Crohn’s & IBD: What You Need to Know

If you’ve ever heard of Inflammatory Bowel Disease, or IBD for short, you might already be familiar with two of its most common forms: Crohn’s Disease and Ulcerative Colitis. These chronic conditions affect the digestive system, causing inflammation and discomfort in different parts of the gut, and can have a big impact on daily life.

As yet, scientists don’t know what causes these diseases, but genes and the environment play a role. Over 200 genes have been linked to genetic susceptibility to IBD.¹ The immune system is also involved and new treatments have been developed to try and decrease the activity of the immune system.

What’s the difference between Crohn’s and Ulcerative Colitis?

While Crohn’s and UC share some similar symptoms there are some key differences that help doctors get the right diagnosis. Crohn’s can be hard to distinguish from UC if only the colon is affected.

What Is The Most Common Age To Be Diagnosed With Crohn’s Disease?

People of any age can be affected by Crohn’s Disease but it is most commonly diagnosed at early adolescence (age 12 to 14 years) with symptoms of abdominal pain, diarrhoea, mouth ulcers and weight loss. Crohn’s can have a big impact on children, affecting their growth, nutrition and pubertal development – often kids are picked up when they fail to thrive or grow as tall as their peers.

What A Flare-up Looks Like

Crohn’s disease has a pattern of flare-ups and remission. Remission is when there are periods of time with few or no symptoms at all. Flare-ups are when symptoms come back. Flare-ups can be triggered by things like eating a particular food, having an infection or taking a certain medicine. Flare-ups are managed with a combination of medical treatment, diet and lifestyle changes.

Flare-up Symptoms May Include:

• Abdominal pain and cramping
• Sometimes diarrhoea
• Tiredness
• Fever
• Decreased appetite leading to weight loss
• Mucous or blood in bowel motions
• Mouth ulcers
• Inflammation of skin, eyes and joints
• Kidney stones
• Iron deficiency anaemia.²

The aim when treating Crohn’s is to induce and maintain remission for the patient. When this happens, patients get relief from their symptoms, tests for inflammatory markers in their blood return to normal, the lining of the gastro-intestinal tract heals, and the body’s ability to absorb nutrients is no longer impaired. In kids, their growth normalises and daily activities like school, work, sports and socialising are no longer interrupted.

Managing Flare-ups In Kids Versus Adults

There are a host of different medicines used in treating Crohn’s – some are used to get the patient into a state of remission and then others are used to keep the patient symptom-free once remission has been induced.

For kids, especially those that have been newly diagnosed, one of the most effective treatments is something called ‘exclusive enteral nutrition (EN)’. This is when a child or adolescent is given a liquid diet only for up to 8 weeks. EN gives the gastro-intestinal tract time to rest, leading to healing of the mucosal lining.

Other Medications Used Are³

• Antibiotics – to treat complications such as abcesses or fistulas or to prevent secondary infections.
• Steroids – bring inflammation and swelling under control, easing symptoms but can become less effective over time.
• Anti-ulcer drugs and H2-antagonists – treat ulcers and irritation by reducing acid in the gut.
• Aminosalicylates (5-ASAs) (e.g mesalazine, sulfasalazine) – decrease gut inflammation and control symptoms without suppressing the immune system.
• DMARDs (Disease-modifying antirheumatic drugs) – suppress the immune system and can relieve pain.

The Role Of Biologics

Biologic medicines changed the way inflammatory bowel diseases such as Crohn’s were treated and managed when introduced around twenty years ago.⁴ Biologics such as infliximab and adalimumab are used for moderate to severe disease or when a patient has not responded well to other treatments. These medicines have the advantage that they can target specific proteins of the immune system involved in inflammation. In this way biologics block only very specific pathways of the immune system rather than the whole immune system.

If you have been newly diagnosed with Crohn’s Disease it is important to have a good understanding of your specific diagnosis, available treatment options and possible complications. With a combination of lifestyle changes and medications it is possible for people with Crohn’s to lead normal lives with long periods of remission.