IBD: Crohn’s Disease

What is Crohn’s Disease?

Inflammatory bowel disease (IBD) is at least two, separate disorders that cause inflammation (redness and swelling) and ulceration (sores) of the small and large intestines. These two disorders are called ulcerative colitis and Crohn's disease. 

Crohn's disease can occur anywhere in the digestive tract but is common in the lower small bowel (ileum) or large bowel. 

Malnutrition and blood disorders are common conditions in Crohn's Disease patients found to be caused by avoiding food items either because of existing symptoms or concern that they may bring on symptoms. Almost half of Crohn's Disease patients have additional health issues affecting their joints, skin, eyes, and biliary tract that may be more debilitating than the bowel symptoms. 

Canada has one of the highest incidence and prevalence rates of IBD in the world with more than 200,000 Canadians living with the disease. These disorders are expensive and can be debilitating. The total direct and indirect costs of IBD are $1.8 billion with the main indirect cost being related to long-term work loss. The average age for people developing IBD often coincides with the most important socioeconomic period of life. The severity of symptoms may prevent those with IBD from realizing their career potential or family creation.

Living Positively

Crohn's is a chronic (long-term) condition with symptoms that can disappear and then flare up again throughout your life. Living with the unpredictable nature of Crohn's can pose physical and emotional challenges that may seem overwhelming at times. However, there are several things that you can do to contribute to your health and well-being.

Be informed, proactive, and involved in your care. By establishing a solid partnership with your health care team, developing coping skills, and maintaining a positive outlook, it is possible to stay healthy and happy, despite living with ulcerative colitis.

Diet and lifestyle changes

Although diet and stress do not cause ulcerative colitis, there may be times when changes in your lifestyle may help control your symptoms and lengthen the time between flare-ups. The following changes may help to ease your symptoms:

  • Limit milk/dairy products. If you are lactose intolerant (cannot digest the sugar in milk), milk and dairy products can produce symptoms of excess gas and diarrhea.
  • Restrict intake of certain high-fibre foods: such as nuts, seeds, and raw vegetables.
  • Limit intake of caffeine, alcohol, carbonated drinks and fatty foods. .
  • Eat small, frequent meals, rather than large meals..
  • Exercise regularly to promote movement of the colon and reduce stress..
  • Minimize stress. Yoga, meditation and slow, relaxed breathing techniques can help people with ulcerative colitis manage stress..

Ask your doctor or pharmacist if one of these formulations may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.

Statistics

  • The prevalence of Crohn’s disase in Canada is reported to be 319 per 100,000 individuals. (Ng et al. 2018)
  • In 2012, approximately 129,000 people lived with Crohn’s disease in Canada, with an estimated 5,700 new cases annually. (Crohn’s and Colitis Foundation of Canada 2012)
  • People with Crohn’s disease have an elevated risk of premature death (47% higher) and colorectal cancer than the general population. (Crohn’s and Colitis Foundation of Canada 2012)
  • In 2008, physician visits were estimated to cost the Canadian health care system $80 million/year for Crohn’s disease. (Fedorak et al. 2010)
  • In 2012, total indirect costs for Crohn’s disease were estimated to be $869 million. (Crohn’s and Colitis Foundation of Canada 2012)
  • For more information, see Inflammatory Bowel Disease.

Citations:

Crohn’s and Colitis Foundation of Canada. 2012. The impact of inflammatory bowel disease in Canada - 2012 Final report and recommendations.http://crohnsandcolitis.ca/Crohns_and_Colitis/documents/reports/ccfc-ibd-impact-report-2012.pdf?ext=.pdf [accessed 3 September 2018]

Fedorak RN et al. Canadian Digestive Health Foundation Public Impact Series 4: Inflammatory bowel disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2010 Nov;24(11):651-5.

Ng SC et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: A systematic review of population-based studies. Lancet. 2018 Dec 23;390(10114):2769-78.

Signs and Symptoms

Many of the symptoms of Crohn's Disease are similar. Symptoms outside the gut may include aching, sore joints, skin and mouth sores and red, inflamed eyes. 

The most common symptoms of Crohn's disease are abdominal pain (often in the right, lower area of the abdomen) and diarrhea. There may also be rectal bleeding, weight loss and fever. Children may suffer poor growth.

What risks are associated with Crohn's Disease?

