Crohn Disease

Crohn Disease I specialise in the medical treatment and surgery of Crohn’s disease.  I Am a Consultant General and Colorectal Specialist at Mid Cheshire Hospital, BMI Alexandra Hospital and South Cheshire Private Hospital.  I am also the Lead Consultant for Enhance Recovery Programme in Colorectal Surgery and Colorectal Multi Disciplinary Team at the Mid Cheshire Foundation Hospital.  I do joint inflammatory bowel clinics with gastroenterologist to provide optimum care for Crohn’s patient.

Information on Crohn’s disease

Disease Crohn’s disease can affect any part of the gut.  It is a condition that causes inflammation of the gastrointestinal tract (gut).  It can affect oesophagus (gullet), stomach, and small and large intestine.  However, it most commonly occurs at the lower end of the small intestine, known as the ileum.

Cause

The exact cause of Crohn disease is unknown. It is thought that there may be a genetic link because there is some evidence that it runs in families.  A bacterium or virus (germ) may be a factor in the cause of Crohn’s disease and may trigger the immune system to cause inflammation in the gut.  Crohn’s is more common in smokers and aggravated by stress.

Symptoms

Typical symptoms include, pain, ulcers and diarrhoea. Daily medication can be taken to relieve the symptoms but sometimes, surgery to remove part of the gut, may be required.  It can develop at any age, but usually starts between the ages of 15 and 40.  The outlook for people with Crohn’s disease varies depending on which part of the gut is affected, and the severity and frequency of the symptoms.

The majority of people experience moderate symptoms from to time to time and most (80%) will require surgery at some point. Rare complications, such as a perforated gut, can be life-threatening. The symptoms of Crohn’s disease occur when the wall of the affected part of the gut becomes inflamed. The inflammation often causes one or more of the following symptoms i.e. pain, ulcers around mouth and perianal area, diarrhoea, loss of appetite, weight loss, anaemia and rectal bleeding.

 The symptoms for Crohn Disease vary depending on the part of your gut affected. For example, if you have pain in your abdomen, with no other symptoms, it may be due to a small patch of Crohn’s disease in your small intestine. However, if the condition causes severe diarrhoea and other symptoms, the large intestine will be affected.

Additional symptoms

Some people with Crohn’s disease experience additional symptoms. These can include inflammation of the joints (arthritis),  inflammation of liver, eyes (uveitis) and skin rash.

Diagnosis

The above symptoms for Crohn Disease may indicate the possibility of Crohn’s.  Your GP will request certain blood tests, stool sample to exclude other causes of diarrhoea. A number of tests can be carried out to diagnose Crohn’s disease, and which ones are used will depend on the part of your gut that is affected. Tests that can be used included.  Your GP may request you to the hospital or arrange you to see a specialist who may request a sigmoidoscopy or colonoscopy (Camera examination of the large bowel and or gastroscopy (camera examination of the gullet and stomach).  During the camera examination a biopsy is essential to aid in histological confirmation.  X-ray, CT scan, MRI scan may also help to see the extent of disease.

Sigmoidoscopy and Colonoscopy – investigation of the lower bowel using a (a short, flexible telescope), and colonoscopy of the colon using a (a long, flexible telescope). Colonoscopy requires bowel preparation with laxatives and sedation at the time of examination.  Biopsy or sample is taken for histology.

Barium X-Ray for diagnosing Crohn’s disease, a barium X-ray of the large intestine (barium enema) or small intestine (barium meal) may be used. Barium is usually given in liquid form and will appear white on X-rays, highlighting which parts of the gut are affected.

Treatment

Steroids, to reduce inflammation in your gut, are commonly used to treat Crohn’s disease. They are usually taken in oral tablet form, or as an enema (a tablet inserted into your back passage), if the rectum or lower part of the colon, are affected.

5-aminosalicylate medicines

5-aminosalicylate medicines can be used as an alternative to steroids, to treat mild to moderate symptoms of Crohn’s disease. They include sulfasalazine, mesalazine, and balsalazide. However, they do not always work and you may need to switch to steroids if your symptoms are severe.

Antibiotics and Immunosuppressants

Some people with Crohn’s disease do not respond well to steroids or 5-aminosalicylate medicines. In such cases, a specialist may advise that you use antibiotics to combat infection, and immunosuppressive medicines, such as methotrexate, antibody therapy (infliximab), or a combination of these treatments  

Surgery

As a last resort, if other treatments do not work, surgery may be required to remove the affected part of your gut. The affected part is removed and the two ends are sewn together. Surgery may also be required to treat complications such as obstructions, abscesses, or damage to your gut.