Crohn’s disease

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Crohn’s disease is a disease that causes inflammation of the gastrointestinal tract, usually in the small intestine and the first part of the large intestine. Common symptoms are diarrhea, stomach crunch after eating and losing weight. The disease does not pass, but with treatment you can live almost as usual. The treatment consists of different types of drugs.

Crohn’s disease is a so-called inflammatory bowel disease. It can sometimes be difficult to distinguish between Crohn’s disease and ulcerative colitis . It is another inflammatory bowel disease in which only the colon and rectum become inflamed. 

symptoms

You can get Crohn’s disease throughout the gastrointestinal tract. The symptoms you get vary greatly depending on which part and how much of the gastrointestinal tract is inflamed.

These are the most common symptoms of Crohn’s disease:

  • Getting a stomach ache. It is especially common to get stomach cramps after a meal.
  • Getting blood in the poop .
  • Obtaining diarrhea, usually blood-mixed diarrhea. It can also come clean blood if you have diarrhea.
  • Losing weight. This may be because you may be eating less amounts, or because your body is not taking up nutrition properly.
  • Feeling tired and sick, due to anemia or that the inflammation itself makes you tired.
  • Getting bumps and fistulas around the rectum  that hurts. A fistula is a small duct formed between, for example, the rectum and the skin around the rectum.
  • Getting trouble in other parts of the body, such as the skin, eyes and joints.

Crohn’s disease can in turn cause intestinal complications:

  • Peritonitis, which makes the stomach sore when you press it. It may then have accumulated was like a bulge inside the stomach. Sometimes the item can come out through a fistula. 
  • Stops in the intestine that can lead to bowel wrists .

The disease lasts for periods

The disease lasts for periods, so-called forests. This means that you have periods of trouble. Between the woods you have periods when you feel better. The trouble you get and how long they last are different from person to person.

When and where should I seek care?

If  you think you have blood in your pouch, contact a health center or on-call reception. If closed, you can wait until the on-call reception or medical center opens.

If it’s in a hurry

If you have one or more of the following symptoms, please contact a health care center or on-call reception immediately:

  • You have intense and bloody diarrhea.
  • You have a fever and stomach ache that does not go over, as well as blood in the pooch or more diarrhea than before.

If closed, seek care at an emergency room.

If you have already been diagnosed with Crohn’s disease

Contact your gastrointestinal clinic or health care center if you know you have Crohn’s disease and you are getting worse:

  • You get more stomach ache or diarrhea.
  • You get a fever that you suspect may have to do with your illness.
  • You lose weight.
  • You can feel discomfort from the joints, skin or eyes.

Investigations and investigations

The doctor feels on his stomach

At the doctor at the health center, you first have to tell you about your complaints. Then the doctor feels on the stomach and, if necessary, examines the rectum with a plastic tube, called a rectoscope .

The survey usually takes no more than a few minutes. It doesn’t usually hurt, but the rectal examination can be perceived as unpleasant.

You are allowed to submit blood tests and stools

Often, you may have blood  and stool samples taken  at the clinic or in a laboratory.

The blood tests may not show if you have Crohn’s disease, but if you have severe inflammation in the body. They can also show if you have anemia or if you get too little nutrition.

With the help of stool samples, the doctor can see if the inconvenience is due to something else, for example a bowel infection. The doctor can also see how high the protein calprotectin you have in the pouch.

A person with Crohn’s disease usually has higher levels of calprotectin. However, some people who have no inflammatory bowel disease may also have a slightly elevated value of calprotectin.

Referral to gastrointestinal specialist

You usually get a referral  to a gastrointestinal specialist if the doctor at the health center suspects that you have Crohn’s disease. The gastrointestinal specialist is also called a gastroenterologist.

At the gastrointestinal reception, various groups of health care professionals work in teams. A team can consist of, for example, gastrointestinal specialists, surgeons, nurses, ostomy therapists and dietitians. Often you have the most contact with a specialist nurse in the team.

