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Crohns disease
Information for patients Colorectal Surgery Department, William Harvey
Hospital Ashford
What is Crohns disease?
Crohns disease is a chronic inflammatory process primarily involving the bowels. Although it may
involve any part of the bowel from the mouth to the anus, it most commonly affects the last part
of the small bowel (ileum) and/or the large intestine (colon and rectum). Please see the diagram
below.
Crohns disease is a chronic condition
and may present at various times
over a lifetime. Some people have
long quiet periods, sometimes for years,
when they are free of symptoms.
There is no way to predict a quiet
period or when symptoms will present.
What are the symptoms of Crohns disease?
Because Crohns disease can affect any part of the bowel, symptoms may vary greatly from patient
to patient. Not all patients experience all of the symptoms, and some may experience none of
them.
Common symptoms
Cramping - tummy pains
Diarrhoea
Less common symptoms
Back passage pain or discharge
Skin lesions
Fever
Weight loss
Bloating
Abscess or fistula*
Fissure (split in anal skin)
Joint pain
* Fistula is an abnormal communication between the inside and the outside of the bowel which
leads to leakage of bowel contents to the outside.
Who does it affect?
Any age group may be affected, but the majority of patients are young adults between 16 and 40
years old. Crohns disease occurs most commonly in people living in northern climates. It affects
men and women equally and appears to be common in some families. About 20% of people with
Crohns have a relative, most often a brother or sister, and sometimes a parent or child, with some
form of inflammatory bowel disease.
Crohns disease and a similar condition called ulcerative colitis are often grouped together as
inflammatory bowel diseases.
What causes Crohns disease?
The exact cause is not known. However, current theories centre on an immunological (the body’s
defence system) and/or bacterial cause. Crohns disease is not contagious, but it does have a
slight genetic (inherited) tendency.
An x-ray study of the small intestine may be used to diagnose Crohns disease.
How is Crohns disease treated?
• Medication
Initial treatment is almost always with medication. There is no cure for Crohns disease, but
medical therapy with one or more drugs provides a means to treat early Crohns disease and
relieve symptoms. The most common drugs prescribed are steroids, such as predisolone and
methylpredisolone, and various anti-inflammatory agents.
Other drugs occasionally used include 6-mercaptopurine and azathioprine, which suppress the
body’s defences. Metronidazole, an antibiotic with immune system effects, is frequently helpful in patients with anal disease. Recently a new drug called Infliximab has been tried in cases of
complicated Crohns disease.
Crohns disease, September 2015
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• Diet
Changing the form in which nutrients are delivered can help symptoms. Replacing normal
diet with liquid feed can be as effective as drug therapy. If nutritional therapy is considered
appropriate for you, you will be referred to the Dietitian for the management of your special
liquid diet.
• Surgery
In more advanced or complicated cases of Crohns disease, surgery may be recommended.
Emergency surgery is sometimes necessary when complications, such as bowel perforation,
blockage, or significant bleeding occur.
Other less urgent indications for surgery may include abscess and fistulas, severe back passage disease, or persistence of the disease despite appropriate drug treatment.
Not all patients with these or other complications require surgery. This decision is best reached
through consultation with your Gastroenterologist and your Colorectal Surgeon.
What is the aim of surgery?
The aim of surgery is to resect as much affected bowel as possible without compromising the
intestinal function. For instance, if the right colon is involved with Crohns and there is obstruction
or fistula, the surgeon will remove the right colon in an operation called right hemicolectomy. If the
left side is involved, it may be necessary to remove the entire colon. If the small bowel is involved,
the resection is confined to the affected area only, ensuring that adequate length of small bowel is
left to serve vital functions of absorption of food.
The aim of surgery in Crohns is not only to remove the offending part adequately, but also to
ensure that the join in the bowel is wide enough to ensure easy passage of food stuff. There
is some evidence that if the join is not wide enough, there is likely to be stagnation of food which
may lead to the pathology coming back early.
Nutrition is all important in Crohns. The protein levels often drop and it is imperative that surgery
is carried out after the protein levels in the blood are restored. This may mean a period before
surgery of nutrition either through a fine tube in the stomach (passed through the nose) or directly
into the blood stream.
How succesful is surgery for Crohns disease?
By the very nature of the pathology, complications are high. Chances of Crohns disease coming
back in the area removed could be as high as 50% after a right hemicolectomy. Leaks from the
anastomosis (join in the bowel) are also high. Very often, it becomes necessary to re-operate
soon after the first operation for collections of pus. An average person with Crohns is likely to have
undergone three operations on the intestines in their lifetime.
Should surgery for Crohns disease be avoided at all costs?
While it is true that medical treatment is preferred as the initial form of therapy, it is important
to realise that surgery is eventually required in up to three quarters of all patients with Crohns
disease. Many patients have suffered unneccessarily due to a mistaken belief that surgery for
Crohns disease is dangerous or that it inevitably leads to complications.
Crohns disease, September 2015
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Surgery is not a cure, although many patients never require additional operations. A conservative
approach is frequently taken, with a limited resection of intestine (removal of the diseased portion
of the bowel) being the most common procedure.
Surgery often provides effective long-term relief of symptoms and frequently limits or eliminates
the need for ongoing use of prescribed medications.
Where can I find more information?
• National Association of Colitis and Crohns disease (NACC) - www.nacc.org.uk
Any complaints, comments, concerns, or compliments
If you have other concerns please talk to your doctor or nurse. Alternatively please contact our
Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314,
or email [email protected]
Further patient information leaflets
In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets
covering conditions, services, and clinical procedures carried out by the Trust. For a full listing
please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff.
After reading this information, do you have any further questions or comments? If so,
please list them and bring to the attention of your nurse or consultant.
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are therefore happy to provide the information in this leaflet in
Braille, large print, or audio - upon request.
If you would like a copy of this document in your language, please contact the ward or department
responsible for your care.
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This leaflet has been produced with and for patients
Information produced by the Colorectal Surgery Department, William Harvey Hospital Ashford
Date reviewed: September 2015
Next review date: September 2017
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