What are the symptoms of Crohn's disease?
Inflammatory bowel disease has two main forms Crohn’s disease and ulcerative colitis. Clinicians generally follow testing procedures initially to check whether patients with the symptoms of irritable bowel syndrome are also suffering from inflammation of the bowel.
Crohn’s Disease causes ulceration and inflammation, which negatively impact the body’s ability to digest food, absorb nutrients and eliminate waste.
It can affect any part of the gut, but is most likely to develop in the small intestine or the colon. The symptoms of Crohn’s disease vary depending on which part of the digestive system is inflamed, but include:
- tiredness and fatigue
- loss of appetite
- unintentional weight loss
- blood and/or mucus in faeces
- abdominal pain including inflammation in the bowel
- feeling a frequent need for bowel movements
- generally feeling unwell
Inflammatory bowel disease occurs at all ages, however Crohn’s is usually diagnosed in people between the ages of 20 and 30. Stress and eating certain foods do not cause the disease, but they can make your symptoms worse.
Crohn’s is a lifelong condition (chronic) and as such is typified by periods of remission and relapse. Currently there is no cure for Crohn’s although some medication, and therapy can give long periods of relief from symptoms.
What causes Crohn's disease?
What causes Crohn’s disease is unknown. Research points to an auto-immune reaction i.e. when the immune system attacks healthy cells in a body. Genetics also seems to be a factor. Previous infections can trigger the immune system to respond abnormally.
Someone with a relative with the disease has at least 10 times more risk of getting Crohn’s than the general population. This ratio increases to 30 times if that relative is a sibling. Also smokers with Crohn’s disease tend to have more severe symptoms than non-smokers.
Crohn’s disease is a long-term condition that causes inflammation in the digestive tract. It can affect any part of the digestive tract, from the mouth to the anus. Most often affects the small intestine and the beginning of the large intestine.
Patches of inflammation can be interspersed between healthy portions of the gut, and can penetrate the intestinal layers from inner to outer lining.
Crohn’s causes two primary types of complications:
- within the intestinal tract
- extra-intestinal or systemic, which can affect the entire body
The most common systemic complications are arthritis and joint inflammation. Other serious complications include fistulas, and bleeding from intestinal obstructions.
As smoking has an adverse effect on Crohn’s Disease, patients are encouraged to quit.
Older adults with chronic inflammation of the gastrointestinal tract may develop dementia more than seven years earlier than those without the condition, according to a new study by researchers at UC San Francisco and Taipei Veterans General Hospital in Taiwan.
There’s currently no cure for Crohn’s disease, so the aim of treatment is to stop the inflammatory process, relieve symptoms (induce and maintain remission) and avoid surgery wherever possible.
Treatment includes: drugs, nutritional supplements and surgery, or a combination of these treatments. The goal of treatment is to control the inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhoea and rectal bleeding.
Most Crohn’s patients will be treated with drugs, including 5-ASA therapies (eg: mesalazine) and steroids, which control or reduce the inflammation. The 2 medicines used mostly to treat Crohn’s disease in the UK are called infliximab and adalimumab. These target a protein called tumour necrosis factor-alpha (TNF-alpha), which is believed to be responsible for the inflammation associated with Crohn’s. Infliximab is given as a drip into a vein in your arm (known as an infusion) in hospital. Adalimumab is given as an injection, and it may be possible for you, a family member or a friend to be taught how to give it, so you don’t need to visit hospital for every treatment.
Some Crohn’s patients are given Modulen, a liquid feed comprising pre-digested nutrients. This helps rest the bowel. If drug treatments fail, then surgery may be needed to remove inflamed sections of the intestine, part or all of the colon.
Immunosuppressants (eg: azathioprine) are used to maintain remission.
Surgery can significantly improve the quality of life in some individuals, but recurrence of the disease after surgery is common.
IBS Clinics and treatment of Crohn’s Disease
Crohn’s disease involves 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.
At IBS Clinics we are specialists in helping people with inflammatory bowel disease. So we often work with people with Crohn’s Disease. We 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 for inflammatory bowel disease sufferers, 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.
Tests and supplements
There is no specific diagnostic test. The diagnosis of Crohn’s disease is suspected in patients the above symptoms as well as anal diseases, such as ulcers or fissures.
Laboratory blood tests may show elevated levels of white blood cell counts and sedimentation. Both of these suggest infection or inflammation. Other blood tests may show anemia, low blood proteins, and body minerals.
Barium X-ray studies can be used to define the distribution, nature, and severity of the disease. With inflammatory bowel disease a colonoscopy is more accurate than a barium X-ray for detecting smaller inflammations.
Tests can need to repeated from time to time to check how treatment is working.