If your child has intestinal inflammation, the child should be treated by specialists in pediatric diseases with a focus on gastrointestinal problems.

More research may be needed

You may be able to do more examinations depending on what the blood and stool samples show, as well as what symptoms you have. You will then receive a referral to the exam (s) to be performed.

Here is a list of surveys you can do:

  • A colonoscopy involves examining the mucosa of the colon and rectum using a flexible tube called a colonoscope.
  • A  magnetic camera survey is done to assess your illness and how widespread it is.
  • A computed tomography is done to detect if, for example, you have product collections or intestinal stops.
  • A capsule endoscopy, which means you swallow a small mini camera. It can take pictures from inside the gut.
  • An X-ray with contrast agents in the intestine, which can show if you have a narrowing in the small intestine, for example.

It may take time to get the right diagnosis

The doctor makes the diagnosis by showing both the symptoms and various examinations together that you have Crohn’s disease. It can sometimes be difficult to distinguish Crohn’s disease and ulcerative colitis if the inflammation is present only in the large intestine.

There is also an intermediate form of Crohn’s disease and ulcerative colitis, so-called unclassified inflammatory bowel disease. Symptoms and treatment are about the same as with ulcerative colitis. Unclassified inflammatory bowel disease is sometimes shortened to IBD-U.

It may take some time for a secure diagnosis. Sometimes the doctor makes a first diagnosis which must then be changed, depending on how the disease develops.

Can feel both good and hard to know

Many can feel relieved when they get an explanation for their problems. Others may find it difficult because Crohn’s disease is a lifelong disease. However, getting the right diagnosis can still be the basis for getting the right treatment.

Treatment

Most people with Crohn’s disease need some kind of treatment. The treatment does not cure the disease, but it reduces and relieves inflammation of the intestine. Treatment also reduces the risk of getting sick again.

The treatment can be medication, surgery or both. Most do not need surgery. To get enough nutrition you may also need special diets, nutritional solutions and extra supplements of vitamins and minerals. The treatment you receive depends on what your illness looks like.

Occasionally, children with Crohn’s will not grow properly if medical treatment does not work. Then surgery can be a good alternative.

Treatment with drugs

Drug treatment for Crohn’s disease affects the disease in several ways:

  • The treatment relieves the hassles you get when the gut is inflamed.
  • The treatment heals the intestinal mucosa as well as possible.
  • The treatment affects the immune system and prevents the gut from being inflamed again.

If you have sudden and intense symptoms you will usually receive a short-term treatment with cortisone to relieve the problems. When they are then reduced, you may use other drugs that reduce inflammation and reduce the risk of inflammation of the intestine. Which drugs and what dose you receive will depend on your illness.

Medicines that relieve the problems

Medication with antibiotics relieves symptoms

Some types of antibiotics can have an effect on the symptoms that Crohn’s disease can cause. This is especially true if you have so-called fistulas. Antibiotics do not cure the inflammation of the intestine.

Medicines for diarrhea and leakage

You may also need medication to reduce diarrhea and rectal leakage. These drugs also prevent you from losing fluid through loose poop. Fiber supplements can also help make stools firmer and reduce diarrhea.

Tell your doctor if you are taking this type of medicine. The drugs can give you a mistaken idea that you have fewer diarrhea per day, and thus a mistaken idea of ​​how inflamed the gut actually is.

If the last part of the small intestine has been removed, drugs that bind bile can reduce diarrhea.

Drugs for skin cracks

Ointments and suppositories can relieve skin cracks in the rectum which hurts.

Drugs that suppress inflammation

Medicines with cortisone reduce the inflammation of the intestine. How much dose and how long you need cortisone medication varies.

Follow the instructions given to you by your doctor

It is important that you follow the prescription and dosing schedule given to you by your doctor when taking cortisone in tablet form. Most treatments with cortisone are terminated by reducing the dose incrementally, sometimes for several months. Do not end the treatment without talking to your doctor. 

