your lower bowel through your rectum. X-rays of your abdomen will then show the inside of your bowel more clearly and can show if you have a fistula.
  • Treatment Treatment of Crohn's disease

    There isn't a cure for Crohn's disease but there are treatments to help ease your symptoms and prevent complications. The treatment you have will depend on how severe your condition is. If your condition is mild, you may not need any treatment.

    Diet

    It's important to eat a healthy, balanced diet if you have Crohn’s disease. You may find that certain foods, such as those high in fibre, can make your symptoms worse. If this happens, it might help to remove these foods from your diet while you have symptoms. However, get some advice from a dietitian first. For more information, see our frequently asked questions.

    During a flare-up, a liquid diet made up of simple forms of protein, carbohydrates and fats may help to ease your symptoms. These diets are called elemental or polymeric diets. You will need to follow them for three to six weeks. Because they are easier to digest they help rest your bowel, improve your nourishment and ease inflammation.

    Medicines

    Medicines can help to prevent a flare-up or ease your symptoms of Crohn’s disease. You may need to go into hospital for treatment if you have severe symptoms during a flare-up.

    The main treatments are listed below. You may need to have just one, or a combination of these.

    • Aminosalicylate (eg balsalazide, mesalazine or olsalazine). These can ease inflammation and reduce the chance of a flare-up (you take them all the time to help prevent this). If you do have a flare-up, your doctor may increase the dose to try to control your symptoms, or prescribe other treatments to reduce inflammation.
    • Corticosteroids (such as prednisolone, hydrocortisone and beclometasone). These are very effective but are usually only used for a short time during a flare-up. This is because they can cause side-effects such as diabetes, infections, cataracts, acne and osteoporosis. Immunosuppressants (such as azathioprine, mercaptopurine, ciclosporin and methotrexate) suppress your immune system and reduce inflammation but they may also increase your risk of infection.
    • Antibiotics (such as metronidazole or ciprofloxacin). These will reduce your risk of infection.
    • Biological therapies (such as infliximab or adalimumab). Your doctor will usually only prescribe you these if your symptoms are severe and other treatments haven't worked for you.

    If you need pain relief, you can take over-the-counter painkillers, such as paracetamol. Don't take non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or aspirin. These can cause a flare-up of Crohn's disease. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or your doctor for advice.

    Surgery

    Medicines will usually control your symptoms. However, if you have tried a number of different medicines and they haven't worked, your doctor may suggest surgery. You might also need surgery if you have complications of Crohn's disease, such as an abscess or fistula.

    You may have an operation to remove a severely inflamed part of your bowel. Or you might have surgery to widen areas where your bowel has narrowed because of a stricture, or to drain an abscess. Even if all of the affected part of your bowel is removed, the condition can return in areas of your bowel that were previously healthy. Therefore, surgery isn’t a cure for Crohn’s disease.

    Eight out of 10 people with Crohn's disease may need to have an operation at some point in their life. Some people may need several operations to treat Crohn’s disease.

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  • Causes Causes of Crohn's disease

    The exact reasons why you may develop Crohn's disease aren't fully understood at present. However, your family history may play a role and increase your risk of getting it. Up to four in 10 people who have Crohn’s disease have a close relative who also has the condition. It’s thought that an abnormal immune reaction to certain bacteria or viruses in your bowel may cause the condition if you’re at increased risk.

    You may also be more likely to develop Crohn’s disease if you:

    • smoke
    • have a diet that’s high in fat or sugar
  • Complications Complications of Crohn's disease

    If you have severe inflammation of your bowel, you may develop complications.

    Complications of Crohn’s disease include the following.

    • A fissure. This is a tear in the wall of your anus which can hurt and bleed when you go to the toilet.
    • A narrowing (stricture) in your bowel. This develops when scar tissue builds up after inflammation and it can partially or completely block your bowel. This can cause pain, vomiting and swelling in your abdomen.
    • An abscess (collection of pus). If the inflammation from Crohn’s disease affects the full thickness of your bowel wall, it's possible for a hole to develop. If this happens, the contents of your bowel can leak through it and cause an abscess. The abscess may then spread either through to your skin or into a nearby part of your body. This can cause a fistula.
    • A fistula. This is an abnormal connection between a hole in your bowel and the surrounding tissues. A fistula can develop between two parts of your bowel, or between your bowel and other parts of your body. This may be your bladder, vagina (in women) or skin.
    • Malnutrition and anaemia. Damage to your bowel can affect how well your body is able to absorb vitamins and minerals from your food.
    • Bowel cancer. Crohn's disease increases your risk of developing bowel cancer. See our frequently asked questions for more information.
  • Living with Crohn's disease Living with Crohn's disease

    When your condition is in remission and you have few or no symptoms, you may find Crohn's disease has little impact on your day-to-day life. However, when you get a flare-up, your symptoms can make life more difficult. Frequent bouts of diarrhoea can make it harder to work. About one in 10 people who have had Crohn’s disease for longer than five years are unable to work.

