Crohn’s disease in Australia: a complete guide for patients

What is Crohn’s disease?

No one wants to wake up every morning feeling sick and exhausted. Nowadays we consider chronic diseases like Chron’s disease a normal event in our lives, which is completely wrong. We have the knowledge and the ability to treat these diseases. However, most people don’t know anything about it or are unwilling to discuss this topic with others because of embarrassment .

It’s time for us as a society to overcome this problem.

Crohn’s disease was first described in 1932¹, yet we are not any closer to finding a cure for this condition. Crohn’s disease can cause inflammation in one or more sites along the digestive tract, causing multiple symptoms and potentially leading to life-threatening complications in certain patients.

Main types of Crohn's disease

There are four main types of Crohn’s disease, depending on which part of the digestive tract is affected². These are:

Ileocolitis

This is the most common form of Crohn’s disease. Here, inflammation and irritation occur in the ileum (the lower part of the small intestine) and colon (part of the large intestine). Symptoms associated with this form of Crohn’s disease include:

- diarrhea;
- marked weight loss; and
- pain or cramping in the mid- or lower-right region of the abdomen.

Ileitis

This form of Crohn’s disease has a similar presentation to ileocolitis but only affects the ileum, causing inflammation and irritation.

Gastroduodenal

This type of Crohn’s disease causes inflammation and irritation to the stomach lining and the duodenum (top part of the small intestine). Symptoms associated with this form of Crohn’s disease include:

- nausea;
- lack of appetite; and
- weight loss.

Jejunoileitis

In this form of Crohn’s disease, there are multiple inflammation points in the jejunum (upper half of the small intestine).

Symptoms of Crohn’s disease

People diagnosed with Crohn’s disease may experience mild or even no symptoms or suffer from severe gastrointestinal problems. In some cases, symptoms develop with age, worsening over time. Some common symptoms of Crohn’s disease include^3-4:

Diarrhoea
Fever
Fatigue
Abdominal pain and cramping
Blood in your stool
Mouth sores
Reduced appetite and weight loss
Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)

Although less common, people diagnosed with Crohn’s disease may also experience:

Inflammation of skin, eyes and joints
Inflammation of the liver or bile ducts
Kidney stones
Iron deficiency or anaemia
Delayed growth or sexual development in children

Crohn's disease: when to see a doctor

While some symptoms can be managed at home, people experiencing Chron’s disease should seek medical attention if these symptoms appear:

Abdominal pain
Blood in your stool
Nausea and vomiting
Ongoing bouts of diarrhoea that don’t respond to over-the-counter medications
Unexplained fever lasting more than a day or two
Unexplained weight loss

Who gets Crohn's disease?

Crohn’s disease can affect anyone at any age. It can affect young and older men and women, as well children. However, epidemiological studies suggest that Crohn’s disease usually occurs in the second to fourth decades of life and may more commonly affect people who are 50-60 years old³.Studies also suggest that Crohn’s disease is more common in highly industrialised countries, like the USA, UK and Australia. Studies also indicate that Chron’s disease more commonly affects people living in urban settings compared to those living in rural areas³.

How common is Crohn's disease?

Global epidemiology studies suggest that developed countries currently have the highest incidence and prevalence of Crohn’s disease. The highest annual incidence of Crohn’s disease is currently found in Canada, where 20.2 of each 100,000 inhabitants have this condition. Australia is currently among the countries with the highest annual incidence of Crohn’s disease, with 29.3 cases per 100,000 inhabitants³.Studies have also shown a marked increase in the incidence and prevalence of Crohn’s disease in areas where this disease was not expected. This increase has been observed to occur in parallel with the urbanisation of these areas. Similar results have been shown among populations that immigrate from a low-incidence region to a high-incidence region. The first and second generations experience higher prevalence and incidence of Crohn’s disease than their parents and grandparents, respectively⁵.

What causes Crohn's disease?

There is no clear cause for Crohn’s disease, but there is consensus on the multi-factorial origin of this condition. Researchers agree that Crohn’s disease results from the complex interaction of genetic susceptibility, environmental factors, and alterations to an optimal intestinal microflora, which can cause an abnormal mucosal immune response and compromised epithelial barrier function^4-5. Some of the most important factors known to influence the onset of Crohn’s disease include:

Genetics

It has been estimated that about 12% of patients with Crohn’s disease have a family history of this disease⁶. Certain ethnic groups have also been shown to have different susceptibility to Crohn’s disease. For example, people with Ashkenazi Jewish background have a higher likelihood of developing Crohn’s disease compared to the general population. Likewise, Crohn’s disease is less common in African Americans or Hispanics^5-6. So far, at the DNA level, around 200 genes have been associated with Crohn’s disease⁵.

