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What is Crohn’s Disease
Crohn’s Disease (CD) is a chronic idiopathic inflammatory bowel disease that causes chronic intestinal inflammation of the gastrointestinal tract (Feuerstein & Cheifetz, 2017). CD is usually characterised by a transmural inflammation which most commonly affects the ileum and colon, but can also affect any part of the gastrointestinal tract. As represented by the image below, another distinctive element of CD is that the areas of inflammation occur in a patchy discontinuous manner (Mills & Ciorba, 2018).
What is the significance of Crohn’s Disease?
According to a study carried out by Wilson et al. (2010), the prevalence rate of Crohn’s disease in Australia is considered to be one of the highest in the world at 17.4 per 100,000 – compared to other high incidence countries to 16.5 in New Zealand, 16.3 in Canada, 8.6 in Denmark and 8.3 in United Kingdom. It has a significant contribution to the health system as Crohn’s disease has an incidence rate of 40 per 100,000 between the ages of 15 to 24 in Australia (Wilson et al., 2010).
Cause & Effect of CD
As CD is an idiopathic disease, the cause of CD remains unknown. Although the cause of CD is unknown, Boyapati, Satsangi, & Ho (2015) stated that the generally recognised speculation of CD is a dysregulated immune response disorder in inherently vulnerable individuals, where CD is triggered by environmental factors that disturb the intestinal mucosal barrier, change the good health balance of the gut bacteria, and abnormally stimulate immune responses in the gut. The three main components of genetics, the immune response of the gut, and the gut bacteria can also be manipulated by environmental factors. Normally, without CD, the ileum and the colon would not cause intestinal inflammation of the gastrointestinal tract. The colon would appear normal with no fissure and thickened wall.
Signs and Symptoms of CD
Symptoms of CD can vary but usually include diarrhoea, abdominal pain, unintended weight loss, nausea, vomiting, bowel obstruction, fistula, and sometimes fevers or chills (Feuerstein & Cheifetz, 2017).
Consequences of CD
Patients diagnosed with CD are likely to experience consequences such as nutritional disorders. As the gastrointestinal tract plays a major role in nutritional absorption, malnutrition is likely due to the symptoms of chronic diarrhoea which interfere with nutrition getting absorbed into the body normally. According to Hébuterne, Filippi, Al-Jaouni, and Schneider (2009), 75% of CD patients suffer from malnourishment and one-third of CD patients have a body mass index below 20. Regularly getting tested for nutritional deficiencies in CD patients is advised. To manage nutritional deficiencies, taking regular vitamin supplements and getting nutritional support from qualified health professionals may be one way to successfully manage nutritional intake (Hébuterne et al., 2009). Another consequence CD patients are likely to face is anxiety and depression. Wright, Ding, and Niewiadomski (2018) stated that CD patients suffer a significant impact on mental health and quality of life due to the unbearable symptoms experienced by CD. Therefore, when suitable, seeking help from the psychologist or psychiatrist is critical for CD patients (Wright et al., 2018).
Available treatment drugs for CD
Although there is no cure for CD, the treatment of CD seeks to first induce then maintain remission. The importance of the methods of CD treatment is to control gastrointestinal inflammation rather than only improving current symptoms present. Inducing remission is very critical to lessen gastrointestinal damage (Wright et al., 2018). There are a variety of available treatment drugs that are known to be effective to keep CD under control. There are three main classes of treatment drugs available for CD which are oral 5-aminosalicylates, corticosteroids, and immunomodulators. Oral 5-aminosalicylates which comprise of medications such as sulfasalazine and mesalazine is usually taken for mild symptoms of CD to induce and maintain remission. Corticosteroids which comprise of medications such as prednisolone is also used to induce remission. Immunomodulators that involve medications such as azathioprine and 6-mercaptopurine is considered to be the most effective medication in maintaining remission (Wright et al., 2018).
Possible side effects of treatment drugs
Although there are a few classes of treatment drugs available for CD, it is best advised to consult an experienced health professional to discuss what would be the best possible outcome from these treatment medications as these medications can have possible side effects. The drug class of 5-aminosalicylates has possible side effects of headache, nausea, and diarrhoea. Drug class of corticosteroids has possible side effects of osteopenia or osteoporosis, weight gain, insomnia, mood changes, delirium, cataracts, glaucoma, and skin changes. Drug classes of thiopurines can also have possible effects of nausea, vomiting, pancreatitis, infection and bone marrow suppression. As the drug class of anti-TNF has a route of subcutaneous or IV, possible side effects include infusion or injection site reaction infection (Wright et al., 2018).
- Boyapati, R., Satsangi, J., & Ho, G. T. (2015). Pathogenesis of Crohn’s disease. F1000prime reports, 7, 44. doi:10.12703/P7-44
- Feuerstein, J. D., & Cheifetz, A. S. (2017). Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clinic Proceedings, 92(7), 1088-1103. doi:10.1016/j.mayocp.2017.04.010
- Hébuterne, X., Filippi, J., Al-Jaouni, R., & Schneider, S. (2009). Nutritional consequences and nutrition therapy in Crohn’s disease. Gastroentérologie Clinique et Biologique, 33, S235-S244. doi:https://doi.org/10.1016/S0399-8320(09)73159-8
- Mills, J. C., & Ciorba, M. A. (2018). Gastrointestinal Disease. In G. D. Hammer & S. J. McPhee (Eds.), Pathophysiology of Disease: An Introduction to Clinical Medicine, 8e. New York, NY: McGraw-Hill Education.
- Wilson, J., Hair, C., Knight, R., Catto-Smith, A., Bell, S., Kamm, M., . . . Connell, W. (2010). High incidence of inflammatory bowel disease in Australia: A prospective population-based Australian incidence study. Inflammatory Bowel Diseases, 16(9), 1550-1556. doi:10.1002/ibd.21209
- Wright, E. K., Ding, N. S., & Niewiadomski, O. (2018). Management of inflammatory bowel disease. Medical Journal of Australia, 209(7), 318-323. doi:10.5694/mja17.01001
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