UnderstandingCrohnsDisease

Crohn'sdiseaseisanailmentthatcauses inflammationoftheliningofanypartofthe digestivesystem,whichcanstartatyourmouth andendinyourbackpassage.Mostcommonlyit occursinthesmallintestine(ileum)orthelarge intestine(colon)andinvolvesanimmunereaction. InCrohn'sdisease,theileumbecomesinflamed, whichmakesitdifficulttodigestfoodwhichcan leadtoalackofnutrientsinthebody,further suppressingtheimmunesystem.Atitsworst sufferersofCrohn'sdiseasecandevelop malnutrition. IfCrohn'sdiseasesimplyaffectsthesmall intestine,diarrhoeaandundernourishmentarethe result.Whenthelargeintestineisalsoinflamed,diarrhoeacanbesevere.Diarrhoeacombinedwithmalnutrition mayleadtoanaemiaandlowlevelsofessentialvitaminswhichcancauseseriousproblemsformanypeople, especiallychildren. Symptoms SymptomsofCrohn'sdiseasevarybetweensufferersanddependonwhichpartofthedigestivesystemis inflamed.Somepeoplewillonlyeverhavemildsymptoms,otherswillhaveseveresymptoms.Themost commonare: Recurringdiarrhoea Stomachpainespeciallyaftereating Fatigue(extremetiredness) Unintendedweightloss Bloodandmucusinyourfaeces(stools) Lesscommonsymptomsinclude Feverof38C(100F)orabove Feelingorbeingsick Jointpainandswelling(arthritis)orareasofpainful,redandswollenskinusuallyonthelegs Inflammationandirritationoftheeyes(uveitis) Mouthulcers Symptomstendtocomeandgoandsometimessuffererscanenjoylongperiodsofnoorfewsymptoms:thisis knownasremission.Unfortunatelyitwillbefollowedbytimeswhensymptomsflareupagain. Causes TheexactcauseofCrohn'sdiseaseiscurrentlyunknownalthoughresearcherssuggestitcouldbeduetoa numberoffactors.Geneticsforexampleisonefactor.Approximately3in20peoplewithCrohn'sDiseasehavea closerelativewhoisalsoasuffererandcertainethnicgroupsaremoreatriskthanothers. AnotherfactortoconsiderinCrohn'sDiseaseisaproblemwiththeimmunesystem.Normallytheimmune systemprotectsusagainstharmfulbacteriawhile"friendlybacteria"helpustodigestfood.InCrohn'sdisease, theimmunesystemtriestokillallbacteria,regardlessofwhethertheyarefriendlyornot.Thiscausesmostof theinflammationassociatedwiththedisease.Previousinfectionmayalsobeanissue,withsomeresearchers suggestingthatsufferersofCrohn'sDiseaseareseventimesmorelikelytohavetracesofabacteriumcalled Mycobacteriumaviumsubspeciesparatuberculosis(MAP)intheirsystem.MAPiscommonlyfoundincows, sheepandgoatsandisknowntosurvivethepasteurisationprocess(wheremilkistreatedwithheattokill

