Managing Crohn's disease

Let's start with what we do know. It is estimated that Crohn's disease affects about one in every 650 people in the UK. It's more common in urban than rural areas and in white people of European descent, especially those who descended from Ashkenazi Jews (those who lived in Eastern Europe and Russia). It can start at any age, but usually appears for the first time between the ages of 10 and 40. And, according to recent surveys, it seems to be becoming more prevalent in society, with new cases being diagnosed more often, particularly among teenagers and children. ⁽¹⁾

Now, what we don't know; namely, what causes it. However, it's thought that several things could play a role, including: hereditary (genetic) factors; a problem with your immune system that causes it to attack the digestive system; smoking; a previous stomach bug; an abnormal balance of gut bacteria. ⁽²⁾

First things first, what is Crohn's disease?

Crohn's disease is a type of inflammatory bowel disease (IBD). It's chronic, there's no cure and so it’s a lifelong condition. It causes inflammation of the digestive tract, which can lead to abdominal pain, severe diarrhoea, fatigue, weight loss and malnutrition. ⁽²⁾

Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

In basic terms, the immune system doesn't act as it should. Instead of attacking only foreign invaders like viruses and bacteria, immune system agents turn on healthy cells in the digestive tract, which triggers inflammation and its associated symptoms. ⁽²⁾

When to see a GP

See a GP if you or your child have:

Blood in your poo;
Diarrhoea for more than seven days;
Frequent stomach aches or cramps;
Lost weight for no reason, or your child's not growing as fast as you'd expect.

How does it impact day to day life?

The symptoms may be constant or may come and go every few weeks or months. When they come back, it's called a flare-up.

It can be debilitating and have a big impact on quality of life with unpredictable flare-ups and regular check-ups with GPs and specialist doctors and nurses disrupting school, work and social life, but in most cases it isn't fatal. ⁽²⁾

The good news is that medications can ease the inflammation to make the symptoms more manageable. And if symptoms are well controlled, you can live a normal life with the condition. Support is available from your care team and organisations like Crohn's & Colitis UK if needed.

Also, healthy lifestyle changes can ease symptoms and reduce flare-ups. ⁽³⁾ For example:

Stop smoking;
Eat a healthy, low-fat diet;
Exercise regularly;
Manage stress.

What are the main treatments?

These include:

Medicines to reduce inflammation in the digestive system - usually steroid tablets;
Medicines to stop the inflammation coming back - either tablets or injections;
Surgery to remove a small part of the digestive system - sometimes this may be a better treatment option than medicines. ⁽²⁾

Fact or fiction?

Having a diagnosis of Crohn's increases your risk of getting Covid-19. This isn't true. However, other factors such as the medication you take and whether you are experiencing a flare-up may affect your risk. You can check your risk level using the decision tree from charity Crohn's and Colitis UK. ⁽¹⁾

The IBD Registry's Covid-19 UK IBD Tool can also be used to assess your risk and provide you with a personalised PDF explaining your risk level if you need to show employers. ⁽¹⁾

Eating more fibre can help. Unlike some digestive tract issues, where eating fibre can actually be helpful, with Crohn's eating too much fibre can make the problem worse. When Crohn's leads to strictures, these tight spaces can make it hard for certain foods to pass. Particularly high fibre foods which can plug the intestine because it's narrowed. ⁽³⁾

Crohn's increases cancer risk. The inflammation caused by Crohn's makes cells in the colon turn over quickly, so there's a higher possibility of irregular cell growth for those who've had the disease for at least eight years and, hence, a higher risk of colorectal cancer. Keeping up with colon cancer screening can help catch it early. And receiving Crohn's treatment can reduce the risk. ⁽³⁾

It can cause fertility issues in women. An individual can have Crohn's and still have a healthy pregnancy. That said, flare-ups during pregnancy may increase the risk of miscarriage, premature labour, or low birth weight. Meanwhile, even though there might be a genetic component to Crohn's disease, it doesn't guarantee your children will have it too. ⁽⁴⁾

Sources

About the author

Suzanne Clarkson is the Managing Director of Coach House Communications.