Crohn's disease

Symptoms

Without treatment, symptoms of Crohn's disease can be constant or may come and go every few weeks or months.

When the symptoms come back, it's called a flare-up or relapse. The periods between flare-ups are called remission.

Common symptoms

The main symptoms of Crohn's disease are:

• diarrhoea – which may come on suddenly
• stomach aches and cramps – most often in the lower-right part of your tummy
• blood in your poo
• tiredness (fatigue)
• weight loss

You might not have all these symptoms.

Other symptoms

Some people with Crohn's disease also have:

• a high temperature
• feeling and being sick
• joint pains
• sore, red eyes
• patches of painful, red and swollen skin – usually on the legs
• mouth ulcers

Children with Crohn's disease may grow more slowly than usual.

Causes

The exact cause of Crohn's disease is unknown.

It's thought several things could play a role, including:

• your genes – you're more likely to get it if a close family member has it
• a problem with the immune system (the body's defence against infection) that causes it to attack the digestive system
• smoking
• a previous stomach bug
• an abnormal balance of gut bacteria

There's no evidence to suggest a particular diet causes Crohn's disease.

Diagnosis

Crohn's disease can sometimes be difficult to diagnose because it can have similar symptoms to lots of other conditions.

A GP can check for any obvious causes of your symptoms and refer you for more tests if needed.

Seeing a GP

To find out what the problem might be, the GP may ask about:

• your symptoms
• your diet
• if you've been abroad recently – you might have an infection
• any medicines you're taking
• if you have a family history of Crohn's disease

They may also:

• feel and examine your tummy
• take a sample of blood
• ask you to provide a poo (stool) sample

Blood and stool samples can be tested for things like inflammation – which could be due to Crohn's disease – and infections. It may take a few days or weeks to get the results.

Referral to a specialist

If they think you could have Crohn's disease, a GP may refer you to a doctor called a gastroenterologist for tests to confirm the diagnosis.

Tests you may have include:

• a colonoscopy – a thin, flexible tube with a camera at the end is inserted into your bottom to look for inflammation in your bowel
• a biopsy – tiny pieces of your bowel are removed during a colonoscopy and checked for signs of Crohn's disease
• an MRI scan or CT scan – you may have a special drink first to make your bowel show up clearly on the scan

Treatment Options

There's currently no cure for Crohn's disease, but treatment can control or reduce the symptoms and help stop them coming back.

Medicines are the main treatments, but sometimes surgery may be needed.

Steroids

Most people with Crohn's disease need to take steroids (such as prednisolone) from time to time.

Steroid medicines:

• can relieve symptoms by reducing inflammation in your digestive system – they usually start to work in a few days or weeks
• are usually taken as tablets once a day – sometimes they're given as injections
• may be needed for a couple of months – do not stop taking them without getting medical advice
• can cause side effects like weight gain, indigestion, problems sleeping, an increased risk of infections and slower growth in children

Liquid diet

For children and young adults, a liquid diet (enteral nutrition) can also help reduce symptoms.

This involves having special drinks that contain all the nutrients you need, instead of your usual diet, for a few weeks.

It avoids the risk of slower growth that can happen with steroids.

Enteral nutrition has few side effects, but some people may feel sick or have diarrhoea or constipation while on the diet.

Immunosuppressants

Sometimes you might also need to take medicines called immunosuppressants to reduce the activity of your immune system.

Common types include azathioprine, mercaptopurine and methotrexate.

Immunosuppressants:

• can relieve symptoms if steroids on their own are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are usually taken as a tablet once a day, but sometimes they're given as injections
• may be needed for several months or years
• can cause side effects like feeling and being sick, increased risk of infections and liver problems

Biological medicines

If other medicines are not helping, stronger medicines called biological medicines may be needed.

The biological medicines for Crohn's disease are adalimumab, infliximab, vedolizumab, ustekinumab and risankizumab.

Biological medicines:

• can relieve symptoms if other medicines are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are given by injection or a drip into a vein every 2 to 8 weeks
• may be needed for several months or years
• can cause side effects like increased risk of infections and a reaction to the medicine leading to itching, joint pain and a high temperature

Surgery

Your care team may recommend surgery if they think the benefits outweigh the risks or that medicines are unlikely to work.

Surgery can relieve your symptoms and help stop them coming back for a while, although they'll usually return eventually.

The main operation used is called a resection. This involves:

1. Making small cuts in your tummy (keyhole surgery).
2. Removing a small inflamed section of bowel.
3. Stitching the healthy parts of bowel together.

It's usually done under general anaesthetic (while you're asleep).

You may be in hospital for about a week and it might take a few months to fully recover.

Sometimes you may need an ileostomy (where poo comes out into a bag attached to your tummy) for a few months to let your bowel recover before it's stitched back together.

You may need to take medicine after surgery to help prevent symptoms returning.

When To See A Doctor

See a GP if you or your child have:

• blood in your poo
• diarrhoea for more than 7 days
• frequent stomach aches or cramps
• lost weight for no reason, or your child is not growing as fast as you'd expect

A GP will try to find out what's causing your symptoms and may refer you for tests to check for Crohn's disease.