Crohn’s Disease is an inflammatory bowel disease (IBD) that can effect any part of the gastro-intestinal system from mouth to anus.
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.
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.
There are 3 types of Crohn’s disease that have a high degree of crossover.
The most common sites of bowel affected include
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 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 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
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
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
Most patients with Crohn’s disease can lead relatively normal lives, working and raising families, playing sport and enjoying a good life expectancy.