Crohn's Disease - Medtick
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Crohn’s Disease

What is it?

A long term condition that causes inflammation (hot, red and swelling of the digestive tract from the mouth to the anus, the swelling can occur anywhere along tract or in sections and occurs mainly in the small intestine or the large intestine (colon).

Common examples of Crohn’s disease include:

  • Ileocolitis (affecting the colon and adjacent ileum)
  • Ileitis (affecting just the ileum)
  • Crohn’s granulomatous colitis (affecting just the colon)
  • Gastroduodenal Crohn’s disease (affecting the stomach and adjacent duodenum)
  • Jejunoileitis (affecting the jejunum)

The symptoms of this condition is lifelong and may ‘come and go’ and may cause the following:

  • Deep layers of the intestine become inflamed.
  • This creates ulcers (skin that does not heal, leaving underlying skin exposed), cracks and fissures (tear in the tissue lining)
  • Inflammation can allow an abscess (a pocket of pus) to develop

Other types of colitis include:

  • Ulcerative colitis
  • Intermediate colitis (mainly in children- difficult to tell what form of IBD it is)
  • Microscopic colitis
  • Diversion colitis (inflamed and dysfunctioning colon)
  • Pseudomembranous colitis is caused by Clostridioides difficile (caused by antibiotics use).

The clinical similarities and differences between Crohn’s disease and Ulcerative colitis are highlighted in Table 1.

Table 1 Similarities and differences between Crohn’s disease and ulcerative colitisCrohn’s disease: your guide. Crohn’s & Colitis UK. 2019.
https://www.crohnsandcolitis.org.uk/
about-crohns-and-colitis/publications/crohns-disease (accessed Aug 2021).Ulcerative colitis: your guide . Crohn’s & Colitis UK. 2018.www.crohnsandcolitis.org.uk/about-inflammatory-bowel-disease/publications/ulcerative-colitis (accessed Aug 2021).
Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intest Res 2016;14:111. doi:10.5217/ir.2016.14.2.111
Crohn’s disease: management. NICE guideline NG129. National Institute for Health and Care Excellence. 2019.
(accessed Aug 2021).
Ulcerative colitis: management. NICE guideline 130. National Institute for Health and Care Excellence. 2019.www.nice.org.uk/ng130 (accessed Aug 2021).
Cripps S. Inflammatory bowel disease: NICE updates advice on remission. Guidelines in Practice. 2019.

Diagnosis Tests

The Crohn’s Disease Activity Index (CDAI)​[65]​ or the Harvey–Bradshaw Index (HBI  are the tools most often used to define remission in adults with Crohn’s disease.

However, in clinical practice the CDAI is rarely used as it needs to be measured prospectively and is time consuming.

  • Additionally, it is also not validated to be used post-operatively.
  • The HBI evaluates stool frequency, pain and other clinical features, including extra-intestinal complications, and is increasingly used to guide selection and measure response of biologic therapy.
Harvey RF, Bradshaw JM. A SIMPLE INDEX OF CROHN’S-DISEASE ACTIVITY. The Lancet 1980;315:514. doi:10.1016/s0140-6736(80)92767-1
The Pharmaceutical Journal, PJ, August 2021, Vol 307, No 7952;307(7952)::
DOI:10.1211/PJ.2021.1.101504

Diagnosis to differentiate Crohn’s disease from Ulcerative colitis

Serologic markers for Infamatory bowel disease include most notably Positive perinuclear antineutrophil cytoplasmic antibodies (pANCA) and positive anti–saccharomyces cerevisiae antibodies (ASCA) are associated with Ulcerative colitis and Crohn’s disease.

  • Specifically, pANCA is highly associated with Ulcerative colitis.
  • Positive pANCA and negative ASCA findings suggest Ulcerative colitis.
  • Negative pANCA and positive ASCA suggest Chrohn’s disease.

A colonoscopy confirms the diagnosis of suspected Ulcerative colitis, and it is the technique of choice to assess disease activity in patients with symptomatic Ulcerative colitis.

  • In acute-onset (sudden onset) cases of Ulcerative colitis, plain abdominal radiographs are a useful adjunct to imaging.
  • Such images may reveal colonic dilatation in severe cases, evidence of perforation (tear or hole in intestine), which suggests toxic megacolon, ileus, or obstruction.
  • An MRI is useful in the differentiation of Ulcerative colitis from Crohn’s disease, in that fistulae or the presence of small bowel disease are present only in Crohn’s disease.

Medscape

Cause

  • Unknown
  • Association with Escherichia coli, Salmonella, Campylobacter and mycobacteria maybe
  • May be autoimmune disease – where the immune system may be triggered to “attack” healthy parts of the digestive system
  • Altered gut microbiota maybe
  • Diet (high in animal fats, sugar and processed foods and low in fruit and vegetables can increase risk of developing IBD or experiencing a relapse)
  • Stress (thought that stress activates inflammatory mediators at enteric nerve endings in the gut wall)
  • May be genetic factors
  • Allergic response releasing chemicals called eosinophils
  • Smoking
  • Familial Mediterranean fever (FMF)

Vitamins, herbal and minerals

Medication

Symptoms

  • Reoccurring diarrhoea?
  • Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)?
  • Abdominal pain and cramps especially after eating?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Weight loss (can be due to diarrhoea or difficulty to break down food in body)?
  • Blood and mucus in faeces?

Further questions:

Rare symptoms 

  • High temperature greater than 38°C (100°F) or over and/or chills and sweats longer than 72 hours?
  • Joint pain and swelling?
  • Inflamed and irritated eyes?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Headache which is on and off or a constant headache longer than 24 hours?
  • Heart palpitations, irregular heartbeats?
  • Irritated, depressed, anxiety and/or panic attacks?
  • Balance and dizziness problems?
  • Sunken eyes?
  • Short of breath?
  • Skin not flattened when pinched?
  • Cold hands and feet?
  • Sore throat longer than seven days or more?
  • Swollen lymph glands and/or reoccurring mouth ulcers?
  • Dry skin?
  • Rash?

Nail changes:

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

This condition can lead to:

This condition can cause a wide range of skin conditions:

General tips to control the symptoms of the below:

This condition may show similar symptoms to and/or be mistaken for:

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

Please copy and paste any key words from the title: Crohn’s Disease in the following respective 'Medtick References and/or Sources' to find out more about the disease (this also may include diagnosis tests and generic medical treatments).

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