Crohn’s disease is a form of inflammatory bowel disease that can affect any part of the digestive system, from the mouth to the back passage. It most commonly occurs in the last section of the small intestine (ileum) or in the large intestine (colon). It may also cause problems outside of the digestive system, such as the skin or joints. There are currently around 90,000 people living with Crohn’s disease in the UK.
What Are The Symptoms?
Common symptoms include:
- abdominal pain
- weight loss
Less common symptoms include:
- high temperature
- joint pain and swelling
- inflammation and irritation of the eyes
- skin rashes
- blood and mucus in the stools
How Is Crohn’s Disease diagnosed?
A colonoscopy is the most common test used to diagnose Crohn’s disease. Several other tests (such as a small bowel enema, CT or MRI scan) may be needed to rule out other bowel conditions such as ulcerative colitis.
How Is Crohn’s Disease Treated?
Several different types of medication may be used including anti-inflammatory drugs or steroids. In some severe cases, immunosuppressant medications or the use of biological drugs (antibody treatments) may be required.
When Is Surgery Necessary?
Around 60-75% of people with Crohn’s disease will need surgery to relieve symptoms and treat related complications.
Some of the most common reasons for surgery are:
Poor response to drug or nutritional treatment
Strictures (narrowings) in the intestine
Abscesses or fistulas (a fistula is an abnormal channel or connection linking the bowel to another loop of bowel, another organ such as the bladder or vagina, or the outside skin)
What are the most common operations for Crohn’s Disease?
StrictureplastyThis is a way of treating strictures and blockages in the small intestine which avoids removing any gut. The narrowed section of the intestine is opened up and then reshaped. Food can then pass freely through the reshaped section.
ResectionIf the stricture is long, or there are several strictures close together, a resection may be preferable to a strictureplasty. In a resection the damaged and diseased part of the gut is removed, and the two ends of the remaining healthy sections are joined together (this join is called an anastomosis).
Ileo-caecal resection or limited right hemicolectomyCrohn’s Disease commonly affects both the terminal ileum (the last part of the small intestine) and the caecum (first part of large intestine). If the inflammation is severe and persistent, then it may be necessary to remove that part of the intestine. The healthy end of the small intestine is then joined directly to the large intestine.
Colectomy with ileostomyFor patients with severe Crohn’s Disease in the large intestine, it may sometimes be necessary to remove most or all of the colon. This operation is called a colectomy. The end of the small intestine is then brought out through an opening in the wall of the abdomen. This is an ileostomy or stoma. An external bag is fitted onto the opening to collect the waste. This can be emptied or changed as necessary.
Colectomy with ileo-rectal anastomosisSometimes when the rectum has remained healthy it may be possible to have a colectomy with ileo-rectal anastomosis. In this the colon is removed but, instead of creating an ileostomy, the end of the small intestine is joined directly to the rectum. This operation is not advisable if the rectum is severely inflamed or scarred, or if the anal muscles have been damaged. Without a colon the faeces tend to be very liquid and people with this type of anastomosis may need to empty their bowels several times a day.
Proctocolectomy and ileostomyIf the rectum is also affected by the inflammation it may have to be removed along with the colon and the anal canal, in an operation known as a proctocolectomy. An ileostomy is then created in the same way as for a colectomy.
Can Crohn’s Disease Lead To Cancer?
In patients with severe Crohn’s Disease affecting all or most of the colon and where this has lasted for at least 8-10 years, there is a slightly increased risk of bowel cancer.