bacteria),soitispossiblethatpeoplehavebecomeinfectedwithMAPbydrinkingmilkfromcontaminated animals. Otherfactorsincludesmoking,andenvironmentalfactors.Crohn'sdiseaseisa"diseaseoftherich"meaningitis moreprevalentinthedevelopedworld.Ithasbecomemorewidespreadaspeoplehavebecomewealthiersince the1950s.ThismaybebecauseintheWest,childrengrowupingermfreeenvironments,sotheirimmune systemdoesnotfullydevelopduetoalackofexposuretochildhoodinfections. Treatments ThereiscurrentlynocureforCrohn'sdiseasehowevertreatmentcanimproveorreducethesymptoms.Thefirst portofcallfortreatmentissteroidmedication(corticosteroids)whichreducesinflammationincludingprednisolone tabletsorhydrocortisoneinjections.Thedoseisreducedassymptomsimprovebecauseofsideeffectssuchas weightgain,andthinningofthebones.Mildersteroidsareavailablebutarelesseffective.Medicinestosuppress yourimmunesystem(immunosuppressants)mayalsobeusedbutagaintherearesideeffectsincluding vomiting,fatigueandliverproblems. IfyouhavesevereCrohn'sdiseasebiologicaltherapiescanbeusedtoreducesymptoms.Thesearepowerful immunosuppressants,medicationwhichhasbeendevelopedusingnaturallyoccurringbiologicalsubstances, suchasantibodiesandenzymes.Thesemedicinescancauseallergicreactionssuchastemperature,itchyskin, achesandpains,andproblemsswallowing. Surgeryissometimesrecommendedtoreducesymptoms.Resectioninvolvesremovingtheinflamedareaofthe intestineandstitchingthehealthysectionstogether,whilealternatively,atemporarysurgicalprocedureknownas ileostomywilldivertdigestivewasteawayfromthelargeintestinetogiveitachancetoheal.Duringthis operation,theendofthesmallintestine(theileum)isdisconnectedfromthecolonandreroutedthroughahole madeintheabdomen,whichisknownasastoma.Anexternalbagisattachedtotheopeningtocollectwaste productsandafterafewmonthsasecondoperationreversestheprocedure. PossibleComplications ComplicationsofCrohn'sdiseaseincludefistulas(channelsthatdevelopbetweentwosectionsofthedigestive system),orintestinalnarrowing(stricture)bothofwhichneedtobetreatedwithsurgery.Astrictureiscausedby scarringoftheintestineswhichcanthenbegintoblockandyouwillnotbeablepassstools.Leftuntreated,the bowelcanrupture.Afistulaiswherescarringcausesexcessiveinflammationandulcersdevelop.Largefistulas canbecomeinfectedandcausesymptomssuchaspain,fever,bloodinthestoolsandleakageofstoolsinto yourunderwear. Othercomplicationscaninclude:osteoporosisirondeficiencyanaemiavitaminB12orfolatedeficiencyanaemia andrareskinreactions.SomepeoplewithCrohn'sdiseasehaveaslightlyincreasedriskofdevelopingcolorectal cancerinlaterlife. DiagnosingCrohn'sDisease InitialdiagnosisofCrohn'sdiseasecanbeproblematicasithassimilarsymptomstoseveralotherconditions. YourGPwillwanttoknowaboutyourdiet,anytraveller'sdiarrhoeayoumayhavehad,whatmedicationyouare takingandyourfamilymedicalhistory.YourGPwillrunstandardtestssuchaspulseandbloodpressure checks,heightandweight,takeyourtemperature,andexamineyourtummy.Youwillprobablyhavebloodtests whichcancheckforanaemia,inflammationandinfection.Youmaybeaskedtoprovideastoolsampletocheck forbloodandmucusorotherinfections. Acolonoscopytestwillbeusedtoexaminetheinsideofyourcolon.Thisinvolvesinsertingalongflexibletube withacameraontheend,knownasanendoscope,intoyourcolonthroughyourbackpassage(rectum).A biopsycanbetakenatthesametime.Alternativelyawirelesscapsuleendoscopymaybeusedwhichinvolves swallowingasmallcapsule.Thistransmitsimagestoarecordingdevicewornonabeltorinasmallshoulder bag.Afewdaysafterthetest,thecapsulepassesoutinyourstools. Otherteststhatmayberunincludemagneticresonanceenterography/enteroclysis(MRE)andtomography enterography/enteroclysis(CTE)scanswhichuseacontrastliquidtoshowyoursmallintestineduringthescans. Asmallbowelenema(SBE)andsmallbowelfollowthrough(SBFT)aretwosimilarteststhathavetraditionally

beenusedtoexaminethewholeoftheinsideofthesmallintestine.DuringanSBE/SBFT,alocalanaesthetic sprayisusedtonumbtheinsideofyournoseandthroat.Atubeispasseddownyournoseandintoyourthroat, beforebeingthreadedintoyoursmallintestinesandbariumispasseddownthetube.Thebariumcoatsthelining ofyoursmallintestinessothattheyshowupclearlyonXrays. Foodstoavoid Certainfoodstriggerintestinalsymptoms,soCrohn'sDiseasesufferersneedtomanagetheirdietswhichwillin turneasesymptomsofwind,bloating,abdominalpain,crampinganddiarrhoea.Thefoodsthattriggersymptoms differforeachpersonwithCrohn'sdiseasebutcanincludealcohol,milkanddairyproducts,spicyfood,fatty food,rawvegetablesandhighfibrefoods.Alowfibrewithlowresiduedietcanhelptoeasesymptomssoavoid cornhulls,nuts,rawfruit,seedsandvegetables. ItisrecommendedthatCrohn'sdiseasesufferersfollowahighcalorie,highproteindiet,eatregularmeals,plus anadditionaltwoorthreesnacks,andtakedoctorrecommendedvitaminandmineralsupplements. KeepingadailyfooddiarycanhelpyoutoselfmanageCrohn'sdisease.Simplynotewhatyoueatandwhenand thenrecordanysymptomsyouhaveintheaftermath.Experimentwithleavingitemsoutofyourdietor increasingothersthatdonotexacerbatetheproblem. Imagecredit:wavebreakmediamicro/123RFStockPhoto