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Crohn's Disease

Crohn’s disease is an inflammatory bowel disease. A number of genes and environmental factors are associated with Crohn’s disease. About 10-15% of patients with Crohn’s disease have a family history of the disease and a further 1 in 20 have a family history of ulcerative colitis.  Whilst some families have multiple members affected, only half of identical twins have a twin with the disease, so genetics are not the only factor. Immune regulation and other triggers like infection and stress are also a factor.

Crohn’s disease is usually diagnosed between the age of 15yrs- 40 years but can arise at any age.

Crohn’s disease is a condition which can effect any part of the gastro-intestinal tract, but most commonly effects the area around the  ileo-caecal valve, in approximately a third of patients. About a quarter of patients have disease affecting only the colon. A smaller number of patients have disease elsewhere, in the gastro-duodenum, the small bowel or more widely distributed in the bowel.

Crohn’s disease may present with abdominal pain, nausea and vomiting, loose and or bloody stools, perianal fistulation or sepsis and or weight loss. The specific features with which an individual patient presents are largely related to the site and severity of their individual disease.

The course of the disease is variable, some patients find they rarely have symptoms after their initial presentation despite having little or no therapy to prevent further relapse, whilst others suffer ongoing symptoms in spite of aim of aggressive treatment with immunomodulators, surgical intervention and biological therapies. A range of treatments of varying efficacy and risk is available. The treatment with the lowest risk of serious side-effects is a group of drugs called 5 ASAs, which can be given orally or rectally. Whilst these are of definitive benefit in ulcerative colitis the evidence in Crohn’s disease is less good. Steroids, either in the form of oral prednisolone, budesonide or intravenous hydrocortisone are an effective treatment for acute relapses but are not effective for the maintenance of remission and confer a considerable risk of side effects. In those who have required steroids twice or more in a year mosts UK gastroenterologists would consider the addition of an immunomodulator such as mercaptopurine or azathioprine or biological agent at this stage to reduce the risk of relapse. A range of biologicals are available. Surgical intervention is an option for patients with complex, stricturing Crohn’s or disease which is not responding to conventional medical therapies.

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