Dr Philippa Kaye on Crohn’s Disease
Dr Philippa Kaye looks at what causes Crohn’s disease and the treatments available to help the condition…
Dr Philippa Kaye
Millie, 58, had made an appointment because she was terrified she had bowel cancer. She rarely came to see a doctor and had no major health conditions but had noticed her bowel habits had changed.
Millie said she had always been constipated, going every two or three days passing hard stools, and would often eat prunes to try and encourage things along.
A few months before she was going every day easily, and said to be honest that she was delighted and didn’t think anything of it, until about a month or so later when she started having diarrhoea multiple times a day. She didn’t pass any blood with the stool but described sometimes passing what she described as mucous, and noticed her clothes were getting bigger.
Millie was referred on a two week suspected cancer wait to see the colorectal surgeons in the hospital. Symptoms of bowel cancer include change in bowel habit, abdominal pain, blood in the poo, unexplained weight loss and fatigue. Millie did not have bowel cancer but was diagnosed with Crohn’s disease which is a type of inflammatory bowel disease.
What is Crohn’s Disease?
Crohn’s disease causes inflammation of the intestines and can affect the gastrointestinal system anywhere from the mouth to the anus. It affects about 145 in 100 000 people in the UK, most commonly diagnosed between about 15 and 30 years old, with a smaller second peak between 50 and 70. It is more common if you have a family history of Crohn’s or are a smoker but the exact cause is not known. Inflammation can flare up periodically and cause symptoms, which vary depending on the part of the intestine involved.
What are the symptoms of Crohn’s Disease?
The commonest symptom is diarrhoea, which can be multiple times a day and you may notice that there is blood, mucous, or pus mixed in with the diarrhoea. There is also abdominal pain and you may feel unwell with fever and loss of appetite – unintentional weight loss can also occur.
Some people may have non gut related symptoms – mouth ulcers are common.
How is it diagnosed?
Depending on your symptoms you may be offered blood and stool tests, a colonoscopy or gastroscopy or an MRI. As Crohn’s disease can affect any part of the gastrointestinal system the choice of imaging will depend on your symptoms.
Millie was referred to the colorectal surgeons and was diagnosed after blood tests, stool tests and a colonoscopy where biopsies were taken. She was given treatment to calm down the flare up of inflammation in the gut and then to prevent further flare ups. She will also have regular colonoscopies as patients with Crohn’s disease have increased risk of developing bowel cancer.
How is Crohn’s Disease treated?
Most commonly patients are given a course of steroid treatments for flare ups for a few weeks and then gradually tapered off – they reduce inflammation to improve symptoms.
Immunosuppressant medications like azathioprine or mercaptopurine, or newer biological monoclonal antibody therapies like infliximab can be given to prevent flare ups. Sometimes a liquid diet is helpful as a way of resting the bowel, under the supervision of dietitians. Surgery can also be used if other medical therapies are not effective, to remove the part of the intestine which is severely inflamed.
Complications of Crohn’s Disease
With severe disease with lots of flare ups scar tissue can build up in the intestine leading to narrowing of the gut which can cause intestinal obstruction which requires surgical treatment.
Other complications include perforation where a hole forms in the intestinal wall which needs emergency surgery. A fistula can develop – a channel between two organs or two parts of the gut – and surgical repair is required.
If there are nutritional deficiencies, conditions like osteoporosis can occur. With Crohn’s disease you have a higher risk of bowel cancer.
Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.
Article written on December 16, 2021; article reviewed and updated on July 31, 2024.
Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on Ulcerative Colitis, Pre-diabetes, Skin Cancer, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.
Allison Hay
I joined the "My Weekly" team thirteen years ago and, more recently, "The People's Friend". I love the variety of topics we cover both online and in the magazines. I manage the digital content for the brands, sharing features and information on the website, social media and in our digital newsletters.