Medicines that affect the immune system

Often Crohn’s disease is treated with so-called immunomodulatory or biological drugs. These drugs affect the immune system and are often used to suppress inflammation of the intestine.

The drugs also reduce the risk of the inflammation coming back. You can sometimes use this type of treatment for several years.

Treatment with surgery

Sometimes you may need surgery for Crohn’s disease. The most common reasons are as follows:

  • If it has become crowded in the intestine so that you have been stopped in the intestine.
  • If you have had various complications such as fistulas, scars and scars.
  • If you have severe problems despite using medicines.
  • If you get a lot of side effects from the drugs.
  • If children do not grow properly because of the disease.

If you need to remove a piece of the intestine

You may need to remove some of the bowel if it is highly inflamed. The surgeon then removes as small a portion of the intestine as possible, and connects the intestine ends. The intestinal contents can then pass the same way as before the operation. Usually the function of the intestine is not affected too much.

If examinations have shown an increased risk of colon or rectal cancer, you may need to have the entire colon or rectum removed.

You may need an ostomy

If you are ill during the operation, the bowel ends can sometimes not be connected. Then you may need to get a temporary bag on the stomach where the intestinal contents are emptied, so-called ostomy. When you feel better, the surgeon can connect the bowel ends in a new operation, and the stoma can be removed.

If you have severe inflammation of the colon, the surgeon may need to have the colon removed. You will then get a permanent ostomy. This also applies if you have severe inflammation of the rectum and have very troublesome fistulas around the rectum.

Good to quit smoking before surgery

If you smoke, it is important that you try to stop before an operation. The wounds heal faster, blood circulation and fitness improve so you recover faster.

You should quit smoking altogether, but if it does not succeed then it is good if you can refrain from smoking before the surgery and even the first weeks afterwards. If you need help to quit smoking , your doctor can tell you what support is available.

What happens in the body?

Most often, the lower part of the small intestine and the first 
part of the large intestine are inflamed. Crohn’s disease is an inflammation of the gastrointestinal tract. The most common is that the lower part of the small intestine and the first part of the large intestine become inflamed. But inflammation can occur throughout the gastrointestinal tract, from the mouth down to the rectum opening. Sometimes you get the disease in only the small intestine, colon or rectum.

When the gut is often inflamed, you lose both protein and blood. Inflammation also prevents the gut from absorbing nutrition properly.

It is probably the body’s own immune system and the bacteria in the gut that causes the cells to attack the intestinal mucosa. The intestinal mucosa then becomes inflamed, swells and becomes sore and bleeds. This is why you can have bloody diarrhea.

Sometimes the symptoms can disappear for quite some time, but the disease itself remains in the body. It is common for the problems to decrease with age.

The most common thing is to get sick the first time when you are between 15 and 35, but you can get sick regardless of age.

What is Crohn’s disease?

Crohn’s disease is caused by both inheritance and external environmental factors. The fact that someone in your family has the disease does not mean that you are certain to have it, but there may be an increased risk.

Crohn’s disease and pregnancy

Most people with Crohn’s disease can become pregnant and have babies. The disease does not affect the ability to become pregnant. It is best to be as symptom free as possible when you become pregnant.

Talk to your doctor if you are or would like to become pregnant. Consult with them which medicines you can use during pregnancy and if you want to breastfeed.

Also talk to your midwife and doctor how you want to give birth.

No increased risk of congenital injury due to Crohn’s disease

Many people with inflammatory bowel disease worry that the child will inherit the disease, or that the child will have congenital injuries that have occurred during fetal development. But the probability is high that the baby is born without inflammatory bowel disease or congenital damage. 

Complications and sequelae

If you have had Crohn’s disease in the colon for many years, there may be an increased risk of getting colon or rectal cancer  Therefore, you may need to remove parts of the bowel for preventative purposes.

If you have long-term inflammation of the colon, you may have regular colonoscopy checks. It is for being able to detect precursors to cancer in time.

