Crohn's disease

​

Crohn's disease is an inflammatory condition that can affect any part of the digestive system from the mouth to the anus. It is sometimes regarded as a chronic condition that that can be ongoing life-long with periods of no symptoms (remission) and episodes of active disease (flare-ups). It is not infectious to others. Depending on the site of disease, people will have varying symptoms making this quite a complex disease to manage. The symptoms can be related to local disease or the effect on nutritional deficiencies causing abdominal pains, diarrhoea, tiredness, feeling unwell, mouth ulcers, weight loss and anaemia. Within the bowel complicated disease can cause narrowing, abscess, perforation and fistulation (connecting tracts to other organs or the abdominal wall). Perianal disease around the back passage area can mimic those in the general population but may need to be managed very differently, therefore experience in management of this is important by the treating surgeon or doctor. In similarities to Ulcerative Colitis, there are also extra-intestinal manifestations (affected other organs) that include joints, skin, eyes, bones, kidneys and liver. Remember that there are a number of ways to manage all these conditions and the majority of people learn to live with the disease with the right help.

​

Ulcerative Colitis

​

Ulcerative Colitis is an inflammatory condition that causes inflammation and ulceration of the inner lining of the ofthe large bowel, usually starting from the rectum and working more proximal around the colon. Proctitis is when inflammation only affects the rectum, left sided bowel disease is distal colitis, and when the whole bowel is affected this is called total or pan-colitis.  It can cause some inflammation of the end of the small bowel (backwash terminal ileitis). Local bowel disease can cause narrowing of the bowel (strictures), perforations (holes in the bowel), toxic megacolon (dilatation) and fistulas to form (connections to other organs). Again like Crohn's disease there can be similar extra-intestinal manifestations of the disease.  This may also have episodes of remission and flare-up like Crohn's disease and currently there is no cure for this. There is however a number of medication that can help to control the symptoms which range from diarrhoea with blood or mucus, abdominal pains, tiredness, feeling generally unwell, weight loss and anaemia. Once again remember that there are a number of ways to manage all these conditions and the majority of people learn to live with the disease with the right help.

​

Patients with ongoing symptoms, those suffering long-term side-effects of medication, failed acute non-responsive flare-ups to medication or high risk of cancers may require surgery. There are multiple approaches to surgery and with one surgery impacting on future surgical options, the right decisions need to be made early in regards to surgical management. Surgery can ultimately result in either a stoma formation or consideration of an internal pouch through staged operations which can be done laparoscopically (through keyhole surgery).

​

General Information

​

As Crohn's affects around 1 in 650 people in the UK and a rising incidence affecting mostly the 10 to 40 year old age groups with a second peak in the over 60's, there are a lot of aspects to consider in the management of this disease, particularly in the younger age groups.  Ulcerative Colitis affects around 1 in 420 people in the UK. The Crohn's & Colitis UK website is an excellent resource to answer a number of questions about the disease, living with Crohn's and Ulcerative Colitis, and aspects of both the medical and surgical management of the disease.  Furthermore given the younger age groups affected, psychological support is vital.  Due to the complex nature of these diseases a multidisciplinary team approach is usually considered involving medical doctors (gastroenterologists, an experienced surgeon who understands the variety of surgical approaches, nutritional teams, stoma nurses and inflammatory bowel disease nurses amongst others. The link below has excellent information on all aspects of both diseases.