Crohn’s Disease: Causes, Diagnosis and Management

Crohn’s disease is a very serious problem with not very good outcomes. There has so far not been any medical or surgical cure for this condition and those who have this disease suffer a great deal of physical and psychological challenges. Though the condition is not very common in Africa, it is good for Africans to know about it so as to take necessary precautions against this condition.

What is Crohn’s disease?

Crohn’s disease is an inflammatory disease of the gastrointestinal tract which can affect any part of the digestive tract, from the mouth to the anus. It belongs to the class of diseases called inflammatory bowel diseases, where ulcerative colitis is. It more commonly affects the ileum (last part of the small intestine) and the begging of the large intestine (caecum). The disease eats up the lining of the intestine causing abscesses, fistula and obstruction of the intestine.

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Although a rare condition, Crohn’s disease is seen more among individuals in the developed western world. Statistics show that it affects 3.2 per 1000 people in Europe and North America and less common in Asia and Africa although rates have been shown to be increasing in developing countries since 1970. In 2015, inflammatory bowel diseases resulted in 47,400 deaths and those with Crohn’s disease had a slightly reduced life expectancy.

 

What Causes Crohn’s Disease?

The cause of this condition has still not been known but several theories and combination of risk factors have been linked to the condition. Among the top of the list include

  • Immune system factors : When a person’s immune system malfunctions foe whatever reason and starts to attack the “healthy bacteria” in the intestinal tract, which help protect against the harmful bacteria, these harmful bacteria can then take advantage and start attacking the intestinal lining causing inflammation.
  • Environmental factors : The adverse environmental impact of industralization have been linked to the high incidences of the disease in the developed world and the developing countries. Increase use of hormonal contraceptive use has been postulated as a predisposing factor.
  • Genetical factors : It has been seen that genetics play a role in the occurrence of Crohn’s disease. Those with a family history of the disease are more susceptible to develop Crohn’s disease. The role of racial factors have not been conclusive.
  • Smoking : Cigarette smoking has been enlisted as the most important controllable risk factor for Crohn’s disease. Those who smoke are at higher risk of developing Crohn’s disease and those who already have the disease will have more severe symptoms from tobacco smoking.
  • Age : Although the disease can affect all ages, statistics show that it is more common before the age of 30. Average age of between 19 – 40 years of age and affects males and females almost equally.

 

What are the symptoms of Crohn’s Disease?

Some individuals can have the disease for a long time before they start showing symptoms. In its active stage, the symptoms of Crohn’s disease include

  • Abdominal pain (especially at the area affected).
  • Diarrhoea which may be up to 20 times a day in severe cases with or without blood.
  • Fever.
  • Weight loss.
  • Mouth ulcers.
  • Pain or abscess around the anus.

 

How Crohn’s Disease is diagnosed

Diagnosing Crohn’s disease is generally difficult because of similar conditions of the inflammatory bowel disease class that have similar clinical presentation. The use of imaging techniques to view the intestinal tract is the best way the disease is clinically diagnosed. They may include

  • Colonoscopy
  • Capsule endoscopy
  • Endoscopic biopsy
  • CT scan
  • MRI scan
  • Full blood count can be done to assess anaemia.

 

Management of Crohn’s Disease

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There is no medical or surgical cure for Crohn’s disease. The current management of the disease are conservative and to relieve symptoms. There are times when the symptoms will suppress for a while and then resurface again later on.

Current management therapy for Crohn’s disease are :

  1. Lifestyle changes and diet : people with Crohn’s disease will have to undergo serious lifestyle and dietary changes to cope with the condition. Smokers must put a stop to their cigarette smoking. Reduction of stress, moderate activities and exercise are areas of changes. Eating small amounts of food and staying away from food that precipitate diarrhoea as well as taking more liquid diet are some of the dietary changes for Crohn’s disease patients.
  2. Medications : The medications used in controlling symptoms of Crohn’s disease include corticosteroids, immunosuppresive drugs, antibiotics and antidiarrhoeals.
  3. Surgery : This is necessary only when there is complications of the disease and other interventions are not sufficient. The affected area of the intestine can be cut off and the intestine rejoined again. This can help for a while but relapse of the inflammation can occur again at the rejoined area. Crohn’s disease patients usually undergo through several surgeries trying to manage the condition.
  4. Alternative medicine : Though the efficacy can not be confirmed, Crohn’s disease patients have been seen to resolve to complementary and alternative medicine like acupuncture and use of herbs.

 

Complications of Crohn’s Disease

  • Bowel ulcers and obstruction
  • Increased risk of bowel cancer
  • Anal and genital area fistula
  • Anaemia
  • Liver and gall bladder disease
  • Skin rashes
  • Arthritis
  • Inflammation of the eye
  • Growth delay in children
  • Malnutrition due to malabsorbtion of nutrients by the small intestine.
  • Crohn’s disease may result in anxiety and mood disorders especially in young people who have stunted growth and embarrassment from faecal incontinence.

There are no much studies about the true incidence, prevalence, risk factors, mortality rates and other associated parameters of Crohn’s disease in African countries. With more researches conducted around this topic, Africans might just have a head start to win the fight against this rare but debilitating disease condition. We hope that soon enough drugs will be available for curative treatment of Crohn’s disease.

Reference

Crohn’s disease

https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304

 

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