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Crohn’s Disease

Description

Crohn’s Disease is an inflammatory bowel disease (IBD) that can effect any part of the gastro-intestinal system from mouth to anus.

Incidence

Crohn’s disease is not uncommon in Australia and the incidence is increasing. It usually affects people between 15 – 30 years but there is a rise in incidence around 65 years as well. It affects males and females equally.

Cause

The cause is unknown but involves a combination of genetics and environmental influences. It is much more common in developed countries. It seems to be a dysfunction of the immune system that becomes over-active leading to inflammation of the bowel.

Types

There are 3 types of Crohn’s disease that have a high degree of crossover.

  • Inflammatory – inflammation of the bowel
  • Stricturing – narrowing due to scar
  • Fistulising – parts of bowel inflame and connect to each other causing abnormal communications

Sites

The most common sites of bowel affected include

  • ileocolic – the last part of the small intestine and the colon (large intestine)
  • ileum
  • colon

The anus and perianal area is commonly affected in Crohn’s disease as well and this can occur with or without the above bowel involvement.

Symptoms

Symptoms are variable and range from mild to severe. Abdominal pain, bloating, diarrhoea, passing blood and mucous per rectum can occur. Systemic symptoms such as fever, malaise and weight loss are common. Anal pain and a pus like discharge can occur from anal disease. Uncommonly, other organ systems can be affected by Crohn’s including the eyes, joints, liver and skin.

Diagnosis

Diagnosis can be difficult and sometimes delayed as symptoms are variable and mimic other bowel conditions. Usually a history and examination leads to some of the following investigations

Colonoscopy – a fibreoptic flexible telescope to view the entire colon and rectum and last part of the small intestine. Biopsies can be taken
MRI small bowel – allows detection of lesions in the small intestine.Pilcam – a ‘pill’ is swallowed that takes photos as it passes through the small intestine

Treatment

There is no medical or surgical cure for Crohn’s disease. The aims of treatment are firstly, to induce a remission and secondly to maintain remission.

The mainstay of treatment is medications. There is a vast array of medications for the treatment of Crohn’s disease and these should be monitored by a gastroenterologist. These include

  • Anti – inflammatories – 5ASA (Salazopyrim, Pentasa)
  • Steroids – hydrocortisone, prednisolone
  • Immunomodulators – azathioprine (Imuran), methotrexate
  • Biologicals – infliximab (Remicade), adalimumab (Humira)

Surgery

Surgery is common in Crohn’s disease and up to 75% of Crohn’s patients will undergo a surgical procedure during the course of the disease. Surgery is used for complications of Crohn’s where medication has been unsuccessful. Types of surgery include

  • Small bowel resection – The diseased segment (either a stricture or fistula) is removed and the ends of bowel usually joined back together. Occasionally, a temporary stoma (bag) is needed.
  • Stricuroplasty – A small bowel narrowing is widened without removing the segment. This is used to preserve bowel at those at risk of losing too muh.
  • Draining abscess – Draining perianal abscesses and placing draining setons (a rubber band loop) is common in perianal disease.
  • Colectomy – the colon and/or the rectum is removed in cases of uncontrolled colitis or pre-cancerous changes

Outcomes

Most patients with Crohn’s disease can lead relatively normal lives, working and raising families, playing sport and enjoying a good life expectancy.

  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: 1300 553 347
Fax: (02) 9650 4924

Double Bay

Double Bay Day Hospital Specialist Suites
Suite 3.01, Level 3, commercial
451 New South Head Road
Double Bay

Phone: 0290 863 133
Fax: (02) 9086 3123

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