Crohn's Disease

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Crohn’s disease is a chronic (long-term) condition that affects the lining of the digestive system. It predominantly causes disruptive inflammation in the final section of the small intestine (known as the terminal ileum) and the colon, in the large intestine.

Crohn's disease overview

Crohn's disease causes the gut to swell, which restricts the passage of digesting food and causes malabsorption (when nutrients are prevented from absorbing through the walls of the small intestine and entering the bloodstream).

Crohn’s disease can sometimes cause long-term damage. In severe cases, the swelling inside the digestive system leads to the formation of deep ulcers that hollow through to the opposite side of the gut lining and infect surrounding organs, such as the skin.

Crohn’s disease is one of the two main inflammatory bowel diseases (IBD). The other main IBD is known as ulcerative colitis, which tends only to infect the inner lining of the gut.

Symptoms of Crohn’s disease

The symptoms of Crohn’s disease vary in nature from patient to patient. The symptoms can occur in any order or combination at any time.

The most common symptoms of Crohn’s disease are:

• reoccurring diarrhoea
• abdominal pain (this usually worsens after eating)
• fatigue
• blood and mucus found in faeces
• weight loss- occasionally the swelling in the gut prevents the absorption of nutrients into the body and the symptoms of diarrhea and abdominal pain can restrict the appetite.

Other less common symptoms include:

• vomiting
• skin rashes
• irritation of the eyes (this is called uveitis)
• joint swelling and pain (this is called arthritis)
• high temperature (38°C or above)
• nausea.

Causes of Crohn’s disease

The exact cause of Crohn’s disease remains unknown. Experts suspect there are a number of determining factors, some inherited and some environmental. A selection of speculated causes include: 

The immune system

The job of the immune system is to fight foreign bodies in order to prevent disease and infection. Experts believe that in the event of Crohn’s disease, the immune system somehow becomes confused and begins to fight against the good bacteria as well as the foreign.

Crohn’s disease causes the immune system to send an antibody known as ‘tumor necrosis factor’ to begin killing the 500 types of ‘friendly bacteria’ found in the digestive system. This is thought to cause most of the inflammation in the gut.

Genetics

There are three pieces of evidence that suggest a relationship between genetics and Crohn’s disease:

1. 1/5 people who have Crohn’s disease will have a family member who also has it. If your parent has Crohn’s disease, you will have a 5-10% chance of developing it yourself. This evidence strongly suggests that genetics plays a part in the cause of Crohn’s disease.

2. Scientists have identified 32 gene mutations associated with Crohn’s disease- all associated with the handling of bacteria in the digestive system.

3. Crohn’s disease is far more common in certain ethnic groups (white Caucasian) than others, suggesting once again that genetics could be a determining factor^1.

Previous infection

According to the NHS, particular genetically susceptible individuals can develop Crohn’s disease after contracting a particular infection during childhood. The speculated source of the infection is a bacterium known as mycobacterium avium subspecies paratuberculosis (MAP). The infection often leads to an abnormal immune system response, which can lead to Crohn’s disease. 

MAP is found in sheep and cows and is thought to be passed from animal to human through the milk of contaminated animals. 

Environmental factors

Research has unearthed a number of unusual factors concerning Crohn’s disease that point towards an environmental cause. These are as follows:

1. You may have heard Crohn’s disease described as the ‘disease of the rich’. It acquired this nickname after scientists discovered that the disease is far more prevalent in more economically developed parts of the world, such as the US and certain parts of western Europe, and less prevalent in less economically developed countries such as parts of Asia and Africa. The points to the idea that Crohn’s is caused by something that only exists in the environment of developed, or ‘westernised’ places. 
    
2. Before WWI, Crohn’s disease was relatively rare. After the 50s, the rate of occurrence rapidly increased, suggesting that a change or changes in lifestyle or environment made during this era encouraged the development of Crohn’s disease.

Both of these findings suggest that something about the modern, westernized world causes Crohn’s disease.

Explanations for environmental factors include:

1. ‘The Hygiene Hypothesis- currently there is little evidence to support the hygiene hypothesis, but some experts believe that because of a modern, western lack of exposure to infections and disease (households are far cleaner and more ‘germ-free’ than they used to be/children are perhaps kept in safer, more contained environments), immune systems are less developed than they used to be. 
   