Inflammation in other body parts

In Crohn’s disease you can get inflammation in other parts of the body. Most common is inflammation of the joints, eyes or skin changes. It is uncommon, but you can also get diseases of the liver and its bile ducts or kidneys. The risk of getting blood clots also increases slightly.

Living with Crohn’s disease

Crohn’s disease is a disease you have throughout your life, but with treatment it can often be symptom-free. You can also do other things to feel as good as possible.

Learn about the disease and the drugs

Find out which drugs are available, how they work and what side effects are available. Ask your doctor or specialist nurse in the team what the treatment looks like, when to take the different drugs and why.

When you learn about how the different drugs work and about the treatment, you may be more involved in the treatment. It can be empowering and motivating when you know why you are using a particular drug, for example.

Also, try to learn what you are reacting to and how your illness works. One tip might be to write a diary. In it you can record how you are feeling, what you have eaten and what you have done. Then it will be easier to see if there is anything in particular that will cause you more or less symptoms.  

You can read more about Crohn’s disease and other inflammatory bowel diseases at the Patient and Gastrointestinal Association’s website .

Increased security

Having a good contact with the healthcare staff makes you safer. Talk to your nurse and tell how you would like to be treated. Find out who to contact when you get worse.

Tell about your illness to close relatives and friends

Tell your relatives and friends that you have Crohn’s disease and what it means. Many people with inflammatory bowel disease find it difficult to have a disease that is not always visible. For example, it may be difficult for people in the area to understand how the disease affects you, and that at times you cannot cope as much as otherwise.

Test out what you can eat

If you have intestinal distress, you should avoid eating foods that are difficult to digest. Otherwise, it may increase the risk of bowel swelling. Examples of such foods are:

  • Sponge.
  • Citrus fruits.
  • Asparagus.

Otherwise, there are no specific recommendations on what to eat and drink, or what to avoid. What you can eat is individual and depends on how you feel. Some get worse from eating spicy, deep-fried and high-fiber foods, and from dairy products. Alcohol can also cause you more symptoms.

Try to find out what your symptoms are. If you need dietary advice, please contact a dietitian.

Try to stress less

Some can also alleviate their hassles by changing their lifestyle. If you notice that you are getting worse from stress, you can try to stress less. If you need to help manage your stress, talk to your doctor or nurse in the team.

It is also good to try to sleep just fine .

Talk to your employer or student health

Talk to your employer or student health about your work or studies being greatly affected. You may be able to work from home, get an individual study plan, or study remotely.

Shot the teeth

Since Crohn’s disease can mean that the gut cannot absorb all the nutrition from the food, it is common to eat several snacks a day. Eating multiple snacks or a lot of sugar increases the risk of getting holes in your teeth. Therefore, make sure you take care of your teeth  and go to a dentist regularly.

You can get  special dental allowance. This means that you pay less when you visit the dentist.

Drink a lot if you have severe diarrhea

Be sure to drink plenty and get extra salt and sugar if you have severe diarrhea. One sign that you have been getting enough fluid is that you are peeing as much as usual, despite the diarrhea.

Meet other people through patient organizations

Sometimes it can be nice to talk to others who also have inflammatory bowel disease. They often understand how you feel without having to tell them too much. When you meet others, you can also get advice and tips on what you can do in different situations.

The Gastrointestinal Association has local associations where you can get in touch with others who have inflammatory bowel diseases.

They also have the Youth Association Young Stomach for people up to 30 years who have an inflammatory bowel disease. The site also has personal stories that you can read.

Influence and participate in your care

As a patient, you have under the Patient Act chance to affect your health.

You can seek care at any medical center or open specialist clinic  you want throughout the country. Sometimes referral to the open specialized care is required .

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. For example, you should receive information about treatment options and how long you may have to wait for care and treatment .

Children should also be involved in their care. The older the child, the more important it is.

You have the opportunity to get help from an interpreter. You also have the opportunity to get help from an interpreter if you have a hearing loss .

If you need tools , you should get information about what is available and how to get it.

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