Overview

Crohn's disease is a chronic inflammatory condition that belongs to a group of disorders known as Inflammatory Bowel Disease (IBD). It can cause inflammation anywhere along the digestive tract, although it most commonly affects the end of the small intestine and the beginning of the large intestine. Unlike some conditions that affect only the surface lining, Crohn's disease can involve deeper layers of the bowel wall.

The condition can cause periods of active symptoms, known as flare-ups, followed by periods when symptoms are mild or absent. Common Crohn's Disease Symptoms include persistent diarrhoea, abdominal pain, fatigue, reduced appetite, weight loss, and blood in the stool. Some patients may also develop complications such as intestinal narrowing, fistulas, or abscesses.

At Sarvodaya Hospital, our gastroenterology team provides personalised Crohn's Disease Treatment based on disease location, severity, complications, previous treatment, and overall health. Our approach may include medicines, nutritional support, advanced endoscopic procedures, biologic therapies, and surgery when required.

Symptoms of Crohn's Disease

• Persistent diarrhoea
• Abdominal pain or cramping
• Fatigue
• Reduced appetite
• Unintentional weight loss
• Blood in the stool
• Fever
• Nausea
• Vomiting
• Bloating
• Urgent need to pass stool
• Feeling that the bowel has not completely emptied
• Mouth sores
• Anaemia

Causes of Crohn's Disease

• Abnormal immune system response
• Genetic susceptibility
• Family history of IBD
• Changes in gut microbiome
• Environmental factors
• Smoking
• Previous gastrointestinal infections
• Certain dietary and lifestyle factors

Risk Factors for Crohn's Disease

• Family History: People with a close relative who has Crohn's disease or another form of IBD may have a higher risk.
• Age: Crohn's disease can occur at any age but is commonly diagnosed in adolescents and young adults.
• Smoking: Smoking is associated with an increased risk of Crohn's disease and can make the condition more difficult to manage.
• Immune System Factors : Abnormal immune responses may contribute to persistent inflammation in genetically susceptible individuals.
• Environmental Factors: Environmental and lifestyle factors may influence the development and progression of IBD.
• Previous Gastrointestinal Problems: Certain gastrointestinal infections or changes in the gut microbiome may influence disease development in susceptible people.

Diagnosis of Crohn's Disease

• Medical History and Clinical Examination: The gastroenterologist evaluates symptoms, illness duration, bowel habits, weight changes, family history, nutritional status, and previous medical conditions.
• Stool Tests : Stool investigations can help identify infections and assess intestinal inflammation. Faecal calprotectin may be used as a marker of intestinal inflammation in appropriate patients.
• Colonoscopy : Colonoscopy allows the gastroenterologist to examine the lining of the colon and the end of the small intestine. Biopsies can be collected from different areas to look for characteristic inflammatory changes.
• Upper Gastrointestinal Endoscopy : Upper endoscopy may be recommended when symptoms suggest involvement of the upper digestive tract.
• Capsule Endoscopy : In selected patients, capsule endoscopy can help examine parts of the small intestine that may not be easily reached using conventional endoscopy.
• CT or MRI : Cross-sectional imaging can evaluate the small bowel and identify inflammation, narrowing, fistulas, abscesses, or other complications.
• Biopsy : Tissue samples collected during endoscopy are examined under a microscope to support diagnosis and exclude other conditions.

Treatment Options for Crohn's Disease

• Medication Therapy: Medicines may be used to reduce inflammation, control symptoms, induce remission, or maintain remission. Depending on the patient's condition, treatment may include corticosteroids for short-term control, immunomodulators, biologic medicines, or other advanced therapies.
• Biologic and Advanced Therapies: Biologic medicines target specific pathways involved in intestinal inflammation. They may be recommended for patients with moderate to severe disease or those who do not respond adequately to conventional medicines.
• Nutritional Therapy: Nutritional support is an important part of Crohn's disease management, particularly in patients with weight loss, poor appetite, anaemia, vitamin deficiencies, or malabsorption.
• Symptom Management: Depending on the symptoms, treatment may address diarrhoea, abdominal discomfort, nutritional deficiencies, anaemia, and other complications.
• Advanced Endoscopic Treatment: Endoscopic procedures may be used for selected complications. For example, certain narrowed areas of the intestine may be assessed and treated through endoscopic dilation in appropriately selected patients.
• Crohn's Disease Surgery Treatment: Surgery may be required when Crohn's disease causes complications that cannot be adequately controlled with medicines.

