Sometimes, one may also experience symptoms that present themselves in other areas of the body, these are called extraintestinal manifestations of Crohn’s disease. These symptoms might not initially be linked to the bowel as they are not apparent in this area of the body, as such the sufferer may not realise these are signs of Crohn’s disease. Symptoms can be constant or sufferers may experience frequent Crohn’s disease flare-ups, often without warning or any apparent reason.
What is Crohn’s Disease?
Crohn’s disease is a type of inflammatory bowel disease which causes parts of the digestive system to become inflamed and can cause intense abdominal pain and cramping, among its many potential symptoms. The inflammation can affect anywhere along the gastrointestinal tract. The most common location, however, is the end of the small bowel called the ileum. When this part of the bowel becomes inflamed it is known as ileitis.
There is no cure for Crohn’s disease, however, treatment aims to reduce acute flare and long-term inflammation. With recent developments in medical and surgical treatments, many patients can now live normal lives where they are unaffected by their condition. For many others, they are affected by ongoing symptoms due to the consequences of the condition. Crohn’s can lead to secondary conditions such as bowel cancer, weak bones, or a lack of iron (due to the body’s difficulty absorbing nutrients from food), and damage to the bowel that may require surgery. Therefore, it is important to receive regular follow up through a specialist gastroenterologist to ensure that any treatment plan is optimised for every individual.
What Causes Crohn’s Disease?
First described by Dr. Burill Crohn in 1932, Crohn’s disease is an autoimmune condition where the immune cells of the body incorrectly attack the cells within the gut. However, the exact cause of Crohn’s disease is unknown. Research into Crohn’s is ongoing but as yet, a comprehensive cause for the disease is yet to be discovered.
Some evidence suggests that Crohn’s has a genetic component. It is thought that Crohn’s disease may occur following exposure to an event, such as a stomach bug, however, this is not proven at this point.
Crohn’s disease typically starts between 15-40 years, however, between 50-60 years of age there is another rise in incidence.
Smoking is believed to exasperate symptoms and smokers are actually more than twice as likely to develop Crohn’s disease. Whilst associations have been suggested for specific diets and Crohn’s disease, these are largely unproven or have weak associations.
Crohn’s Disease Symptoms
Symptoms usually start in childhood or early adulthood and include:
- diarrhoea
- stomach aches and cramps
- blood in stools
- tiredness (fatigue)
- weight loss
- anal symptoms (skin tags, fistulae, abscesses, scarring etc)
Crohn’s disease symptoms in females and males tend to be the same, and the disease is equally likely to affect men as women in Western countries. However, Crohn’s disease tends to be higher in males in Asian populations. Symptoms may be continuous or come and go weekly or monthly. When people experience a recurrence of active inflammation, these are called flare-ups.
One may also experience extraintestinal manifestations of Crohn’s disease. These symptoms may present themselves before gastrointestinal symptoms become apparent. Extraintestinal manifestations may include:
- Arthritic symptoms that affect fewer than 5 of the large joints (ankles, knees, hips, wrists, elbows, and shoulders)
- Painful and/or reddened lumps of between 1 and 5 centimetres in diameter under the skin of the legs or arms
- Mouth ulcers
- Red eye which may be painless or painful, itching or burning
- Osteoporosis (weakened bones due to the body’s difficulty absorbing nutrients from food)
Are There Different Types of Crohn’s Disease?
No, there are not different types of Crohn’s disease, however, there are different names to describe where the inflammation is located in the gastrointestinal tract. They are:
- Gastroduodenal Crohn’s – affects the stomach and the beginning of the small intestine
- Ileitis – inflammation of the last section of small intestine
- Ileocolitis – inflammation of the end of the small intestine and the large intestine
- Jejunoileitis – inflammation to the middle and end of the small intestine
How is Crohn’s Disease Diagnosed?
As it shares symptoms with other bowel conditions, Crohn’s can be hard to diagnose in some individuals.
As such, unless an emergency admission is required, a GP will usually complete a thorough assessment where they will ask about:
- Symptoms
- Diet
- Recent trips abroad which may have resulted in contracting an infection
- Current medications
- Any family history of the disease
A physical examination may also take place whereby the GP may feel and examine the stomach and/or take a blood sample. Additionally, a stool sample will often be requested which can be tested for inflammation and infections.
If a GP suspects Crohn’s disease is the reason for symptoms, they will make a referral to a gastroenterologist for tests which can determine whether or not Crohn’s is the cause. These tests may include:
- A colonoscopy whereby a camera fitted to the end of a thin, flexible tube is inserted into the rectum to look for visible signs of Crohn’s disease in the bowel, such as inflammation or ulcerations.
- A biopsy whereby small pieces of the bowel are removed and examined for signs of Crohn’s disease.
- An MRI or CT scan may be performed where a specialist looks at the bowel externally. For this procedure, a barium sulfate drink may be required to be drank 60-90 minutes before the scan which will help the bowel to show up clearly.
Crohn’s Disease Treatment
Whilst there is no cure, treatment for Crohn’s disease aims to reduce episodes of active inflammation and to reduce symptoms.
There are different medications to treat Crohn’s disease and sometimes surgery is an option.
Steroids are commonly prescribed for Crohn’s in the first instance to induce remission, and reduce inflammation. They can however have side effects including weight gain, indigestion, sleep disturbance, and increased risk of infections (as they reduce the body’s immunity) and in children, can result in slower growth.
As maintenance therapy, most individuals are prescribed other anti-inflammatory agents known as steroid-sparing agents. Depending on the severity of the disease and whether the condition is resistant to first-line options there are a few different management options. Some patients may require more aggressive immunosuppressive therapies commonly referred to as biological therapies. These target a specific aspect of the immune system to reduce inflammation and as with steroids and other immunosuppressants are started by gastroenterologists.
For people with a Crohn’s diagnosis, it is also important to make changes to their lifestyle. In those who smoke tobacco, one of the most important changes they can make is to stop smoking. No specific diets have been shown to aid in the reduction of inflammation associated with Crohn’s disease, however, some individuals may need to avoid certain foods because of inflammation and scarring in different parts of the gut. Changes to diet should ideally be supported by a trained professional, such as a dietician to reduce the risk of vitamin and mineral deficiencies.
Surgical treatment may be required as an emergency or on an elective basis to treat areas of inflammation that are refractory to best medical therapy or complications such as narrowing of the bowel or the development of fistulae. However, as Crohn’s disease can affect any part of the gastrointestinal tract there is no guarantee that surgery is curative for any individual.
A specialist will discuss all possible treatments with their patient and a suitable Crohn’s treatment plan will be agreed upon together. This can be reviewed further down the line to ensure the best plan for the individual is in place.
Medical Cannabis for Crohn’s Disease
In 2018 cannabis was rescheduled, making it available for medical purposes when prescribed by a specialist doctor. Clinical research into medical cannabis for Crohn’s disease specifically is limited, but there is growing evidence through the UK Medical Registry, where patients across a range of conditions report a change in quality of life related to living with inflammatory bowel disease.
It is important to note that medical cannabis does not cure of treat active bowel inflammation and therefore can only be considered to help with managing symptoms that have not responded to first-line therapies. Patients should still receive regular care and medications through their local gastroenterologist if they are prescribed medical cannabis.
Find out more on our ‘Getting Started’ page or complete a free 10 minute eligibility assessment for a consultation to see if medical cannabis is a suitable option for you for a consultation with a gastroenterologist.
