Introduction

Crohn's disease
Crohn's disease

Crohn’s disease is a lifelong condition in which parts of the digestive system become inflamed.

It's one type of a condition called inflammatory bowel disease (IBD).

Symptoms

Crohn's disease affects people of all ages. The symptoms usually start in childhood or early adulthood.

The main symptoms are:

  • diarrhoea
  • stomach aches and cramps
  • tiredness (fatigue)
  • weight loss
  • blood in your poo

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.

When to see a GP

See a GP if you or your child have:

  • blood in your poo
  • diarrhoea for more than 7 days
  • frequent stomach aches or cramps
  • lost weight for no reason, or your child isn't growing as fast as you'd expect

A GP will try to find out what's causing your symptoms and may refer you for tests to check for Crohn's disease.

Treatments

There's no cure for Crohn's disease, but treatment can help reduce or control your symptoms.

The main treatments are:

  • 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

You'll usually have a team of health professionals helping you, possibly including your GP, a specialist nurse and specialist doctors.

Living with Crohn's disease

Living with Crohn's disease can be difficult at times. Unpredictable flare-ups and regular check-ups with your care team can disrupt school, work and your social life.

But 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 and Colitis UK if you need it.

Causes

The exact cause of Crohn’s disease is unknown. It's thought several things could play a role, including:

  • your genes - you're more likely to get it if a close family member has it
  • a problem with the immune system (the body’s defence against infection) that causes it to attack the digestive system
  • smoking
  • a previous stomach bug
  • an abnormal balance of gut bacteria

There's no evidence to suggest a particular diet causes Crohn's disease.

 

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Symptoms

Without treatment, symptoms of Crohn's disease can be constant or may come and go every few weeks or months.

When the symptoms come back, it's called a flare-up or relapse. The periods between flare-ups are called remission.

Common symptoms

The main symptoms of Crohn's disease are:

  • diarrhoea - which may come on suddenly
  • stomach aches and cramps - most often in the lower-right part of your tummy
  • blood in your poo
  • tiredness (fatigue)
  • weight loss

You might not have all these symptoms.

Other symptoms

Some people with Crohn's disease also have:

  • a high temperature (fever)
  • feeling and being sick
  • joint pains
  • sore, red eyes
  • patches of painful, red and swollen skin - usually on the legs
  • mouth ulcers

Children with Crohn's disease may grow slower than usual.

When to see a GP

See a GP if you or your child have:

  • blood in your poo
  • diarrhoea for more than 7 days
  • frequent stomach aches or cramps
  • lost weight for no reason, or your child isn't growing as fast as you'd expect

A GP will try to find out what's causing your symptoms and may refer you for tests to check for Crohn's disease.

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Diagnosis

Crohn's disease can sometimes be difficult to diagnose because it can have similar symptoms to lots of other conditions.

Your GP can check for any obvious causes of your symptoms and refer you for more tests if needed.

Seeing your GP

To find out what the problem might be, your GP may ask about:

  • your symptoms
  • your diet
  • if you've been abroad recently - you might have an infection
  • any medicines you're taking
  • if you have a family history of Crohn's disease

They may also:

  • feel and examine your tummy
  • take a sample of blood
  • ask you to provide a poo (stool) sample

Blood and stool samples can be tested for things like inflammation - which could be due to Crohn's disease - and infections. It may take a few days or weeks to get the results.

Referral to a specialist

If they think you could have Crohn's disease, your GP may refer you to a doctor called a gastroenterologist for tests to confirm the diagnosis.

Tests you may have include:

  • a colonoscopy - a thin, flexible tube with a camera at the end is inserted into your bottom to look for inflammation in your bowel
  • a biopsy - tiny pieces of your bowel are removed during a colonoscopy and checked for signs of Crohn's disease
  • an MRI scan or CT scan - you may have a special drink first to make your bowel show up clearly on the scan

What happens if you're diagnosed with Crohn's disease

If your doctor thinks you have Crohn's disease, they'll tell you about the condition and the treatment options.

It might be difficult to take in everything they tell you.

If you're unsure about something later, write down any questions you have and make another appointment to go over them.

The charity Crohn's and Colitis UK has information for people diagnosed with Crohn's disease.

 

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Treatment

There is currently no cure for Crohn’s disease, but treatment control or reduce the symptoms and help stop them coming back.

Medicines are the main treatments, but sometimes surgery may be needed.

Steroids

Most people with Crohn's disease need to take steroids (such as prednisolone) from time to time.

Steroid medicines:

  • can relieve symptoms by reducing inflammation in your digestive system - they usually start to work in a few days or weeks
  • are usually taken as tablets once a day - sometimes they're given as injections
  • may be needed for a couple of months - don't stop taking them without getting medical advice
  • can cause side effects like weight gain, indigestion, problems sleeping, an increased risk of infections and slower growth in children

The charity Crohn's and Colitis UK has more on steroids.

Liquid diet

For children and young adults, a liquid diet (enteral nutrition) can also help reduce symptoms.

This involves having special drinks that contain all the nutrients you need, instead of your usual diet, for a few weeks.

It avoids the risk of slower growth that can happen with steroids.

Enteral nutrition has few side effects, but some people may feel sick or have diarrhoea or constipation while on the diet.

Crohn's and Colitis UK has information on food and Crohn's disease, which has more on enteral nutrition.