Too many people skip potentially life-saving procedures because of misunderstandings and misconceptions about the bowel prep. However, most people who have had colonoscopies, will tell you it isn't nearly as bad as you think and that the benefits far outweigh the risks.

Tests and Treatment

Treating Crohn's Disease

Although several drugs are useful in controlling these conditions, as yet a cure has not been found. Since the disease is not curable, long-term treatment is often required.

Medications

These include anti-inflammatory drugs (sulfasalazine/5-ASA), corticosteroids (prednisone and budesonide),immunosuppressives (methotrexate and azathioprine) and immunomodulatory agents (infliximab). Some of these may be given by different methods including oral, rectal and intravenously. Antibiotics may be useful in certain circumstances for Crohn's disease.

Benefits and Risk Assessment Tool

Click through our online e-learning tool below to explore the different medications and treatment options for IBD. Remember, no treatment is NOT an option!


Sometimes, additional action may be required to achieve remission. Below are some auxiliary treatment options that may be suggested by your doctor.

Symptomatic treatment

Specific medications are used to treat diarrhea and abdominal cramps. Anti-diarrheal drugs slow the muscles of the intestine which in turn slow the passage of stool through the body and help with diarrhea. While abdominal pain often occurs with IBD, it is important to note that the pain is a consequence of the disease and, if treated appropriately, the pain should subside. People with IBD should be careful to avoid taking an excess of pain killers and anti-diarrheal drugs since this may lead to complications.

Dietary treatment

Diet alone is not effective in treating Crohn's disease or ulcerative colitis. However, it is important that patients with IBD have a well-balanced diet. Calcium is important to protect bones. Fibre may not be tolerated during flare ups. Certain vitamins (for example, B12) may be required. Selected patients may sometimes be helped by a registered dietitian.

Surgery

People with both Crohn's disease and ulcerative colitis may need surgery at some point in their lives. Surgery is less common in ulcerative colitis than in Crohn's disease and is often performed when ulcerative colitis is no longer responding to medical treatment. Unlike Crohn's disease, surgery will cure ulcerative colitis by removing all diseased bowel. With the colon being completely removed the patient may require an ileostomy (bag outside the body to collect waste) or a second operation to form a new rectum (called a pouch procedure). Despite all of the advances in medical research over the last several decades, we still do not know the cause of IBD and much further research is required.

Testing for Crohn's Disease

Tests are needed to determine whether the patient has ulcerative colitis or Crohn's disease and to rule out other causes. To diagnose these disorders the doctor will take a complete history and perform a physical examination. In addition, blood tests are used to find out if you are anemic (low blood count) as a result of blood loss, or if there is an increased number of white blood cells in your body, suggesting an inflammatory process 

Stool samples can tell your doctor if there is blood loss or if an infection by a parasite or bacteria is causing some of your symptoms. 

The doctor may also look inside your rectum and large bowel through a long, flexible video camera called an endoscope. During this safe procedure, samples of the lining of the intestine (biopsies) may be taken to be looked at under the microscope. 

On some occasions an X-ray exam may be required. This is done by putting barium (a white chalky solution) into the upper intestine (swallowing barium) or by putting the barium into the bowel by inserting a tube into the anus

FAQs

Am I going to get cancer because I have Crohn's Disease?

People with Crohn's Disease are at an increased risk of developing colon cancer. Having regular endoscopies will help identify polyps that could potentially develop into cancer.

Does diet affect Crohn's Disease?

Diet alone is not effective in treating Crohn's disease. However, it is important that patients with Crohn's Disease have a well-balanced diet. Calcium is important to protect bones. Fibre may not be tolerated during flare ups. Certain vitamins (for example, B12) may be required. Selected patients may sometimes be helped by a registered dietitian.

How is IBD different than IBS?

Although both illnesses can be seriously debilitating, there are several primary differences between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). IBD is an autoimmune disorder that causes swelling and ulcerations (sores) in the bowel. IBS involves problems with motility (how the bowel moves contents through our intestines) and sensitivity (how the brain interprets sensations in the bowel). Symptoms of IBS may wax and wane and possibly disappear altogether whereas IBD is a chronic condition.

Benefit and Risk Assessment Tool for IBD Treatments

[iframe_loader type='iframe' width='100%' height='600' frameborder='0' scrolling='no' src='/wp-content/uploads/articulate_uploads/IBD-Benefits-and-Risk-Assesment-Tool/story.html'] Making informed decisions is imperative to your good health but understanding the benefits and risks associated with IBD therapy options can be challenging. CDHF developed the IBD e-BRAT – a tool to help you learn more about common risks as well as important benefits around the therapy options. Explore your options on the tool now!  

