What is Crohn's disease?
Crohn's disease is one of the two main types of inflammatory bowel disease (IBD) which are characterised by chronic intestinal inflammation. Crohn's can affect any part of the digestive tract from the mouth to anus but most commonly affects the lower small intestine (ileum) and the large intestine (colon). The inflammation tends to be patchy rather than continuous and extends throughout the thickness of the bowel wall.
Complications which may develop in Crohn's disease include malabsorption and malnutrition, strictures (narrowing of bowel wall or intestinal obstruction), fistulae (abnormal channels connecting loops of intestine to itself or other body organs) and fissures (tears in the anal lining).
It is estimated that approximately 28,000 Australians have Crohn's disease (although numbers are expected to be higher), with women slightly more likely to be affected than men. Crohn's can affect anyone of any age but usually first presents between 15 and 30 years of age.
Symptoms
Crohn's disease presents with a number of symptoms which can range from mild to severe including:
People affected by Crohn's disease may go through periods of remission where they experience no, or very mild, symptoms. However, they can then also relapse, where symptoms flare up once more. Crohn's disease patients may also experience additional complications with their joints, skin, eyes, kidneys and liver.
What causes Crohn's disease?
Despite extensive research the exact cause of Crohn's disease remains unknown, but it is thought to involve a complex combination of interacting factors including genetics, the immune system, microbial factors and environmental factors.
Genetics
Genetics do have a role in Crohn's disease, and a family history of IBD is associated with an increased risk of an individual developing the disease. Numerous genes have been linked to increased Crohn's disease risk with research being heavily focused on why mutations in these genes may predispose an individual to Crohn's disease.
Immunological factors
An abnormal immune response to normal substances and bacteria found in the intestine is characteristic of Crohn's disease and causes the inflammatory injury in the bowel. What triggers this inappropriate immune reaction currently remains unknown.
Microbial factors
The normal balance of healthy gut bacteria is disrupted in Crohn's disease and the role of the gut microbiota in IBD has become a hot topic over recent years. There has also been a lot of research into specific bacterial infections including mycobacterium paratuberculoisis (MAP) contributing to Crohn's disease development however there is no conclusive evidence to suggest this is the case.
Environmental factors
Smoking has been well-established as contributing to the development (being associated with a 3-4 times increased risk) and the exacerbation of Crohn's disease, and patients are strongly advised to quit. Diet is also thought to play an important role, and living in a Western society is also associated with increased prevalence of the disease.
Diagnosis
Crohn's disease can be difficult to diagnose due to its similarities to other gastrointestinal disorders such as ulcerative colitis. There is no single test for Crohn's disease and a number of investigations may be required to determine a correct diagnosis including:
Treatment
Crohn's disease treatment depends on disease location, severity, complications and response to previous treatment. There is no cure for Crohn's disease and current treatments focus on controlling inflammation, relieving symptoms and correcting nutritional deficiencies. Common treatments include:
Anti-inflammatory agents
Aminosalicylates (5-ASA) are used to treat mild to moderate inflammation in Crohn's disease by controlling inflammation, inducing and maintaining remission of disease. Corticosteroids may be used in moderate to severe cases but due to potential side effects, are only recommended as a short-term treatment.
Immunosuppressive agents
Immunosuppressive agents suppress the immune system to control inflammation by suppressing the release of inflammation-inducing chemicals.
Antibiotic agents
Antibiotics may be useful in preventing and controlling bacterial infections, and reduce harmful intestinal bacteria. They may also be used in healing fistulae or abscesses in people with Crohn's disease.
Nutritional supplementation
As Crohn's can lead to nutritional deficiencies, supplements may be recommended, particularly for children with impeded growth and development.
Surgery
Many patients with Crohn's disease may require surgery to solve problems such as stricture, obstruction or fistulae or even require resectioning to remove diseased portions of the gastrointestinal tract. This may involve joining the remaining intestine directly to an opening (stoma) on the surface of the abdomen to which a bag can be attached to collect faecal matter.
Resources
Crohn's and Colitis Australia
https://www.crohnsandcolitis.com.au/about-crohns-colitis/
IBD support Australia
http://www.ibdsupport.org.au/
Gastroenterological Society of Australia
http://www.gesa.org.au/resources/patients/inflammatory-bowel-disease/
Centre for Digestive Diseases
http://www.cdd.com.au/pages/disease_info/crohns_disease.html
Crohn's disease is one of the two main types of inflammatory bowel disease (IBD) which are characterised by chronic intestinal inflammation. Crohn's can affect any part of the digestive tract from the mouth to anus but most commonly affects the lower small intestine (ileum) and the large intestine (colon). The inflammation tends to be patchy rather than continuous and extends throughout the thickness of the bowel wall.
