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Crohn’s Disease

Crohn's disease is a chronic condition where the bowels become inflamed and develop ulcers, similar to those of ulcerative colitis. However, in Crohn’s disease, this inflammation can occur anywhere in the gastrointestinal tract (not just in the bowel).

  1. Can cause abdominal pain, diarrhoea, and rectal bleeding
  2. Most commonly diagnosed between the ages of 15 and 35
  3. Managed with various long-term treatments

If you have Crohn’s and would like to speak to a doctor online, or are concerned you may have symptoms of the disease, you can use our video consultation service . We work with GMC-registered practitioners, who are available for appointments at a convenient time for you. 

Crohn’s Disease
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Description

Crohn’s disease is a chronic condition that causes inflammation of the digestive system. It consists of periods of remission and flare ups, and results in ulcerations in the gut, which in turn cause bloody stools that characterise moderate to severe Crohn’s disease. Mucus in the stool, abdominal pain, diarrhoea and needing to go to the toilet urgently are other common symptoms, and some people may experience skin irritation and fatigue.

What the exact cause of Crohn’s disease is remains unclear, but it is thought to be a combination of genetics, a reaction in the immune system to certain bacteria, and a reaction to an environmental trigger such as stress or smoking.

According to NICE guidelines, the prevalence of Crohn’s disease is 10.6 per 100,000 people in the UK, and its rates are increasing worldwide. It can occur at any age, but it's most likely to present itself in adolescence and young adulthood. It is equally as likely to affect men as women.

There are many different types of Crohn’s disease that affect different areas of the gut. Crohn’s in the ileum is the most common, and it causes pain in the right side of the abdomen. Crohn's in the ileum is unlikely to produce blood in the stool. Colonic Crohn’s disease (throughout the large intestine, usually in patches) is the second most common, and  causes more frequent bowel movements and bloody diarrhoea. Small bowel Crohn’s disease is the other main type which usually affects children and young people.

Crohn’s disease can also lead to other complications, both in the gut and elsewhere in the body. It may cause intestinal strictures, where the intestinal wall is narrowed, making it more difficult to pass bowel contents, and fistulas, where the wall of the bowel can tear and leak into organs nearby. Perforations, where a bowel wall is ruptured, can also occur. Crohn’s disease can sometimes lead to inflammation in other parts of the body, such as the joints, skin and eyes.

In terms of managing the condition, it varies depending on the severity. A doctor may advise medication or dietary therapy or both. Provided that a medication plan is followed accordingly, many people with Crohn’s disease are able to carry on life as normal for the most part. However, intermittent flare ups are inevitable and unpredictable with the condition.

A doctor may suggest trying a balanced and nutritious diet, with the caveat that certain triggers may lead to relapses. For example, some people find it can help to adjust the amount of fibre in their diet, as well as spicy foods and dairy products, but this varies from one person to the next. For some, stress may be a trigger, and should be avoided wherever possible. Smoking is also thought to make Crohn’s worse and exacerbate symptoms.

If you have symptoms that may be indicative of Crohn’s disease, or have already been diagnosed with the condition and would like to consult with a doctor online, our online private video consultation service can help. Book a slot at a time that suits you best.

Page last reviewed:  26/02/2020
Diagnosis and treatment

How is Crohn’s disease diagnosed?

Crohn’s disease may be suspected on the basis of symptoms, which include blood and mucus in the stool, going to the toilet more than normal (diarrhoea), increased urgency and sometimes weight loss.

Someone who has these symptoms persistently will normally be referred to a specialist.

Will I need tests?

Yes. In order to rule out other conditions that can often be confused with Crohn’s disease, such as ulcerative colitis or irritable bowel syndrome, a doctor will perform a number of tests to confirm a diagnosis. 

A full blood count is conducted, as around two thirds of people with inflammatory bowel disease are anaemic. An increased platelet count also indicates inflammation. A stool sample will be carried out to rule out an infection, and to establish if there are signs of bleeding and inflammation.

There are various types of endoscopies that can be performed to examine the inside of the bowel. This involves using a long, thin tube with a camera on the end to get an idea of where the inflammation is. The two most common types are a colonoscopy to look at the colon and rectum, and a sigmoidoscopy, which is a shorter version of a colonoscopy.

A doctor may also wish to use imaging procedures to confirm a diagnosis. X-Rays, MRI scans and ultrasound can all be utilised to provide an accurate picture of what is happening inside the intestine.

What will a doctor normally advise?

Once you have been diagnosed with Crohn’s disease, you will be referred to a gastroenterology specialist for ongoing care. They will help you to form a treatment plan by assessing the severity of your symptoms. 

You’ll normally need to see them regularly (at least once a year in most cases) to monitor your disease activity and treatment.

What treatments are there for Crohn’s disease?

Depending on the severity of the condition, there are a number of treatment options for Crohn’s disease. In most cases, the medications are used to reduce the frequency of flare ups and manage them when they do occur. 

The available treatment options are mostly the same as for ulcerative colitis: 5-ASAs (to help reduce inflammation in the intestine lining); corticosteroids (to alleviate symptoms during a flare-up); immunosuppressants such as Azathioprine (to suppress the immune system which in turn reduces inflammation) and, where necessary, biologics (newer drugs which prevent inflammation by targeting specific proteins).

If these treatments aren't successful, surgical measures may be explored. For example, a stricturoplasty widens the narrow part of the intestine, and a resection can remove particularly inflamed sections of the intestine.

However, surgery on the bowel is not always successful in sending Crohn’s into remission; the condition may sometimes occur further up the gastrointestinal tract. A doctor will normally weigh up the risks and benefits of surgery with a patient before a mutual decision is reached.

Page last reviewed:  26/02/2020
Questions and Answers

How is Crohn’s disease treated?

There is no cure for Crohn’s disease. Treatment focuses on extending the remission period and minimising the impact of relapses. A specialist will help you formulate a treatment plan, which is vital in order to successfully manage symptoms. This can range from simple dietary changes to medication and surgery.

What treatments are there?

Treatment for Crohn’s disease depends mostly on the severity of the condition. Drugs used to treat Crohn’s disease all work to reduce the inflammation in their own way. These include: corticosteroids, 5-ASAs, biologics, and immunosuppressants.

Alternatively, there are a couple of surgical options which involve either widening the intestine or removing particularly inflamed sections.

Can I consult a doctor about Crohn’s disease online?

Yes, you can consult with one of our UK doctors by using our private online video service. Our clinicians will be able to advise you on the best management techniques for Crohn's, and what treatment options are available to you. They can also prescribe medication, which you can have dispensed at our UK pharmacy or sent to your local pharmacy via an e-prescription.

Page last reviewed:  26/02/2020

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