Crohn’s Disease

Crohn’s disease is a chronic inflammatory bowel disease that causes inflammation of the digestive tract. This condition can affect any part of the gastrointestinal tract from the mouth to the anus, but most commonly involves the end of the small intestine and the beginning of the colon. Crohn’s disease causes the intestinal wall to become thick, inflamed, and ulcerated, which can lead to abdominal pain, severe diarrhoea, fatigue, weight loss, and malnutrition.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Crohn’s Disease

Patients with Crohn’s disease may experience a range of symptoms that can vary in severity and may develop gradually or suddenly.

Abdominal Pain and Cramping

Pain typically occurs in the lower right abdomen where the ileum is located but can occur anywhere along the digestive tract. The pain may range from mild to severe and often worsens after eating.
Persistent diarrhoea

Inflammation in the intestines can disrupt normal water absorption, resulting in loose, watery stools. Diarrhoea may contain blood, mucus, or pus.
Weight Loss

Reduced appetite and malabsorption of nutrients can lead to unintended weight loss. The body struggles to absorb nutrients properly when the intestinal lining is inflamed.
Fatigue

Chronic inflammation, anaemia, and malnutrition can cause persistent fatigue. The body expends additional energy combating inflammation.
Fever

A low-grade fever may occur during flare-ups, signalling inflammation in the body. This symptom often accompanies other signs and symptoms of an active disease state.
Mouth Sores

Canker sores may develop inside the mouth, adding to discomfort. These ulcers resemble those found in the intestines.
Perianal Disease

Fistulas, abscesses, or fissures can develop around the anus, a common complication for many people with Crohn’s disease.

Causes and Risk Factors

The development of Crohn’s disease is influenced by a combination of genetic, immune, environmental, and microbial factors that contribute to chronic inflammation in the digestive tract.

Genetics

Individuals with family members who have Crohn’s disease are at a higher risk of developing the condition. Multiple genes have been identified that may increase susceptibility.

Immune System Dysfunction

The immune system attacks harmless bacteria or food in the intestines, causing inflammation. This abnormal immune response continues without proper regulation.

Environmental Factors

Smoking, a high-fat diet, and certain medications may trigger inflammation in genetically susceptible individuals. Urban living and industrialised settings show higher rates of inflammatory bowel disease.

Microbiome Changes

Alterations in gut bacteria may contribute to inflammation in Crohn’s disease. The balance between beneficial and potentially harmful bacteria becomes disrupted.

Diagnostic Methods

Blood Tests

These tests check for anaemia, infection, and inflammation markers, such as C-reactive protein and erythrocyte sedimentation rate. Blood tests also screen for antibodies associated with inflammatory bowel disease and can help rule out other conditions.
Stool Analysis

A laboratory examination of stool samples can detect the presence of blood, mucus, and signs of infection. Calprotectin levels in stool serve as a reliable marker of intestinal inflammation, helping to differentiate between inflammatory bowel disease and irritable bowel syndrome.
Colonoscopy

This procedure allows direct visualisation of the colon and terminal ileum using a flexible, lighted tube with a camera. During a colonoscopy, small tissue samples (biopsies) can be collected for microscopic examination to confirm the diagnosis and evaluate patterns of inflammation.
Imaging Studies

CT enterorrhaphy and MR enterrography provide detailed images of the small intestine that standard X-rays cannot capture. These specialised imaging techniques use oral contrast materials to highlight the bowel and detect inflammation, strictures, fistulas, and other complications.

Treatment Options

Treatment for Crohn’s disease aims to reduce inflammation, relieve symptoms, prevent complications, and achieve long-term remission.

Non-Surgical Treatment

Anti-inflammatory Medications: Aminosalicylates and corticosteroids work to decrease inflammation in the digestive tract. Corticosteroids act quickly to control flare-ups but are not suitable for long-term use due to potential side effects like bone loss, weight gain, and increased infection risk.
Immunosuppressants: These medications reduce immune system activity that contributes to inflammation. Azathioprine, mercaptopurine, and methotrexate suppress the immune response more broadly and may take several months to become fully effective.
Biologics: These medications target specific proteins involved in inflammation. Anti-TNF agents, anti-integrin therapies, and interleukin inhibitors block specific pathways in the inflammatory process and may be effective when other treatments fail.
Antibiotics: These can reduce drainage from fistulas and abscesses and sometimes help heal inflamed areas. Metronidazole and ciprofloxacin may decrease harmful bacteria in the intestine that could trigger or worsen inflammation.

Surgical Treatment

Strictureplasty: This procedure widens narrowed sections of the intestine without removing any bowel tissue. An incision is made along the narrowed area, which is then sutured in a way that expands the passage. This approach helps maintain intestinal length and absorption capacity.
Bowel Resection: Diseased portions of the intestine are surgically removed, and the remaining healthy sections are reconnected. This procedure aims to eliminate severely affected tissue while preserving as much of the intestine as possible to minimise complications like short bowel syndrome.
Abscess Drainage: Pockets of pus (abscesses) can be drained either percutaneously under imaging guidance or surgically. A doctor may insert a needle or catheter to drain the abscess, while more complex cases may require surgical drainage.
Fistula Repair: Abnormal connections between sections of the intestine or between the intestine and other organs are surgically closed. Depending on complexity, the procedure may involve direct closure or the use of tissue flaps to reinforce healing.

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Prevention and Management

While Crohn’s disease cannot be prevented, patients can manage the condition through medication adherence, regular medical check-ups, and lifestyle modifications. A balanced diet tailored to individual triggers helps maintain nutrition, though specific food restrictions vary among patients. Stress reduction techniques like meditation may help prevent flare-ups. Smoking cessation benefits all Crohn’s patients, as smoking worsens symptoms and increases the risk of complications. Regular exercise supports overall health and may reduce inflammation. Patients should maintain detailed symptom records to identify patterns and triggers, enabling proactive management with their healthcare team before severe flares develop.

Frequently Asked Questions (FAQ)

What are the potential complications of untreated Crohn’s disease?

Without treatment, Crohn’s disease can cause bowel obstruction, fistulas, abscesses, and malnutrition. It may also slightly increase the risk of colon cancer and lead to complications outside the intestines, such as joint pain, skin conditions, eye inflammation, and liver or bile duct disorders.

Can Crohn’s disease go into remission?

Yes, with appropriate treatment, many people experience extended periods where symptoms are minimal or absent, known as remission. However, the condition is chronic, and flare-ups can still occur over time.

Can Crohn’s disease be controlled with diet alone?

Diet can help reduce symptoms and prevent flare-ups, but it does not cure Crohn’s disease. Most people require a combination of medical treatments, such as medication or surgery, along with dietary adjustments, for effective long-term management.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)

Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.

Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.

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