This e-learning tool was made possible due to an unrestricted educational grant from Pfizer Canada

What’s Health Canada Saying about Biosimilars? Infographic

IBD Treatments and Pregnancy

https://www.youtube.com/watch?v=UnhyzoKCjck
At the 2016 CDHF Healthy Gut Summit, Dr. Vivian Huang gave an interesting presentation on what Inflammatory Bowel Disease (IBD) is, the treatments available, and specifically how IBD affects pregnancy. 

Living with Crohn’s Disease Infographic

Fecal Calprotectin: The Inside Story On Inflammation

https://www.youtube.com/watch?v=uS0PFfuwMY8
If you have IBD, you know the painful symptoms you suffer from during a flare are caused by inflammation. Wouldn’t it be great to know -- in advance -- if a flare was on its way, so that you could prevent it from happening! Well, a safe, simple, non-invasive test could help you do just that! Watch the CDHF's latest animation on the Fecal CalProtectin -- or fCal -- test now.​

Uncovering Biologics: Your IBD BodyGuard!

https://www.youtube.com/watch?v=wUdtfvOkF0s
If you have Inflammatory Bowel Disease (IBD), you know that taking medication to manage your symptoms and prevent flares is imperative. Your doctor may prescribe a biologic if you have moderate to severe Crohn's Disease or Ulceractive Colitis. Watch the CDHF’s latest animation on biologics and learn how they can protect you from the painful and debilitating symptoms of IBD.

IBD Treatment Options: Understanding Your Benefits and Risks Animation

https://www.youtube.com/watch?v=evV_Dngm-IQ
Making informed decisions is imperative to your good health but understanding the benefits and risks associated with IBD therapy options can be challenging. CDHF developed the IBD BRAT - a tool to help you learn more about common risks as well as important benefits around the therapy options. Watch this animation for an overview now.

Inflammatory Bowel Disease with Dr. Mike Evans

https://www.youtube.com/watch?v=Keqzt83KMVA
Helping you understand the details of IBD. Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

What’s Health Canada Saying about Biosimilars?

[embed]https://www.youtube.com/watch?v=1OeDtXWn3_8[/embed]
A biosimilar biologic drug, or biosimilar, is a drug demonstrated to be highly similar to a biologic drug that was already authorized for sale (known as the reference biologic drug).  Biosimilars are approved based on a thorough comparison to a reference drug and may enter the market after the expiry of reference drug patents and data protection. Watch this video to get more insight into what Health Canada is saying about biosimilars!

Pediatric Inflammatory Bowel Disease – Dr. Thomas Walters

https://www.youtube.com/watch?v=CoKuPsG01vo
Dr. Walters presentation on pediatric inflammatory bowel disease at CDHF's Digestive Health in Children and Adolescents Public Forum.

Webseminar: Understanding the Benefits and Risks of IBD Therapies

https://www.youtube.com/watch?v=gPoES4-eisA This empowering session reviewed the basics of IBD, outlined the benefits and risks of medications used to treat ulcerative colitis and Crohn’s disease and answered the many questions of attendees. Special thanks to Dr. Talat Bessissow for sharing his insights and expertise and to AbbVie Inc. for sponsoring our IBD Treatment Options Webseminar.

Biosimilars for IBD: Making the Transition Webinar

[embed]https://www.youtube.com/watch?v=XG3F9LyMS5g&feature=youtu.be[/embed] On May 28th, Dr. McCurdy answered the following questions in a very informative webinar presentation on Biosimilars:
  • What’s the difference between a reference biologic drug and a biosimilar?
  • Biosimilars: What’s Health Canada saying?
  • What is the clinical evidence to date?
  • How do doctors go about transitioning their patients from a reference biologic drug to a biosimilar?
Watch this webinar now!

Hot off the Presses: The Latest IBD Information from Scientific Meetings with Dr. Silverberg Webinar

[embed]https://www.youtube.com/watch?v=HAG6qYhkyv4[/embed] In this educational webinar, Dr. Silverberg reviewed the most recent scientific findings in Inflammatory Bowel Disease (IBD) and discussed the role of diet and gut bacteria in IBD. Watch the recording of this webinar now.
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