Crohn’s Disease affects approximately 60,000 people in the UK, or 1 in 1000 with 3,000 to 6,000 new cases diagnosed each year.
- inflammatory disease of the intestines which can affect any part of the gastrointestinal tract from anus to mouth, causing a wide variety of symptoms.
- Autoimmune disease in which the immune system reacts to the normal gut flora as if it was an infection, producing an inflammatory response.
Signs and symptoms of Crohn’s disease range from mild to severe and can develop gradually or appear without warning. There are also periods of remission.
Abdominal pain and cramping
Inflammation and ulceration can cause the walls of portions of the bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through the digestive tract and leads to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more serious cases, the pain may be severe and include nausea and vomiting.
This is the most common extra-intestinal complication of Crohn’s and may affect as many as 30% of people with the disease. Although arthritis is typically associated with advancing age, in Crohn’s it often strikes young patients as well.
In addition to joint pain, arthritis also causes swelling of the joints and a reduction in flexibility.
Reduced appetite and weight loss
Unsurprisingly Crohn’s patients often associate food with pain and are reticent to eat for fear of making their symptoms worse.
Depending on what part of the gut is impacted, malabsorption can result which leads to lack of nutrients and weight loss.
Crohn’s disease causes small sores on the surface of the intestine which ultimately become large ulcers that penetrate deep into and through the intestinal walls. Crohn’s patients may also suffer with mouth ulcers.
Blood in the stool
Food moving through the digestive tract may cause inflamed tissue to bleed, or the bowel may bleed on its own. It is also possible to pass bright red blood or darker blood mixed in with stools.
Inflammation causes secretion of large amounts of water and salt. The excess fluid cannot be reabsorbed and diarrhoea results. Intestinal cramping contributes to loose stools.
Nutrient deficiencies often cause anaemia which untreated creates significant fatigue.
Fever can be a symptom of Crohn’s disease because of the low-grade inflammation associated with the disease.
Uveitis is one of the most common eye problems in Crohn’s. Uveitis is an inflammation of the uvea (a blood-vessel-rich lining inside the eye that brings nutrition to the cornea, retina, iris, and lens) when inflamed, the uvea becomes swollen, the retina swells, and vision becomes blurred.
Around 1% of Crohn’s sufferers will have a skin issue, the most common being Erythema Nodosum (the name literally means “red bumps”).” These tender red nodules, which usually appear over the shins or ankles and sometimes on the arms, affect 1-2% of those with Crohn’s disease of the colon. Women are more commonly affected than men. Erythema Nodosum generally appears in conjunction with a flare-up, but it may also occur just before. It tends to improve when the bowel disease is brought under control. Another skin issue is Pyoderma Gangrenosum – this condition is marked by pus in the skin associated with deep ulcerations. It is also most often found on the shins or ankles but sometimes occurs on the arms. Beginning as small blisters, these lesions eventually join together to form into deep, chronic ulcers. This disorder affects about 1% those with Crohn’s disease. Pyoderma gangrenosum often follows a similar course to the pattern of the disease itself, and may heal as the symptoms are brought under control.
Allopathic Treatments for Crohn’s Disease
Most Crohn’s patients will be treated with drugs, including 5-ASA therapies (eg: mesalazine) and steroids, which control or reduce the inflammation. Immunosuppressants (eg: azathioprine) are used to maintain remission.
Various antibiotics are also used; and a new range of drugs are being introduced called monoclonal antibodies (eg: infliximab).
Some Crohn’s patients are given Modulen, a liquid feed comprising pre-digested nutrients. This helps rest the bowel. If drug treatments fail, then removal of part or the whole colon may be necessary.
As smoking has an adverse effect on Crohn’s Disease, patients are encouraged to quit.
Nutritional Therapy for Crohn’s Disease
Crohn’s disease is thought to involve a hypersensitive immune response to some of the normal intestinal flora. Diet has been shown to influence the nature of the intestinal flora and several studies have shown that specific foods can trigger symptoms in patients with Crohn’s disease, while avoidance of those foods can help reduce symptoms or maintain clinical remission.
(The East Anglia Diet and Crohn’s Disease Study).
At IBS Clinics, we often work with people with Crohn’s, and use stool and food sensitivity testing in order to assess the state of an individual’s gut flora and level of inflammation, and identify any foods the person is sensitive to, because by improving gut flora and avoiding problem foods inflammation can be reduced. In our experience, this approach works extremely well and it is possible to initiate a period of remission or to extend the time between flare ups.
Nutritional deficiencies are common in patients with active Crohn’s disease; deficiencies of protein, zinc, selenium and folic acid have been described and may alter immune responses. Fish oil has been shown to help maintain remission of Crohn’s disease and glutamine and aloe have been shown to improve healing.
The use of selected supplements can be very helpful in reducing inflammation, restoring nutritional status and supporting the healing process.
There are a number of dietary approaches for Crohn’s sufferers which include an almost vegetarian anti-inflammatory diet or the Specific Carbohydrate Diet.
Both approaches are very effective especially when tailored to the individual.
The nutritional therapy approach for Crohn’s disease may be a consideration for patients who cannot tolerate the medications used for the disease or who wish to seek an alternative solution. Please note that we would NEVER recommend that your medications be reduced or stopped. Modifications to medications must only be done in consultation with your GP or specialist.