Crohn's Disease and Life Expectancy

What is Crohn’s disease?

Crohn's disease is a lifelong condition that belongs to the umbrella term of irritable bowel disease (IBD), where parts of your bowel become swollen and ulcerated. Your immune system starts attacking your gut, causing pain, ulcers, and inflammation anywhere in your digestive system. The end of the small intestine and the beginning of the colon are the most common areas affected.¹ 

Crohn's disease is different from ulcerative colitis and other IBD conditions despite having similar symptoms. The difference is that Crohn's disease can “skip” parts of your bowel, meaning that you can have healthy patches of the gut in-between areas affected, whereas ulcerative colitis does not present these healthy patches.³  There are also different types of Crohn's disease depending on the portion of your gut affected, with their own particular presentation and symptomatology:³

• Ileocolitis: Affects the last portion of your small bowel and the colon.
• Ileitis: Only affects the last portion of the small bowel, known as the ileum.
• Gastroduodenal: Affects the stomach and the beginning of the small bowel. 
• Jejunoileitis: Affects the upper half of the small intestine, known as jejunum. 
• Colitis: Affects just the large bowel, known as the colon.

Signs and symptoms

The signs and symptoms of Crohn’s differ, depending on what tract of the bowel is affected, but most commonly include:²

• Stomach cramps and pain, mainly in the lower right side of your abdomen
• Loose stools
• Blood in your poo
• Tiredness
• Weight loss

Less common symptoms include:²

• High temperature
• Joint pain
• Vomiting and sickness

Symptoms might not all be present and not all the time. Crohn's disease presents symptoms often as relapses, meaning that you will experience periods where you will feel fine with no or mild symptoms and periods where the symptoms will be more severe. 

Causes and Risk Factors 

The exact cause of Crohn's disease remains unknown; however, hereditary and immune problems are likely to play an important role.⁴

• Immune system: although it has been identified that an immune response is behind Crohn's disease, it remains unclear why this is happening.
• Heredity: although Crohn's is more common in people with relatives affected by the disease, most people with Crohn's have no history of the condition in their family.

As mentioned earlier, it is still unclear what exactly causes Crohn's disease, but the following risk factors have been identified:⁴

• Age: Crohn's disease can occur at any age but most cases are diagnosed before the age of 30.
• Smoking: is directly linked to more severe cases of Crohn's and more risk of needing surgery.
• Family history: 1 out of 5 cases of Crohn's has a first-degree relative affected with this condition. 
• Ethnicity: although it affects predominantly Caucasian individuals, it has been observed in an increase of cases in the Black population in the UK and the USA.
• Medication: although they don’t directly cause Crohn's disease, drugs like ibuprofen, naproxen, and diclofenac can cause swelling in your bowels and therefore aggravate Crohn's symptoms.

Diagnosis

Crohn's disease can be difficult to diagnose as its symptoms are common with many other conditions. Some tests to rule out Crohn's might include:⁵ 

• Biopsy: a tiny piece of your bowel is taken and analyzed to look for signs of Crohn's disease.
• MRI and CT scan: they capture images of your body to help with diagnosis.
• Colonoscopy: a tube with a camera is inserted through the back passage to check for inflammation in the bowels.
• Complementary tests: blood and faeces sample.

Treatment

Unfortunately, there is no current cure for Crohn's disease; however, there are different treatments to help reduce or stop the symptoms:⁶

Medication

• Steroids: Reduce inflammation in the bowels, generally for two weeks. Side effects: weight gain, risk of infections.

• Immunosuppressants: Second-line treatment when steroids don’t help. These decrease the activity of your immune system to reduce attacks on bowel cells. Treatment can last for months. Side effects include sickness, risk of infections and liver problems.

• Biological medicines: Third line, in case the first two fail. Generally, these are long-term treatment lasting anywhere from months to years. Side effects include risk of infections, pain in joints, fever, and itching.

• Surgery:  is only considered once the medication is not working or the benefits outweigh the risks. The procedure is called resection, where they cut up a piece of your bowel with Crohn's and rejoin the healthy parts together. Generally, this operation involves small cuts in your stomach and it's usually done under general anesthesia. Depending on the area of your bowel affected or the size of bowel that needs to be removed, you may require a colostomy: a little hole in your bowel where the feces comes out and gets collected in a little bag. This is normally for a few months until your bowel recovers properly and gets healthy. 

Life Expectancy/Prognosis

Crohn's disease is not fatal; there is no reason you cannot live a full life if you take care of yourself. However, Crohn's disease can cause serious complications if your health is not well controlled; these complications can be life-threatening if not treated correctly:⁴

• Bowel obstructions: When the walls of the bowel become obstructed with scars and swelling. Faeces may not be able to pass through and can cause a blockage or obstruction. 
• Anal fissure: Small tear in your anus that can cause discomfort when opening bowels, leading to infections and perianal fistulas.
• Malnutrition: Crohn's disease often causes loose stools, abdominal pain, and reduced appetite, which leads to nutrient deficiency. 
• Ulcers: Sores are produced by chronic swelling of the bowels. It can happen anywhere in your digestive system, from mouth to anus. 
• Fistulas: Sometimes, ulcers can cross your bowel creating a small hole or tunnel (fistula), connecting parts of your body that should not be in contact. Fistulas can get infected and produce an abscess (swollen area with the accumulation of pus), which can cause life-threatening situations like sepsis.
• Colon cancer: Crohn's disease increases the risk of having bowel cancer.
• Other problems: Liver and gallbladder problems, osteoporosis, and arthritis.
• Thrombosis: Crohn's disease increases the risk of suffering blood clots in veins and arteries.

Although not caused directly by Crohn's disease, the medication used to alleviate its symptoms can severely impact your health, causing diabetes, glaucoma, infections, cataracts, and bone fragility.

Recent studies have shown that people with Crohn's disease usually have the same life expectancy as people without the condition, according to Crohn's and Colitis Foundation.⁷

There are a few habits and alternative therapies that you can do to prevent flare-ups and complications of Crohn's disease:⁸

• Mind therapies: This can include yoga, meditation, and exercise. Although stress doesn’t cause Crohn's, it can make the symptoms worse. 
• Dietary supplements: Omega-3 fatty acids and curcumin. 
• Probiotics 
• Medical cannabis
• Avoid medication that can upset your bowels: This includes naproxen, ibuprofen, and diclofenac.
• Quit smoking: Reduces flare-ups, the amount of medication required and the chances of requiring surgery.
• Diet control: A soft diet may help your symptoms, instead of high-fibre or spicy food. It may also help to cut out food that may irritate your bowels, such as dairy, greasy or fried food, carbonated drinks, caffeine, and flatulent food. 

Summary

Crohn's disease is a life-long condition that affects your digestive tract when the immune system attacks the cells in your gut, most commonly in the small and large intestines. This causes inflammation, swelling and ulcers in your bowel. Although it is not clear what causes Crohn's disease, there are risk factors that play an important role. It is not an easily diagnosable disease as it shares symptoms with many other IBD conditions, requiring several tests to confirm its diagnosis. 

The treatment varies on the type of Crohn's, frequency of flare-ups and symptoms, but they are generally drug treatment firstly and surgery if needed. Although Crohn's disease is not a mortal disease, it is important to control its potential complications, as some of them can lead to life-threatening situations. Crohn's disease is a long-term condition that should not stop you from living a fully normal life if well managed.