Complications which may develop in Crohn's disease include malabsorption and malnutrition, strictures (narrowing of bowel wall or intestinal obstruction), fistulae (abnormal channels connecting loops of intestine to itself or other body organs) and fissures (tears in the anal lining).
It is estimated that approximately 28,000 Australians have Crohn's disease (although numbers are expected to be higher), with women slightly more likely to be affected than men. Crohn's can affect anyone of any age but usually first presents between 15 and 30 years of age.
Symptoms
Crohn's disease presents with a number of symptoms which can range from mild to severe including:
- Diarrhoea (which may be bloody)
- Abdominal pain
- Vomiting
- Rectal Bleeding
- Loss of appetite
- Weight loss
- Anaemia
- Weakness and fatigue
People affected by Crohn's disease may go through periods of remission where they experience no, or very mild, symptoms. However, they can then also relapse, where symptoms flare up once more. Crohn's disease patients may also experience additional complications with their joints, skin, eyes, kidneys and liver.
What causes Crohn's disease?
Despite extensive research the exact cause of Crohn's disease remains unknown, but it is thought to involve a complex combination of interacting factors including genetics, the immune system, microbial factors and environmental factors.
Genetics
Genetics do have a role in Crohn's disease, and a family history of IBD is associated with an increased risk of an individual developing the disease. Numerous genes have been linked to increased Crohn's disease risk with research being heavily focused on why mutations in these genes may predispose an individual to Crohn's disease.
Immunological factors
An abnormal immune response to normal substances and bacteria found in the intestine is characteristic of Crohn's disease and causes the inflammatory injury in the bowel. What triggers this inappropriate immune reaction currently remains unknown.
Microbial factors
The normal balance of healthy gut bacteria is disrupted in Crohn's disease and the role of the gut microbiota in IBD has become a hot topic over recent years. There has also been a lot of research into specific bacterial infections including mycobacterium paratuberculoisis (MAP) contributing to Crohn's disease development however there is no conclusive evidence to suggest this is the case.
Environmental factors
Smoking has been well-established as contributing to the development (being associated with a 3-4 times increased risk) and the exacerbation of Crohn's disease, and patients are strongly advised to quit. Diet is also thought to play an important role, and living in a Western society is also associated with increased prevalence of the disease.
Diagnosis
Crohn's disease can be difficult to diagnose due to its similarities to other gastrointestinal disorders such as ulcerative colitis. There is no single test for Crohn's disease and a number of investigations may be required to determine a correct diagnosis including:
- Medical history
- Physical examination
- Blood tests
- X-rays
- Examination of stools
- Colonoscopy (direct visualisation of the bowel using a miniature camera attached to a long flexible tube that is inserted inside the anus)
- Biopsy
Treatment
Crohn's disease treatment depends on disease location, severity, complications and response to previous treatment. There is no cure for Crohn's disease and current treatments focus on controlling inflammation, relieving symptoms and correcting nutritional deficiencies. Common treatments include:
Anti-inflammatory agents
Aminosalicylates (5-ASA) are used to treat mild to moderate inflammation in Crohn's disease by controlling inflammation, inducing and maintaining remission of disease. Corticosteroids may be used in moderate to severe cases but due to potential side effects, are only recommended as a short-term treatment.
Immunosuppressive agents
Immunosuppressive agents suppress the immune system to control inflammation by suppressing the release of inflammation-inducing chemicals.
Antibiotic agents
Antibiotics may be useful in preventing and controlling bacterial infections, and reduce harmful intestinal bacteria. They may also be used in healing fistulae or abscesses in people with Crohn's disease.
Nutritional supplementation
As Crohn's can lead to nutritional deficiencies, supplements may be recommended, particularly for children with impeded growth and development.
Surgery
Many patients with Crohn's disease may require surgery to solve problems such as stricture, obstruction or fistulae or even require resectioning to remove diseased portions of the gastrointestinal tract. This may involve joining the remaining intestine directly to an opening (stoma) on the surface of the abdomen to which a bag can be attached to collect faecal matter.
Resources
Crohn's and Colitis Australia
https://www.crohnsandcolitis.com.au/about-crohns-colitis/
IBD support Australia
http://www.ibdsupport.org.au/
Gastroenterological Society of Australia
http://www.gesa.org.au/resources/patients/inflammatory-bowel-disease/
Centre for Digestive Diseases
http://www.cdd.com.au/pages/disease_info/crohns_disease.html
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