Crohn's Disease
Crohn's disease and Ulcerative Colitis are inflammatory bowel diseases that affect more than 61,000 Australians.
What is Crohn's disease?
Crohn's disease is an inflammatory bowel disease that causes full thickness inflammation of the bowel wall and may involve any part of the digestive tract from the mouth to the anus. Most frequently the ileum (the lower part of the small bowel) is involved but sometimes only the large bowel may be affected (or both can be are involved in segments or at times throughout).
How common is Crohn's disease?
Crohn's disease affects males and females at a rate of 5 in 100,000 people. Occasionally it can affect more than one member of a family. Both adults and children may have Crohn's disease, but there are peaks of incidence around 25 and 65 years of age.
What causes Crohn's disease?
The cause is unknown, but recent research suggests it is may be an infective process.
Symptoms
Symptoms of Crohn's disease may include:
- abdominal pain; diarrhoea;
- malaise and fever;
- the passage of blood and mucous;
The abdominal pain may be localised, particularly in the lower right side of the abdomen, and it can mimic appendicitis.
Bleeding, when present, may be mixed with the stool and is often unobtrusive and can lead to anaemia and iron deficiency.
Painful mouth ulcers, lethargy and weight loss may also occur.
How does Crohn's disease affect the bowel?
Patchy inflammation involving the lining of the bowel will extend through the full thickness of the bowel wall. The inflammation causes ulceration, scarring, and narrowing of the bowel, resulting in bowel symptoms and a general feeling of malaise. Bleeding from the bowel may cause anaemia.
Abscesses can form adjacent to the inflamed bowel and burst into other organs, causing an abnormal track between the organs (fistula).
Bowel ulceration causes diarrhoea, often with blood and mucous, and can lead to malnutrition.
Narrowing of the bowel causes cramping pain due to the incomplete blockage. Should the anus be involved, fistulae, fissures, watery mucous discharge, and some bleeding may occur.
Other organs may be involved, causing joint and eye inflammations and skin rashes.
Diagnosis
The diagnosis of Crohn's disease is sometimes delayed as the same symptoms can occur with other diseases. It is usually necessary to exclude diseases such as bowel infections or irritable bowel syndrome.
Blood tests are useful when looking for anaemia; they measure the severity of inflammation. They can also detect vitamin or mineral deficiencies. A faeces specimen may be required to exclude infection.
Most people require an examination of part of the bowel. This can be a colonoscopy, gastroscopy or sigmoidoscopy. X-ray, CT scan, and barium enemas are sometimes helpful.
There is no single test that will reliably diagnose all cases, and many people require a number of tests.
Treatments
There is no "cure" for Crohn's disease. Medication may be helpful in controlling inflammation and some of the symptoms. The main drugs prescribed are Salazopyrin and Prednisone. Anti-diarrhoeal medications, iron and nutritional supplements are used. New medications are constantly being developed.
Localised complications of Crohn's disease can cause troublesome symptoms that do not respond to medication and surgery may be necessary.
Any surgical procedure will be tailored to your specific problem. Most patients do not need surgery and, when required, the extent of surgery needed varies considerably.
Prognosis
Most people with Crohn's disease have normal length of life.