Environmental factors

Multiple environmental factors have been associated with Crohn’s disease, like smoking and the use of certain medications. Some key environmental factors involved with Crohn’s disease include⁵:

Cigarette smoking – has been shown to increase the chances of developing Crohn’s disease two-fold, compared to non-smokers.
Antibiotic exposure during childhood can increase the risk of Crohn’s disease 1.74 times relative to children not exposed to antibiotics.
Other medications potentially associated with increased risk of Crohn’s disease include oral contraceptives, aspirin, and non-steroidal anti-inflammatory drugs.

Immune diseases

People with Chron’s disease also tend to have autoimmune problems. A 2017 study analysed data from 47325 patients with IBD and found twenty different immune-mediated diseases that were significantly more frequent in people with inflammatory bowel disease, including Crohn’s disease. It has also been shown that people with Crohn’s disease⁶ have disfunction in immune pathways involved with barrier function, harbour innate immune defects, and dysfunctional adaptive immune cells⁶.

Gut Microbiota

Patients with Crohn’s disease have been shown to have gut dysbiosis, with decreased levels of specific forms of Bacteroides and Firmicutes bacteria and increased levels of Gamma-proteobacteria and Actinobacteria. Furthermore, about 30% of patients with Crohn’s disease have:

increased levels of mucosa-associated adherent-invasive
Escherichia coli
decreased levels of Faecalibacterium prausnitzii, a commensal bacterium with anti-inflammatory properties
increased levels of caudovirales viruses
fungal dysbiosis

However, further research is needed to understand the potential of manipulating gut microbiota and effectively translating findings into clinical practice.

How is Crohn's disease diagnosed?

If you experience symptoms that fit with Crohn’s disease, you should visit a health practitioner. However, no specific tests will quickly diagnose Crohn’s disease. Instead, your health practitioner needs to rule out other possible causes that might explain your symptoms. Some standard tests employed in a patient with suspected Crohn’s disease include:

Blood tests – this test may reveal anaemia signs of infection.
Stool tests – this test may help reveal hidden (occult) blood or microorganisms, such as parasites, which may be present in your intestinal tract.
Colonoscopy – this procedure employs a thin, flexible, lighted tube with a camera to visually evaluate the condition of the entire colon. During the procedure, small tissue samples can be taken for further laboratory analysis to aid with diagnosis. For example, if granulomas are present, this can be a strong indicator of Crohn’s disease.
Computerised tomography (CT) – this procedure offers a more detailed view of the intestinal tract, helping your health practitioner identify lesions.
Magnetic resonance imaging (MRI) – this imaging technique also provides highly detailed images of the digestive tract. MRIs help evaluate a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography).

Treatment for Crohn's disease

There is no cure for Crohn’s disease nor any specific treatment that will eliminate all symptoms related to Crohn’s disease. However, there are effective ways to manage this disease, providing patients with significant improvements to their quality of life.Some common treatments that may be prescribed to a patient with Crohn’s disease include:

Anti-inflammatory drugs – these are usually the first line of treatment and may include medications like:
- Corticosteroids, such as prednisone and budesonide to other treatments.
- Oral 5-aminosalicylates, such as sulfasalazine (Azulfidine)
Immune system suppressors – these drugs also reduce inflammation by targeting the immune system. Some examples of immune system suppressors used in Crohn’s disease include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)
- Methotrexate (Trexall).
Biologics – these are drugs that target proteins made by the immune system. Examples of biologics used to treat Crohn’s disease include:
- Natalizumab (Tysabri) and vedolizumab (Entyvio) are drugs that work by stopping integrins (a type of immune cell molecules) from binding to other cells in your intestinal lining.
- Vedolizumab is a drug similar to Natalizumab in function.
- Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). These drugs are known as TNF inhibitors, as they neutralise an immune system protein known as tumour necrosis factor (TNF).
- Ustekinumab (Stelara) is a drug that works by interfering with the action of an interleukin, a protein involved in inflammation.
Antibiotics – these common drugs may help reduce the amount of drainage from fistulas and abscesses if present. Antibiotics may also help reduce levels of harmful intestinal bacteria, which may be involved in inflammatory pathways through the intestinal immune system. Frequently prescribed antibiotics include:
- ciprofloxacin (Cipro) and metronidazole (Flagyl).
Anti-diarrheal products may include fibre supplements, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), which can help relieve diarrhea symptoms.
Pain relievers, such as acetaminophen, may be recommended. However, other common pain relievers, such as ibuprofen or naproxen sodium, should be avoided, as they may worsen symptoms.
Vitamins and supplements may help if you have nutrient absorption problems.
Nutrition therapy involves following a prescribed diet either by mouth or feeding tube. This approach can help improve your overall nutrition while letting the intestinal tract rest, which can reduce inflammation levels.
Surgery – usually the last resort, surgery may help relieve symptoms when nothing else has worked. About half of all patients with Crohn’s disease end up receiving a surgical procedure. The basic principle is to remove diseased portions of the digestive tract or close fistulas, and drain abscesses. However, the benefits of surgery for Crohn’s disease are usually temporary if the underlying causes of Crohn’s disease are not addressed.