Benefits of Early Crohn's Disease Treatment

Timely Crohn's Disease Treatment can help control inflammation and reduce the risk of long-term complications.

• Controls Inflammation: Appropriate treatment helps reduce intestinal inflammation and control active symptoms.
• Reduces Flare-Ups: Maintenance treatment can help prolong periods of remission and reduce the frequency or severity of flare-ups.
• Prevents Complications: Early management may reduce the risk of strictures, fistulas, abscesses, nutritional deficiencies, and other complications.
• Supports Nutritional Health: Appropriate treatment and dietary support help address weight loss, anaemia, and vitamin or mineral deficiencies.
• Improves Quality of Life: Effective disease management can help patients return to work, education, physical activity, and everyday routines.
• May Reduce the Need for Surgery: Early and appropriate medical management can reduce complications that may eventually require surgical intervention in some patients.

Complications if Left Untreated

• Intestinal strictures
• Bowel obstruction
• Fistulas
• Abscesses
• Intestinal perforation
• Severe bleeding
• Anaemia
• Malnutrition
• Vitamin deficiencies
• Weight loss
• Osteoporosis
• Increased risk of colorectal cancer in some patients with long-standing colonic disease

When Should You See a Doctor?

• Persistent diarrhoea
• Recurrent abdominal pain
• Blood in the stool
• Unexplained weight loss
• Persistent fatigue
• Recurrent fever
• Repeated digestive symptoms
• Symptoms that interfere with daily activities
• A family history of IBD
• Recurrent flare-ups despite treatment

Prevention & Lifestyle Modifications

There is no guaranteed way to prevent Crohn's disease, particularly when genetic and immune factors are involved. However, healthy habits can support disease management and overall wellbeing.

• Avoid Smoking: Smoking can worsen Crohn's disease and is strongly discouraged.
• Follow an Individualised Diet : There is no single diet suitable for everyone with Crohn's disease. Keep a food and symptom record to identify foods that worsen your symptoms and discuss dietary changes with your gastroenterologist or dietitian.
• Stay Hydrated : Adequate fluid intake is particularly important during periods of diarrhoea.
• Maintain Nutritional Health : Follow medical advice regarding iron, vitamin B12, vitamin D, calcium, or other supplements when deficiencies are identified.
• Stay Physically Active : Appropriate physical activity can support muscle strength, bone health, mood, and overall wellbeing.
• Manage Stress : Stress does not cause Crohn's disease, but some patients find that stress can worsen their symptoms. Adequate sleep, relaxation, and appropriate stress-management strategies can be helpful.
• Attend Regular Follow-Ups : Regular gastroenterology appointments help monitor inflammation, treatment response, nutritional health, and possible complications.

Pre- and Post-Treatment Care

Pre-Treatment

• Detailed gastroenterology consultation
• Blood investigations
• Stool tests
• Faecal calprotectin
• Colonoscopy and biopsy
• Upper GI endoscopy when indicated
• CT or MR enterography
• Nutritional assessment
• Assessment for anaemia and vitamin deficiencies
• Review of previous treatments
• Evaluation for complications

Post-Treatment

• Taking medicines exactly as prescribed
• Regular gastroenterology follow-ups
• Monitoring symptoms and bowel habits
• Periodic blood and stool tests
• Nutritional monitoring
• Following an individualised diet
• Maintaining adequate hydration
• Regular physical activity as tolerated
• Monitoring for medication side effects
• Colonoscopy or imaging when recommended
• Prompt reporting of new or worsening symptoms