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 Crohn's
disease
What is IBD?
'Inflammatory bowel disease', or IBD, is a general term that includes
both Crohn's disease and ulcerative colitis. Both diseases cause
inflammation (swelling and bleeding) in the digestive system. Ulcerative
colitis affects the inner lining of the large intestine (colon and
rectum), and Crohn's disease can affect any part of the digestive tract
from the mouth to the anus. Both diseases are manageable, and with
treatment most people are able to carry on living normal lives.
IBD
affects different people in different ways, and no two people with IBD
are alike. Here are some answers to some of the most common questions
about IBD, to help you understand how it might affect you and how it is
managed.
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What are the symptoms of IBD?
 The
most common IBD symptoms are abdominal pain, cramping, tiredness
(fatigue), diarrhoea and weight loss. Other symptoms may include bloody
diarrhoea, slight fever, anaemia (low levels of red blood cells in the
blood which can make you feel tired, faint or breathless) and exhaustion
(extreme tiredness).
Both
Crohn's disease and ulcerative colitis are ongoing (chronic) diseases,
with times when symptoms get worse (called flares, flare-ups, or
attacks) and other times when symptoms get better (remission). Although
the symptoms can make you feel unwell and may make your daily activities
difficult, they can usually be managed with a combination of care,
medication, hospitalisation and (sometimes) surgery. Many people find
that in well managed IBD, making some simple adaptations to their
everyday lives enables them to continue their normal activities.
IBD can start at any age. Both Crohn's disease and ulcerative colitis
are found worldwide, although they are more common in the Western world.
About 2.2 million people in Europe have IBD. Regional differences range
from 1/1000 to 1/500, with the highest numbers in northern Europe.
IBD affects men and women equally, although ulcerative colitis is
slightly more common in men and Crohn's disease is slightly more common
in women.
Although the exact causes of IBD are unknown, they are believed to be
related to changes in the immune system brought about by an
environmental trigger in people who are genetically prone to the
disease. A combination of factors may play a role, including bacteria,
viruses, genetics, smoking and over-the-counter pain medicines. Other
factors, such as stress and diet, are not believed to cause IBD,
although they may be involved in worsening symptoms for some people.
Neither Crohn's disease nor ulcerative colitis is contagious, meaning
you cannot catch it from someone else or spread it to anyone if you have
it. This should not be confused with the fact that the tendency to
develop the disease may be hereditary (passed on through the genes),
since relatives of people with IBD are at a slightly greater risk of
developing the disease. However, other factors (such as environmental
triggers) are also believed to play a role in developing the disease for
these people.
Both Crohn's disease and ulcerative colitis can have complications. With
Crohn's disease, for example, scarring and thickening of the intestine
walls can create a narrowing of the intestine wall, which is called a
stricture, leading to constipation, bloating and pain. The intestine
walls may become fully blocked (called an obstruction), which can cause
severe pain and vomiting that must be treated in the hospital.
Nutritional problems can occur if the body is unable to absorb proteins,
vitamins or minerals. Crohn's disease may also prevent the body from
absorbing calcium and vitamin D, which can lead to osteoporosis (bone
density loss).
With ulcerative colitis, severe bleeding may cause anaemia (low levels
of red blood cells in the blood, which can make you feel tired, faint or
breathless).
If such complications arise, they may also need specific treatment in
addition to treating Crohn's disease or ulcerative colitis.
Not everyone will have these problems, but for some people IBD may also
affect other parts of the body, such as the joints, eyes, mouth, liver,
gallbladder, skin or kidneys. Although some of these problems may
improve with the treatment and management of IBD, specific treatment may
also be needed.
In SEVERE cases
In
severe Crohn's disease, another possible problem is a fistula, or tunnel
caused by inflammation that goes from one part of the intestine to
another or to the skin.
In severe ulcerative colitis, sudden, severe dilation of the colon
(referred to as toxic megacolon) may result in a perforation.
The
type of treatment you will be given depends on several things - such as
whether you have ulcerative colitis or Crohn's disease, the extent of
the disease, and the impact of your symptoms on your daily life. For
people with Crohn's disease, especially mild to moderate symptoms,
treatment with medicine is usually the first approach. Drugs that
suppress the immune system (azathioprine, 6-mercaptopurine or
methotrexate) are often used to help control the inflammation and as
maintenance therapy to keep symptoms from coming back. Active Crohn's
disease is usually treated with steroid tablets (eg, prednisolone) and
sometimes antibiotics are also used. When other drug therapy does not
work well, an anti-TNF drug may be given by infusion (drip) in the
hospital or by injection at home.
For
people with ulcerative colitis, similar treatment options are available.
The lower part of the bowel may be treated with drugs given directly
into the rectum with an enema or suppository. A medicine called
mesalazine may be given by mouth.
With both diseases, surgery may be needed if medication does not work
well or if there are complications. If you have any questions about the
possibility of needing surgery, it is best to discuss your situation
with your doctor. In general, surgery is usually only used in severe
situations when other options are not possible or do not work.
In SEVERE cases
Severe
disease may cause joint pain or arthritis, inflammation of the eyes and
mouth, liver diseases, gallstones, skin rashes, anaemia (low red blood
cell count) or kidney stones.
In
severe cases of both diseases, complications can manifest as a blockage
or leak in the bowel. In severe ulcerative colitis, some patients have
their large intestine removed. Because ulcerative colitis can only
affect the large intestine, their disease is considered 'cured'.
However, with severe Crohn's disease, surgery is not considered to be a
cure because the disease can return in another part of the digestive
system later on.
Together, you and your doctor will develop a treatment plan that
reflects your disease severity, past treatments, and any special needs
and goals you may have. For more details on treatment options for
Crohn's disease and ulcerative colitis, please see
Treatment Plan
for Crohn's disease and
Treatment plan for ulcerative colitis.
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