Crohn's disease is a long-term illness that causes inflammation of the gastrointestinal tract (gut). The gut consists of the oesophagus (gullet), stomach, and small and large intestine. Posted on: 07 May 08
PharmiWeb.com May monthly focus feature highlighting the symptoms and various treatments for Crohnâ€™s disease.
Approximately 1 in 1,500 people have Crohn's disease, and the condition affects slightly more women than men. It can develop at any age, but usually starts between the ages of 15 and 40. In Europe and North America, it most commonly affects Caucasians. The precise cause of Crohn's is unknown. The condition can run in families and is three times more common in smokers. Not smoking may reduce the risk of developing the disease.
What are the symptoms?
Symptoms occur when part of the gut becomes inflamed. Typical symptoms include: Diarrhoea, abdominal pain, fever, loss of appetite and weight loss, feeling generally unwell, and extreme tiredness. The symptoms 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. Some people with Crohn's disease experience additional symptoms. These can include: inflammation of the joints (arthritis), inflammation of the eye (uveitis), inflammation of the liver, and skin rashes.
The reason why these other symptoms occur is not fully understood. However, it is thought that they may be triggered by the immune system as a reaction to the inflammation of the gut.
What's the treatment?
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.Treatments include anti-diarrhoea medication, steroids and painkillers, and medication are commonly used to treat Crohn's disease when it first develops. They are usually taken in oral tablet form, or as an enema if the rectum or lower part of the colon, are affected.
Steroids If the symptoms of Crohn's disease are severe, a course of steroids (corticosteroids) may be recommended for a few weeks. In most cases
(70%), the symptoms improve within four weeks of starting steroids. Once the symptoms improve, the dose is gradually reduced, and then stopped. As steroids can cause side effects, they are not usually used as a long-term treatment.
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, of salazine, 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, immunosuppressive medicines, such as methotrexate, antibody therapy (infliximab), or a combination of these treatments.
Diet If you have particularly bad symptoms, which cannot be controlled using medicines, you may be given a strict diet to follow. In most cases,
after sticking to the diet for a few weeks, the symptoms improve and a normal diet can be gradually resumed. The reasons why this works are not fully understood, but it is thought that some foods, such as dairy products, may trigger the symptoms of Crohn's disease and that resting the gut may help.
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.
Other measures Anti-diarrhoeal medicines can be taken to firm up your stools, and painkillers may be needed at times when your symptoms are
particularly bad. If your symptoms are really severe, you may need to go to hospital to receive fluid intravenously (by a drip).
You may be prescribed iron tablets if you develop anaemia. Also, if your gut is not absorbing food properly, you may need to take vitamin supplements.
If you smoke, giving up will often decrease the frequency of your symptoms
The development of new medications for Crohn's disease is ongoing, and it is likely that there will be a number of new treatment options available, for the condition over the next decade.
For more information about Crohns Disease www.crohns.org.uk This website is a resource for the management and treatment of Crohnâ€™s Disease and other Inflammatory Bowel Diseases designed to help both patients and healthcare professionals. www.nacc.org.uk The National Association for Colitis and Crohn's Disease (NACC)
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