Complications associated with Crohn's disease

Although relatively rate, Crohn’s disease can lead to potentially serious complications, including:

Abscesses – these are infected pockets that form in the digestive tract.
Anal fissures are small tears in the anus, causing pain, itching, and bleeding.
Bowel obstructions – over time, can lead to the build-up of waste matter and gas and may require surgery.
Colon cancer – an increased risk of this cancer with Crohn’s disease.
Fistulas are abnormal tunnel-like openings that form in the intestinal walls and commonly become infected.
Malnutrition – due to chronic diarrhoea, which can lead to deficiencies in specific micronutrients.
Ulcers – are open sores that can form in the mouth, stomach, or rectum.

Crohn's disease and pregnancy

Having Crohn’s disease does not affect their pregnancies for most pregnant women. But, in some cases, Crohn’s disease may lead to increased risks of:

Miscarriage
Premature labour
Low birth weight

Prevention of Crohn's disease

Certain lifestyle choices increase the risk of developing Crohn’s disease. For example, quitting cigarette smoking is an essential first step for smokers. Other factors that can be managed to prevent Crohn’s disease include:

Improving your diet – this includes:
- identifying and avoiding foods that worsen your symptoms
- limiting dairy products
- consume fibre with caution, as it may worsen pain in some cases
- drink water
- consult with a health care practitioner about taking supplements
Exercise regularly – which may help reduce stress levels and promote regular digestion. Some activities for patients with Crohn’s disease can be found here.
Reduce stress – stress and anxiety can worsen symptoms of Crohn’s disease.

Our modern functional medicine approach seeks to understand why inflammation, a landmark of Crohn’s disease, occurs. Through our integrative approach, we have identified key factors that are regularly involved with Crohn’s disease:

Stress
Infections
food allergies or sensitivities
toxin exposure
genetic predisposition
nutrient deficiencies, and
leaky gut.

A common yet poorly recognised factor is the poor diet most people follow, including highly processed foods (like refined seed oils, processed meats or refined sugar), which can potentially contain allergens and toxins. These food components can trigger inflammatory responses in our body, potentially leading to severe symptoms in some people.

We design a customised diet for each of our patients, focused on reducing or eliminating all sources of potentially allergenic ingredients, and promising a healthy diet. For example, for people with Crohn’s disease and other inflammatory disorders, a diet based on trigger-free food is ideal. Such diet includes foods like:

Bone broth
Liver and other organ meats
Fermented and probiotic-rich foods
High-quality meats
Leafy and cruciferous vegetables
Healthy fats (from plants or animals)

Visit our clinic today to learn more about which foods to eat, which to avoid, and which diet is the best for you.

The prognosis for patients with Crohn's disease.

For most people, Crohn’s disease does not change their day-to-day lives, as they don’t experience any significant symptoms.

However, it is important to maintain a healthy lifestyle, including following a healthy diet, not smoking, exercising regularly, reducing stress levels and keeping close track of any symptoms by visiting a health care professional.

When to contact a doctor if you have Crohn's disease.

If you have been diagnosed with Crohn’s disease or you suspect you may have this condition, you should visit a health practitioner immediately if you experience any of these symptoms:

Blood in stool
Chronic constipation
Extreme weight loss
Regular Fever
Inability to pass gas
Nausea and vomiting
Severe abdominal pain
Signs of a flare-up
Uncontrollable diarrhea
Weakness or fatigue that may be signs of anaemia

What questions to ask about Crohn's disease

If you have been diagnosed with Crohn’s disease, here is a list of questions you should consider asking your health practitioner:

Why did I get Crohn’s disease?
What form of Crohn’s disease do I have?
What’s the best treatment for this disease type?
How can I prevent flare-ups?
If I have a genetic form, what steps can my family members take to lower their risk of Crohn’s disease?
Should I make any dietary changes?
What medications should I avoid?
Should I take supplements?
Should I get tested for anaemia?
Do I need to cut out alcohol?
Should I lookout for signs of complications?

Modern Functional Medicine and Crohn's disease

At AUSCFM, our team of doctors and health practitioners use an evidence-based, comprehensive approach to treating and managing Crohn’s disease and all associated symptoms. Our approach is based on extensive testing, including blood, stool, genetic, and microbiota testing. We also rely on extensive patient consultation and investigations aimed at identifying the specific drivers of your condition.

Our main goal is to identify and treat, whenever possible, the underlying causes of Crohn’s disease.

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