Crohn's disease

Crohn’s disease is an inflammatory bowel disease, which may result in abdominal pain, severe diarrhoea, weight loss, fatigue and malnutrition.

The inflammation brought on by Crohn’s disease can affect different areas of the digestive tract, and may spread deep into the affected tissues.

The causes of Crohn’s disease are not known. While stress and poor diet were suspected, these are now known to aggravate flare-ups, rather than cause the disease itself. Although not conclusive, genetics may play a factor as well as an abnormal immune system response to a viral or bacterial infection.

Age also plays a role; most people who develop Crohn’s are diagnosed before the age of 30.

What are its symptoms?

Crohn’s disease symptoms range from mild to severe; onset may be sudden or gradual, and there may also be times when no symptoms are present at all, that is, during remission.

Signs and symptoms include:

  • Diarrhoea
  • Low-grade fever caused by inflammation or infection
  • Abdominal cramping and pain – inflammation or ulceration may interfere with the normal movements of contents through the digestive tract (this pain may be severe and include nausea and vomiting)
  • The presence of blood in the stool
  • Mouth ulcers
  • Weight loss
  • Reduced appetite
  • Signs of severe Crohn’s disease may also include inflammation of the skin, eyes and joints, and inflammation of the liver.

How is it diagnosed?

There is no one particular test to confirm the presence of Crohn’s disease, so your doctor may perform a combination of tests, after reviewing your symptoms and medical history and performing a physical exam. A positive family history may alert your doctor to the possibility and an exam may reveal signs of chronic illness (wasting or anaemia).

Tests and/or procedures may include:

  • Blood and faecal tests to check for infection and anaemia, and the presence of blood in the stool respectively
  • Colonoscopy: A thin, flexible tube with a light and camera are used to inspect the colon and tissue samples taken. The diagnosis is based on a typical appearance of inflammation of the mucosa with areas of ulceration.  
  • CT (computerised tomography) scan: This specialised X-ray technique provides detailed scans of the bowel and its tissues
  • Capsule endoscopy: A capsule containing a camera is swallowed; the images the camera takes can be downloaded and viewed for signs of Crohn’s disease
  • A biopsy (a sample of tissue removed from your body) of the inflamed area

What are your treatment options?

There is no cure and Crohn’s disease treatment typically involves medication, certain lifestyle adaptations, and possible surgery, depending on the severity of the disease. 

  • Medication: These include anti-inflammatories, antibiotics, corticosteroids, immune suppressors, pain relievers, anti-diarrhoea drugs, and supplements including iron, vitamin B12, calcium and vitamin D.
  • Surgery: During surgery the damaged portion of the digestive tract is removed and healthy tissue reconnected. Surgery does not cure the disease, but does offer temporary benefits. Surgery is usually followed up with medication to minimise the risk of recurrence.
  • Lifestyle: Keeping a food diary can help to identify if there are certain foods that cause flare-ups. Some diet recommendations include limiting dairy products, avoiding alcohol and caffeine, including low-fat foods, eating smaller meals and drinking plenty of fluids (water is best).
  • Stress and smoking: Both affect digestive health. Seek advice on stopping smoking, and try to reduce stress by doing exercise, and learning breathing techniques and relaxation.

Can it be prevented?

Because there is no known cause, Crohn’s disease cannot be prevented. But you can reduce flare-ups by following the treatment guidelines above. The experts agree that smoking is an important controllable risk factor for Crohn’s disease, so it’s important to stop smoking.

What to do now

For assistance with stopping smoking, visit the following websites for advice:
Cancer Association of South Africa: www.cansa.org.za/how-to-quit-smoking-and-why
Allen Carr’s Easyway: www.allencarr.co.za
Smokenders: www.smokenders.co.za

The accuracy of this information was checked and approved by physician Dr Thomas Blake in December 2015