What is Crohn’s disease? 

Crohn's disease is a chronic inflammatory disease of the digestive system. It involves the immune-mediated attack of cells in the digestive tract. Inflammatory bowel disease, also referred to as IBD, includes Crohn's disease and Ulcerative Colitis. There is no difference in the prevalence of Crohn’s disease between men and women.¹ The average age of onset seems to be between 15 to 35 years old.¹ Crohn's disease can affect any part of the gastrointestinal tract, from the mouth to the anus, but it most frequently affects the ileum (small bowel) and the first part of the colon.¹ It is important to know which part of your gastrointestinal tract is affected by Crohn's disease. Although Crohn's disease symptoms might differ from person to person, your symptoms and complications depend on the part/parts of the gastrointestinal tract affected.

Symptoms 

According to the Crohn’s and Colitis Foundation, the main symptoms of Crohn’s disease include:

• Diarrhoea - In Crohn's disease, diarrhoea is a prominent symptom of active disease and has a significant negative impact on a patient’s health.²
• Rectal bleeding
• Stomach pain and cramps
• Constipation - This may lead to a bowel obstruction
• A feeling of incomplete bowel evacuation
• Weight loss
• Fatigue (tiredness)

The symptoms could be constant or inconsistent every few weeks or months. It is normal to have these flare-ups (when the symptoms come back) with Crohn's disease.

The effects of alcohol on Crohn’s Disease

Alcohol can trigger a flare-up

Knowing which drinks trigger flare-ups or worsen symptoms is important if you have Crohn's disease. Patients with Crohn’s disease  have been reported to avoid alcohol more than any other food group.³

There has been no clear  evidence of alcohol consumption increases  the risk of developing Crohn’s disease but there is a possible association between alcohol consumption and Crohn’s disease. More research needs to be done on understanding this relationship.

One recent study found that only moderate beer consumption of 1-4 servings a week was shown to be marginally related to a decreased risk of Crohn’s disease. However, they also found that consumption of more than 4 servings a week of alcoholic beverages was found to be associated with an increased risk of Crohn’s disease.⁵ 

In CD patients, stomach pain is more affected by alcoholic beverages, Smirnoff Ice and Elephant beer. This shows that the high sugar content of these drinks is probably to blame, so it is best to steer clear of them.⁶ Additionally, this can be because people drink these types of drinks in higher quantities compared to spirits and liquors.

Many drugs used to treat Crohn's disease are affected by alcohol usage, which can result in worsened side effects or even a loss of effectiveness. In particular, azathioprine and methotrexate are medications used but they both can damage and scar the liver.⁷ Damage to the liver is more likely to occur when using alcohol concomitantly. If antibiotics are given as treatment, it is important not to drink alcohol. 

However, if you are in an active flare it is recommended that you abstain from drinking alcohol.

Alcohol can make the symptoms worse

Alcohol in Crohn’s patients can worsen symptoms or create new ones including:

• A liver disease which is a severe complication of inflammatory bowel diseases
• Diarrhoea
• Vomiting
• Nausea
• Gastritis which is the inflammation of the stomach walls
• Interacting with medications

Figure: Effect of alcohol on Crohn’s patients

Created by Aastha Malik

Alcohol in moderation is not completely off the table 

Don’t have to avoid alcohol completely - unless it is known to trigger severe flare-ups for you - but it is  recommended to avoid carbonated beverages (aka coke and so on as mixers) and beer.

To be safe, consult your doctor first and keep your alcohol intake to one or two drinks each day. Be careful what you consume as well, as sugary beverages may cause you to have an upset stomach the following day. Sugary beverages include fizzy drinks such as coke which are used as mixers and alcoholic beverages such as beer.

Alcohol suppresses the immune system when consumed in small quantities.  That may be beneficial for those who have Crohn's disease as an overactive immune system causes Crohn's disease symptoms including diarrhoea and abdominal cramps.

If you’re worried about your alcohol intake

A good first step is to visit a doctor if you have concerns about your drinking. In addition, there are also many charities and helplines to contact if you are concerned about you’re drinking.

• Alcohol Change UK
• Alcoholic Anonymous  - 0800 9177 650  
• Al-Anon - 0800 0086 811 
• Drinkline National Helpline - 0300 123 1110

Conclusion 

Crohn’s disease is a chronic inflammatory disease which affects the gastrointestinal tract and can cause unpleasant symptoms. Although drinking is known for triggering Crohn's disease, a person with the condition may not need to cut out alcohol completely from their diet. Different alcoholic beverages, the type of Crohn’s disease and various triggers can cause people to react differently to this disease. To understand your symptoms better, your triggers and your alcohol limits,  the best approach would be to visit a doctor.