Crohn's disease affects young and old
Crohn's disease is a chronic inflammatory bowel disease which may affect any part of the gastrointestinal tract but particularly affects the terminal ileum which is the very end of the small intestine, as well as the proximal colon, which is the beginning of the large intestine.
Studies suggest that there are approximately 20,000 people in Ireland currently suffering with Crohn's disease. The onset of Crohn's disease has two age peaks, the first and largest peak occurring between that ages of 15 and 30 years whilst the second and smaller peak tends to occur between the ages of 60 and 80 years. It is more common in women than men, however in children it seems to be more common in boys than girls.
RISK FACTORS FOR CROHN'S DISEASE
There is a genetic component to Crohn's disease with 15-20% of suffers having an affected family member. Smoking increases the risk of developing Crohn's Disease three to four fold and smokers tend to have more aggressive disease than non-smokers. Other exacerbating factors include infections such as respiratory tract infections and medications such as non-steroidal anti-inflammatory medications.
Symptoms are variable but often include diarrhoea (which may be bloody and persistent lasting for at least a six-week period), abdominal pain and/or weight loss. Typically there will be periods of acute exacerbation interspersed with periods of less active disease. Other symptoms such as malaise, anorexia and fever are common. Extra-intestinal features may also be present (see below). Children may present with poor growth, delayed puberty, malnutrition and bone demineralisation.
Extra-intestinal features which may occur include the following:
l Conjunctivitis and iritis (inflammation of the eyes)
l Perianal abscesses
l Anal fissures
l Mouth ulcers
l Fatty liver
l Renal stones
The diagnosis of Crohn's disease is confirmed by clinical examination in conjunction with biochemical investigations as well as endoscopic, histological and radiological investigations.
Disease activity can be assessed by doing regular blood tests which specifically look at patients' inflammatory markers. Prompt referral is essential for patients with abdominal pain and diarrhoea associated with weight loss, iron deficiency, or markedly raised inflammatory markers, especially if diarrhoea occurs at night.
Urgent hospital admission is required if a patient with known Crohn's disease develops severe abdominal pain and severe diarrhoea (occurring more than eight times per day) and especially so if the patient has a temperature or if they suddenly stop passing bowel motions and are vomiting.
In patients with mild disease a drug called mesalazine may be prescribed. Corticosteroids may be added during times of acute relapse when patients who are on long term treatment disimprove. Medications known as 5-aminosalicylate (5-ASA) are also used in patients suffering with Crohn's disease but these medications are less effective than alternative treatment. Anti-diarrhoeal medications are strictly prohibited in patients who become acutely unwell as they can lead to a serious complication known as Toxic Megacolon. They may, however, be prescribed for use in patients who are medically stable.
Bile acid sequestrants such as colestramine and colestipol may be useful in controlling diarrhoea in patients with terminal ileal disease (small intestine). Abdominal cramps may be controlled by using antispasmodic medications such as hyoscyamine, but only if intestinal obstruction has been excluded. Immunomodulators such as methotrexate and azathioprine are increasingly being used early in treatment and are particularly important in patients who are more likely to have aggressive disease. Cytokine modulators, such as Infliximab, block the action of inflammation which causes Crohn's disease and may be used in severe cases.
For those who fail to respond to medication, surgery, although not curative, may be undertaken in order to help relieve symptoms. For all patients and in all cases smoking cessation is vital and is the most important factor in maintaining remission. For support and further information visit www.iscc.ie