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IBD: Crohn’s Disease

What is Crohn’s, tips and support for people with this debilitating 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 with Crohn’s Disease

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 Crohn’s disease.

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.

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.

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.

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.

Preparing for your GI Appointment

Good communication with your doctor is an important part of effective management of a gastrointestinal disorder such as IBD. Before your appointment, take the time to keep a symptom journal that can help you and your doctor see patterns in your activities and identify specific triggers for your symptoms. Include the following information in your journal or CDHF App!

  • Write down the symptoms that are bothering you and for how long you have had them.
  • Write down key personal and medical information, including any recent changes or stressful events in your life.
  • Make a list of the triggers (food, stress, activity) that seem to make your symptoms worse.
  • Make a list of medications you are taking, including the conditions you take them for. Also, note if any of your medications seem to affect your symptoms.
  • Talk to your family members and find out if any relatives have been diagnosed with IBD or another digestive disorder.

Also, create a list of questions to ask your doctor during your appointment. Specifically, you may want to ask your doctor questions such as:

  • What do you think is causing my symptoms?
  • Are there other possible causes for my condition?
  • What diagnostic tests do I need?
  • Do these tests require any special preparation?
  • What treatment approach do you recommend trying first?
  • If the first treatment doesn’t work, what will we try next?
  • Are there any side effects associated with these treatments?
  • The prevalence of Crohn’s disease 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)

Citations:

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.

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.

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