   
2. ‘The Cold Chain Hypothesis’- some experts believe the increase of Crohn’s disease during the latter half of the 20^th century can be attributed to the introduction of refrigerators to homes after WWII. There is a type of bacteria known as psychotrophic bacteria that can survive in cold environments. Scientists believe it is the abundance of this type of bacteria, surviving in our refrigerators, that causes an abnormal immune system response and leads to more cases of Crohn’s disease. 

Lifestyle (smoking)

Smoking has been found to be a big risk factor for Crohn’s disease. People who smoke are twice as likely to develop Chron’s disease than non-smokers, and people who smoke with the condition tend to suffer from more severe symptoms^1.

Diagnosing Crohn's disease

The GP may wish to carry out a number of tests and assessments on a patient suspected of having Crohn’s disease.

1. The tests will begin with an initial assessment where the doctor is likely to ask the following questions: 

• What are your symptoms? (It is useful to write a diary of symptoms documenting information such as when they occur, how frequently, how intensely etc. so the GP can get a good overview of the condition.)

• What are your dietary habits?

• Have you travelled abroad recently? (This is to determine whether or not diarrhea has been contracted from a stomach bug while travelling)

• Are you currently taking any medication, including over the counter medicine?

• Does anybody in your family have Crohn’s disease?

2. The GP may then wish to perform some general medical tests to determine a patient’s state of physical health. These may include:

• taking blood pressure
• checking  pulse
• weighing and measuring height
• taking temperature
• performing a physical examination of the abdomen.

3. After the GP has an idea of the patient’s physical health, they may want to take a blood sample for the following reasons:

• find any presence of infection
• determine levels of inflammation in the body
• test amount of red blood cells in bloodstream. (This determines whether or not the patient has amnesia. If they do this could mean that the patient is malnourished.)

4. The patient may then be asked to provide a stool sample for the following reasons:

• to see if there is blood or mucus present in the sample
• to see if the symptoms are being caused by something else, like a parasite. 

Treating Crohn’s disease

Steroids 

Steroids are a kind of hormone medication used to reduce inflammation.

Steroids are generally only used for a short period of time to treat the active disease because extended use can lead to adverse side-affects. The two most common types of steroids used to treat Crohn’s disease are Budesonide and Prednisolone.

Biological therapies

Biological therapies are a brand new medical invention. They are formed by combining naturally occurring biological substances, such as enzymes and antibodies.

Currently there are 2 biological therapies licensed for legal use in England:

1. Infliximab- this type is administered through a drip over the course of 2 hours and is only used in severe cases of Crohn’s disease. ¼ of people who have used infliximab have experienced an allergic reaction to it. Infliximab works by targeting the area of swelling.
   
   
2. Adalimumab- this type also targets the areas of swelling but is administered via an injection every two weeks. 

Surgery

It is thought that approximately 80% of people with Crohn’s disease will require surgery at some point in their lives. Whereas surgery cannot completely cure Crohn’s, it offers long periods of remission and can improve the quality of a sufferer’s life for many years. The surgeon will remove the inflamed section of the digestive system and reattach the remaining part.

How can a nutritionist help Crohn’s disease? 

There is no conclusive evidence that diet affects or causes Crohn’s disease in any way, although many patients find that avoiding certain food can help to subdue the symptoms.

Suffering from the painful and disruptive symptoms of Crohn’s disease can often make you feel helpless and alone. Discussing your problems with a qualified nutritionist is one step towards regaining control of your life.

A nutritionist will apply their expert knowledge by designing a personalised diet plan tailored to individual requirements. Nutritionists understand how conditions like Crohn’s disease can seriously affect the quality of life and as such, will do all they can to help. 

Becoming educated in all things food will help you lead a healthy life and hopefully hold the nasty symptoms at bay. Having to monitor everything you eat can be frustrating and alienating. Consulting a nutritionist for support and guidance can alleviate some of the pressure and responsibility involved.

To find out more or to talk to a nutritionist near you, please feel free to search our nutritionist directory. 

References

¹ NHS, Crohn's Disease

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