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Dr Helen Webberley MBChB MRCGP MFSRH

GMC no 3657058

Crohn’s disease

Crohn’s disease is named after the American Gastroenterologist Burrill Bernard Crohn, who first described the condition in his seminal paper in the Journal of American medicine Association in 1932.

It is an inflammatory condition of the bowel and unlike ulcerative colitis which only affects the colon, can affect the whole of the intestine, both small and large. It is characterised by areas of inflammation that might be quite separate from each other (skip lesions) which tend to involve the whole thickness of the bowel wall.

Although Crohn’s is regarded as a separate condition to ulcerative colitis there is often a ‘grey’ area, particularly when only the colon only is involved, where the conditions may be difficult to distinguish from each other.

It affects  3.2 out of 1000 people in N. European countries and USA and is more common in developing countries with an increasing incidence since the mid 1970s.

Causes

The cause of Crohn’s disease is still not understood but may be due to several interacting factors all coming together.

An infective cause has been extensively looked for and although microorganisms such as Mycobacterium paratuberculosis, E coli strains and Yersinia have been implicated, no strong link has ever been established and certainly there is nothing to suggest that the condition is infectious to close family members.

There is certainly a genetic element, with identical twins often getting it together (even if they have been separated at birth) and frequently we find more than one member with either ulcerative colitis or Crohn’s disease in any one family.

Other possible interacting factors include, environment, diet, smoking (Crohn’s is twice as common in smokers) and is also often seen to come on after a nasty enteric infection such as Campylobacter or Salmonella.

Pathology

Crohn’s is classically characterised by separate areas of inflammation (skip lesions) which typically affect the whole thickness of the bowel. The condition is chronic and relapsing with ‘good and bad’ times experienced by patients. It may vary with season and often gets better in pregnancy although the opposite can also occur.

Because full thickness inflammation occurs, then narrowing (or stricturing) of the bowel is a fairly common occurrence.

It may often be preceded by episodes of abscess formation around the anus and other extra-intestinal manifestations include, arthritis (particularly of the sacroiliac joints at the back of the pelvis), skin rashes (particularly erythema nodosum which appears as a lumpy purplish and painful rash on the shins) inflammatory eye problems and liver disease.

Symptoms

Unlike ulcerative colitis which is not typically painful, Crohn’s disease commonly is. Colicky abdominal pain which comes in waves, swelling and bloating after meals, diarrhoea which may be blood stained, weight loss and loss of appetite are common. Patients may also experience fever.

Peri-anal infections and abscesses  are common, vaginal discharge and even passing air when urinating can occur

Patients are often frightened to eat because it brings on the pain and frequently are resistant to leave the house because of the diarrhoea.

If you have any or all of these symptoms then you should certainly have them checked out but remember, IBS is much more common and benign.

Investigation and diagnosis

Crohn’s disease can be quite elusive to diagnose particularly if confined to the small intestine where normal endoscopy telescopes can’t reach. Inflammation markers are usually high (CRP, platelets and ESR), serum protein levels low and anaemia is common. As well as endoscopy we rely on special CT and MRI imaging of the bowel to make the diagnosis as well as stool tests (calprotectin).

Don’t worry if investigations ‘miss’ Crohn’s disease, unlike cancer, it doesn’t get worse if there is a delay in treatment.

Treatment

There is no cure for Crohn’s disease but medical therapy can be highly effective in controlling symptoms and significantly improving quality of life.

Treatment is similar to ulcerative colitis (ref), with anti-inflammatories (mesalazine), steroids (prednisolone or budesonide) and immunosuppressants (azathioprine, methotrexate) being used depending on severity of disease.

There is a new generation of drugs called biologics (interferons) which have been shown to be very effective but are expensive. These modify the immune system and are used in specialist centres.

Dietary manipulation has also been shown to be effective, with low fibre diets being effective in patients with bowel strictures and elemental diets (prescribed specialist drinks) having been shown to be as effective as steroids in some studies.

In patients in whom medical therapy has been ineffective then surgery is usually considered which can be highly effective

Cancer risk

There is a small but definite increase in cancer risk with Crohn’s disease, particularly if the colon is affected. Small bowel Crohn’s may be associated with  small bowel tumours such as lymphoma but these are fortunately pretty rare.

In patients with have had active Crohn’s colitis for a number of years then there is an increased risk of developing colon cancer. In these patients, endoscopic bowel screening (colonoscopy) is offered but unfortunately take-up is very sporadic.

If you have any concerns regarding Crohn’s disease, bowel cancer and screening then please refer to our website.

For more information, please ask.

Dr.Helen Webberley in the news!

The silent killer in your home: NHS reveal the REAL danger of carbon monoxide poisoning

GP Dr Helen Webberley has treated many patients with the symptoms of carbon monoxide poisoning and warns of the damage that long-term exposure to the gas can lead to.
She said: “People should not think there is a safe level of poisoning, as exposure to the gas over time, even at a low level, can lead to brain damage.
“Everyone must be vigilant to symptoms which include dizziness, headaches, breathlessness and loss of consciousness.”

 

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