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Crohn's Disease

WHAT IS CROHN'S DISEASE?

Crohn's disease is a bowel disease which gives rise to segments of inflamed bowel.  It may involve any part of the digestive tract from the mouth to the anus.  It most commonly affects the last part of the small bowel (the terminal ileum) and/or the large bowel (colon and rectum).

Crohn's disease is a chronic condition and may recur at various times over a lifetime.  Some people have long periods of remission, sometimes years, when they are free of symptoms.  There is no way to predict when a remission may occur or when symptoms will return.

WHAT ARE THE SYMPTOMS OF CROHN'S DISEASE?

Crohn's disease can affect any part of the bowel.  Therefore symptoms may vary greatly from patient to patient.  Common symptoms include cramping or colicky abdominal pain, diarrhoea, fever, weight loss, and bloating.  Not all patients experience all of these symptoms, and some may experience none of them.

Other symptoms may include anal pain or discharge of mucous or blood, skin lesions, perianal abscess and joint pain (arthritis).

WHO DOES IT AFFECT?

Any age group may be affected, but the majority of patients are young adults between 16 and 40 years old.  It affects men and women equally and appears to be common in some families.  

About 20 percent of people with Crohn's disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.

Crohn's disease and a similar condition called ulcerative colitis {link} are often grouped together as inflammatory bowel disease.

WHAT CAUSES CROHN'S DISEASE?

The exact cause is not known. However, current theories center on an immunologic (the body's defense system) and/or bacterial cause. Crohn's disease is not contagious, but it does have a slight genetic (inherited) tendency.  An x-ray study of the small bowel may be needed to diagnose Crohn's disease.

HOW IS CROHN'S DISEASE TREATED?

Initial treatment is almost always with medication.  There is no "cure" for Crohn's disease, but medical therapy with one or more drugs provides a means to treat Crohn's disease and relieve its symptoms.  The most common drugs prescribed are steroids, such as prednisolone and methyl prednisolone, and various other anti-inflammatory agents may help.   Other drugs occasionally used include 6-mercaptopurine and azathioprine, which are immunosuppressive.  More recently monoclonal antibody treatments have been used.

In patients who fail to respond to the medical therapies or those with complicated disease surgery may be recommended.  In addition emergency surgery is sometimes necessary when complications, such as a perforation of the intestine, obstruction (blockage) of the bowel, or significant bleeding occur.  

A proportion of patients present with problems similar to appendicitis and Crohns disease is diagnosed at operation.  Other less urgent indications for surgery may include abscess formation, fistulas (abnormal communications from the bowel), and severe anal disease.

Not all patients with these or other complications require surgery.  This decision is best reached through consultation with a gastroenterologist or colorectal surgeon.

SHOULDN'T SURGERY FOR CROHN'S DISEASE BE AVOIDED AT ALL COSTS?

While it is true that medical treatment is preferred as the initial form of therapy, it is important to realize that surgery is eventually required in up to three-quarters of all patients with Crohn's.  Many patients have suffered unnecessarily due to a mistaken belief that surgery for Crohn's disease is dangerous or that it inevitably leads to complications.

Surgery is not "curative", although many patients never require additional operations.  A conservative approach is frequently taken, with a limited resection of intestine (removal of the diseased portion of the bowel) being the most common procedure.

Surgery often provides effective long-term relief of symptoms and frequently limits or eliminates the need for ongoing use of prescribed medications.  Surgical therapy is best conducted by a surgeon skilled and experienced in the management of Crohn's disease.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666