Published: 29 September 2021
Published: 29 September 2021
Crohn’s disease is a chronic and lifelong disorder causing inflammation in the gastrointestinal tract. Although it can involve any part of the GI tract, it commonly affects the small intestine or colon (CCA 2019).
Crohn’s disease, along with ulcerative colitis, falls under the umbrella of inflammatory bowel disease (IBD) (CCA 2019).
The severity of Crohn’s disease is unpredictable, but severe flares can lead to hospitalisation and may even require surgery or a temporary or permanent stoma (CCA 2019; Healthdirect 2020).
It’s this fluctuating nature of the condition that has the most impact on patients, affecting their emotional, physical and social wellbeing, and causing potentially life-threatening complications (CCA 2013).
According to the report Improving Inflammatory Bowel Disease Care Across Australia, 1 in 250 people aged between 5 and 40 are affected by IBD (CCA 2013).
Indeed, IBD is considered to be an emerging global disease, with Australia having one of the highest rates of prevalence in the world. There are currently more than 80,000 people with IBD, with this figure expected to increase in the future (CCA 2019).
The report also found that care for inflammatory bowel disease is inconsistent and inadequate despite vast amounts of money being spent on healthcare for the condition (CCA 2013). According to research conducted in 2018, IBD is said to cost Australia $3.1 billion every year (CCA 2018).
As the number of patients with these conditions increases, so too will the cost of treating them.
Crohn’s disease causes inflammation in parts of the gastrointestinal tract, often in ‘patches’. Although any part of the gut can be affected, including the mouth, oesophagus and stomach, it’s typically the ileum where the disease begins (IBD Clinic 2017).
These patches of inflammation can vary in size, and it’s not unusual for several patches to develop along the gut with normal sections in between (IBD Clinic 2017).
The inflammation itself can penetrate all layers of the intestinal wall, not just the lining, which can lead to additional complications such as:
Crohn’s disease can affect people of all ages, although symptoms most commonly appear in adolescence and early adulthood (Healthdirect 2020).
Actual symptoms can vary depending on which part of the gut has been affected by the inflammation, but often include diarrhoea, abdominal pain and feeling generally unwell (Healthdirect 2020).
Weight loss is a common feature in Crohn’s as a result of malabsorption and malnutrition, which can also lead to anaemia and vitamin deficiencies. Loss of appetite, fever, and fatigue are also frequently seen (Healthdirect 2020; Better Health Channel 2014).
Some less common symptoms that may appear as a result of Crohn’s disease include:
Crohn’s disease is usually categorised according to the parts of the gut that are most affected by the inflammation.
(IBD Clinic 2017)
The key difference between Crohn’s disease and ulcerative colitis is that the latter only affects the large intestine, where ulcers and sores will develop. These can then produce mucous and pus, leading to abdominal discomfort, frequent bowel movements and other symptoms (CCA 2019).
It’s unknown what exactly causes Crohn’s disease, although it’s likely related to several factors including genetics and triggers to the immune system (e.g. antigens in the environment such as bacteria or viruses) (CCA 2019).
Due to the similarities between Crohn’s disease and other conditions (e.g. ulcerative colitis and irritable bowel syndrome), it’s important that other conditions are excluded to avoid misdiagnosis (CCA 2019).
Generally, no single test can diagnose Crohn’s disease, so a combination of tests will be used (Healthdirect 2020).
Endoscopy (colonoscopy, sigmoidoscopy or gastroscopy) is often used to examine the colon for signs of inflammation (CCA 2019).
A biopsy might be taken from infected areas of the gut to rule out other possibilities such as infection (Healthdirect 2020).
Other tests used to distinguish between the two types of inflammatory bowel disease include x-rays of the upper and lower GI tract, blood tests, stool sample testing and other visual imaging methods (CCA 2019).
There is no cure for Crohn’s disease, although there are a variety of treatments that can be used to manage the condition and its symptoms. Typically, a holistic approach using medicines, lifestyle management and surgery, where necessary, will be taken (Healthdirect 2020).
Inflammation can be managed using medicines such as steroids, aminosalicylates, immunosuppressants and antibiotics (Healthdirect 2020).
Monoclonal antibodies can also be used in patients with severe cases of Crohn’s disease where other medicines have failed to make an impact. These are genetically engineered antibodies that block the action of a chemical called cytokine tumour necrosis factor alpha (TNF-α), which is involved in the inflammation process of Crohn’s disease, thereby suppressing the immune system’s response (Tidy & Bonsall 2017).
Diet modification can be helpful in reducing and managing symptoms (Better Health Channel 2014).
Individual meal plans are important, as symptoms vary per patient according to where the inflammation is located. An effective meal plan will ensure that essential nutrients aren’t being lost during flare-ups and that nutrition is adequate for the individual and their lifestyle (Fletcher & Luo 2017).
In some cases, where the disease is severe and not responding to medication, or the patient is at risk of colorectal cancer, surgical removal of the colon might be required. A colostomy might also be performed (CCA 2019).
Symptoms of Crohn’s can be unpredictable, and a well-managed case can quickly turn into a severe flare-up of the disease. Frequent communication between the patient and their healthcare practitioners is essential in identifying early symptoms and making rapid referrals when required.
Careful management is essential for this chronic condition.
As Crohn’s disease is a chronic and lifelong condition, it requires careful management from the patient and a good working relationship with the healthcare team around them. Unfortunately, many patients feel disheartened and experience anxiety and depression alongside the condition (Crohn's & Colitis Foundation 2019).
This is particularly common in younger patients, who, while experiencing a flare-up, have been found to experience a lower quality of life and have a higher depression score than those in remission (Brooks et al. 2016).
It’s important to identify risk factors both pertaining to Crohn’s disease and comorbidities that may develop over a patient’s lifetime in order to ensure that best care is delivered, and adverse complications are reduced and prevented wherever possible.