    You may find it helpful to see a counsellor or join a support group to meet others in a similar situation.

  • FAQs FAQs

    Why are people with Crohn's disease more at risk of developing bowel cancer?

    Answer

    The inflammation caused by Crohn's disease damages the cells lining your bowel and this increases your risk of developing bowel cancer. If you have had Crohn's disease for longer than 10 years, it's important to have regular examinations to check for any signs of bowel cancer.

    Explanation

    Crohn's disease damages the lining of your bowel. This means it has to be repaired again and again. It could be that this constant cell activity increases the risk of cancerous cells developing in your bowel.

    You’re more at risk of developing bowel cancer if your large bowel has been affected by Crohn's disease for over 10 years.

    If you have your bowel examined regularly, it can help detect bowel cancer early. This will enable you to get treatment before it has a chance to spread. Your risk of developing bowel cancer depends on how much of your bowel is affected by Crohn's disease and how severe the inflammation is. Ask your doctor to explain this risk to you. It's recommended that a doctor examines your bowel:

    • every five years if your risk of developing bowel cancer is low
    • every three years if your risk of developing bowel cancer is intermediate
    • every year if your risk of developing bowel cancer is high

    You will need to have a colonoscopy to check your bowel for signs of cancer. The test is done using a narrow, flexible, tube-like telescopic camera called a colonoscope, which allows your doctor to look inside your large bowel. He or she will take a biopsy of any suspicious area. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.

    If you’re having your bowel examined regularly, you probably won’t need to have regular screening for bowel cancer. This is offered every two years to everyone aged 60 to 74, including people who don’t have any bowel problems.

    If you have any questions about Crohn's disease and bowel cancer, speak to your GP.

    Is smoking linked to Crohn's disease?

    Answer

    Yes. You’re twice as likely to develop Crohn’s disease if you smoke.

    Explanation

    It’s not known how or why, but smoking doubles your risk of developing Crohn’s disease. If you continue to smoke after being diagnosed with Crohn’s disease, you’re more likely to have severe symptoms and need surgery. If you continue to smoke after you have surgery for Crohn’s disease, your symptoms are more likely to return.

    Stopping smoking is the best way to improve your chance of recovery and reduce your risk of a flare-up. If you stop smoking, you’re much less likely to have a flare-up compared to someone who continues to smoke.

    Ask your GP for support and advice about how to quit smoking.

    I have Crohn's disease, should I follow a special diet?

    Answer

    No. Most people with Crohn’s disease should eat a healthy, balanced diet. During a flare-up, eating low-fibre foods or a liquid diet can help ease your symptoms. However, always ask a dietitian or your GP for advice before you cut out any food groups from your diet.

    Explanation

    Crohn’s disease can affect how well your body is able to absorb vitamins and minerals from foods. This is why it's important to eat a healthy, balanced diet. This can sometimes be difficult as you may find that certain foods make your symptoms worse. These may include dairy products, raw fruits and vegetables (especially those with skin, pith and seeds) and high-fibre foods, such as brown rice.

    If you identify a food that causes your symptoms, try to find a substitute for it rather than just cutting it out completely. Cutting out foods can mean that you miss out an entire food group and the nutrients it provides. For example, if you find that eating foods high in fibre causes symptoms, try switching from eating raw vegetables to well cooked ones instead.

    During a flare-up, eating low-fibre foods or a liquid diet (called an elemental or polymeric diet) can help ease your symptoms. When you have a flare-up, try not to eat high-fibre foods such as wholegrain bread, brown rice and pasta, lentils, grains, seeds, fruit and vegetables. It’s also better to have small, frequent meals throughout the day rather than one large meal in the evening.

    For more information about what to eat or about liquid diets, talk to your dietitian or GP.

  • Resources Resources

    Further information

    Sources

    • Crohn's disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2012
    • Crohn disease. Medscape. www.emedicine.medscape.com, published 4 April 2014
    • Crohn's disease. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 27 April 2011
    • Crohn's disease: management in adults, children and young people. National Institute for Health and Care Excellence (NICE), October 2012. www.nice.org.uk
    • Crohn's disease. PatientPlus. www.patient.co.uk, published 5 November 2012
    • Map of Medicine. Crohn's disease. International View. London: Map of Medicine; 2014 (Issue 1)
    • Crohn's disease. British Society of Gastroenterology. www.bsg.org.uk, published 30 April 2014
    • Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60(5):571–607. doi:10.1136/gut.2010.224154
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 30 April 2014
    • Farraye FA, Odze RD, Eade J, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010; 138(2):738–45. doi:10.1053/j.gastro.2009.12.037
    • Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas. National Institute for Health and Care Excellence (NICE), March 2011. www.nice.org.uk
    • Rubin DC, Shaker A, Levin MS. Chronic intestinal inflammation: inflammatory bowel disease and colitis-associated colon cancer. Front Immunol 2012; 3:107. doi:10.3389/fimmu.2012.00107
    • Food and IBD. Crohn's and Colitis UK. www.crohnsandcolitis.org.uk, published September 2012
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, May 2014.

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