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What is a Crohn’s disease?

Crohn's disease a problem with colon

Crohn’s disease is a disease mainly of the small intestine, in which segments become inflamed and the lining ulcerated, fissured and then greatly thickened. Between these affected segments the intestine remains normal. The condition commonly affects the lower part of the small intestine (the ileum), but can affect any part of the bowel.

Crohn’s disease occurs in 5 to 8 people per 100,000 of population, and at any one time 50 to 60 people per 100,000 have the disease. It is more common in white people than in black. The disease can affect people of any age but usually occurs in the age group between 20 and 40. It affects men and women equally.

Symptoms

The symptoms of Crohn’s disease are:

  • fever,
  • diarrhea,
  • pain in the abdomen,
  • loss of appetite and weight,
  • feeling generally unwell,
  • rectal bleeding,
  • a feeling of fullness and pain in the lower part of the abdomen.

There may be long periods where the condition is inactive, but flare-ups are always liable to occur. These may be greatly helped by appropriate treatment.

Causes

Symptoms of Crohn's disease

The cause of Crohn’s disease is not clear.

Possible causes

  • Infection – Not proven, although some cases start after a bout of gastroenteritis
  • Immunological disorder – Not proven
  • Diet – Not proven, although some people find it’s better to avoid certain foods
  • There is some evidence that both genetic and environmental factors are involved.

Diagnosis

Crohn's disease in a colon

There are few physical signs apart from loss of weight and obvious ill-health. Sometimes a mass can be felt in the abdomen when loops of inflamed bowels are stuck together. There may be fatty stools.

Investigation involves:

  • Stool tests
  • Blood tests
  • Sigoidoscopy- investigation of the lower bowel with a tube and light
  • Colonoscopy- investigation of the colon with a fibre optic telescope
  • Barium X ray

Treatment

Drugs to help to firm up the stools.

Antibiotics may be given to combat any infection.

The types of Crohn's disease

Acute inflammation is usually treated initially with preparations applied directly into the back passage, such as foams or enemas containing corticosteroid drugs or compounds known as aminosalicylates, e.g. sulfasalazine or mesalazine to try and control the inflammatory process.

If the disease does not respond to this local treatment, the same medicines are then taken by mouth as tablets, capsules or granules.

In cases where the disease frequently flares up and is difficult to control with these treatments, drugs that influence the immune system may be useful, but these should usually be taken under the advice of a specialist.

Surgical treatment to remove damaged portions of the bowel may be necessary to treat obstruction, abscess or blood loss. Surgery usually prompts a flare-up of the disorder, and repeated operations, usually at the same site, are often required.

Complications

  • Internal bleeding and iron deficiency
  • Obstruction. (partial or complete blockage of the intestine)
  • Bowel perforation or widening
  • Formation of fistulas.
  • Slight increased risk of bowel cancer
  • Problems with food absorption, due to scarring in the intestine, or because the length is reduced after a number of operations.



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