Immunosuppressants

Sometimes you might also need to take medicines called immunosuppressants to reduce the activity of your immune system. Common types include azathioprine, mercaptopurine and methotrexate.

Immunosuppressants:

  • can relieve symptoms if steroids on their own aren't working
  • can be used as a long-term treatment to help stop symptoms coming back
  • are usually taken as a tablet once a day, but sometimes they're given as injections
  • may be needed for several months or years
  • can cause side effects like feeling and being sick, increased risk of infections and liver problems

Crohn's and Colitis UK has more on azathioprine and mercaptopurine.

Biological medicines

If other medicines aren't helping, stronger medicines called biological medicines may be needed.

The biological medicines for Crohn's disease are adalimumab, infliximab, vedolizumab and ustekinumab.

Biological medicine:

  • can relieve symptoms if other medicines aren't working
  • can be used as a long-term treatment to help stop symptoms coming back
  • are given by injection or a drip into a vein every 2 to 8 weeks
  • may be needed for several months or years
  • can cause side effects like increased risk of infections and a reaction to the medicine leading to itching, joint pain and a high temperature

Crohn's and Colitis UK has more on adalimumab and more on infliximab.

Surgery

Your care team may recommend surgery if they think the benefits outweigh the risks or that medicines are unlikely to work.

Surgery can relieve your symptoms and help stop them coming back for a while, although they will usually return eventually.

The main operation used is called a resection. This involves:

  1. Making small cuts in your tummy (keyhole surgery).
  2. Removing a small inflamed section of bowel.
  3. Stitching the healthy parts of bowel together.

It's usually done under general anaesthetic (while you're asleep). You may be in hospital for about a week and it might take a few months to fully recover.

Sometimes you may need an ileostomy (where poo comes out into a bag attached to your tummy) for a few months to let your bowel recover before it's stitched back together.

Crohn's and Colitis UK has more on surgery for Crohn's disease.

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Living with

Living with Crohn's disease can be difficult at times, but there's no reason you can't have a normal life if your symptoms are well controlled.

Diet and lifestyle

There's no special diet for adults with Crohn's disease, but children may sometimes need a special liquid diet to control their symptoms. Aim to have a healthy, balanced diet.

Some people find that certain foods seem to make their symptoms worse. If you think a particular food is triggering your symptoms, see if avoiding it helps. But don't make any big changes to your diet without speaking to your GP or care team first.

Crohn's and Colitis UK has more on food and Crohn's disease.

If you smoke, stopping smoking may reduce the risk of flare-ups.

Over-the-counter medicines

You may need to be careful taking some over-the-counter medicines if you have Crohn's disease.

Some can trigger symptoms and others may stop your Crohn's disease medicines working properly. For example, anti-inflammatory painkillers like ibuprofen can make some people's symptoms worse.

Ask a pharmacist, your GP or your care team for advice before taking an over-the-counter medicine, including medicines to relieve stomach cramps or diarrhoea (such as loperamide).

Vaccinations

You're more at risk of infections like flu if you're being treated with either:

  • immunosuppressant medicines - such as azathioprine, methotrexate and mercaptopurine
  • biological medicines - such as adalimumab and infliximab

It's recommended you have the flu jab every year and the one-off pneumococcal vaccination.

But avoid having any live vaccines, such as the MMR vaccine, because they could make you ill.

Pregnancy

Most women who have Crohn's disease can have a normal pregnancy and healthy baby.

However, some Crohn's disease medicines can harm an unborn baby, so you should:

  • tell your GP or care team as soon as possible if you get pregnant accidentally – don't stop taking your medicines without getting advice first
  • speak to your GP or care team if you're planning a pregnancy – they may recommend changing your treatment

Women may find it harder to get pregnant during a flare-up, but fertility should return to normal in between. Some Crohn's disease medicines can temporarily reduce fertility in men.

Crohn's and Colitis UK has more on fertility and Crohn's disease.

Contraception

Make sure you use contraception if you don't want to get pregnant.

Ask your GP or care team about the best contraception to use because some types, such as the pill, may not work as well as usual if you have Crohn's disease.

Possible complications

Crohn's disease can increase your risk of other problems, including:

  • damage to your bowel that may require surgery – such as scarring and narrowing (strictures), ulcers and small tunnels running from one part of your bowel to another (fistulas)
  • difficulty absorbing nutrients from food – this can lead to problems like weak bones (osteoporosis) or a lack of iron (iron deficiency anaemia)
  • bowel cancer – you may need regular cancer screening to check for this

Cancer screening

You're more likely to get bowel cancer if you have Crohn's disease. The risk is low at first but increases the longer you have the condition. For example:

  • after 10 years the risk is about 1 in 50
  • after 20 years the risk is about 1 in 10
  • after 30 years the risk is about 1 in 5

If you've had Crohn's disease for more than 10 years or it affects several parts of your bowel, your care team may recommend screening to check for cancer.

This involves having regular colonoscopies. This is where a thin, flexible tube with a camera at the end is inserted into your bottom.

Getting help and support

The unpredictable flare-ups of Crohn's disease can be hard to cope with emotionally and practically.

It may help to:

  • tell your friends and family about your condition – so they can understand the effect it has on your life
  • talk to your GP or care team – they can offer support, treatment and referral to a specialist such as a counsellor if needed
  • use support groups like Crohn's and Colitis UK
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 02/05/2018 14:39:21