Crohn’s Disease

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

Crohn’s disease is a chronic inflammatory condition primarily affecting the digestive tract, particularly the small intestine and colon. As a type of inflammatory bowel disease (IBD), it causes inflammation of the digestive tract lining.

Symptoms can vary in severity and may include abdominal pain, diarrhoea, fatigue, weight loss, and malnutrition. The disease can affect different segments of the digestive tract, potentially leading to complications such as blockages, abscesses, or fistulas.

Symptoms of Crohn’s Disease

Crohn’s disease symptoms can range from mild to severe, and they often develop gradually. Common symptoms include:

Abdominal Pain and Cramping: Severe pain is often localised in the lower right abdomen and caused by chronic inflammation.

Diarrhoea: Frequent, loose, or urgent bowel movements typically result from inflammation affecting nutrients and water absorption.

Fatigue and Weight Loss: Ongoing inflammation can impair nutrient absorption, leading to fatigue and unintended weight loss.

Blood in Stool: Ulceration and inflammation may cause bleeding, resulting in blood appearing in the stool.

Fistulas and Abscesses: Severe cases can lead to complications such as fistulas (abnormal connections between organs) and abscesses (infected pockets).

Causes of Crohn’s Disease

The exact cause of Crohn’s disease is unknown, but several contributing factors include:

Immune System Response

The immune system may mistakenly attack healthy cells in the digestive tract, leading to chronic inflammation.

Genetic Factors

A family history of Crohn’s disease increases risk, with certain genetic markers identified as contributors.

Gut Microbiome Imbalance

Changes in the composition of gut bacteria might promote inflammation, contributing to flare-ups.

Environmental Triggers

Smoking, dietary habits, and exposure to specific bacteria may exacerbate symptoms in susceptible individuals.

Diagnosing Crohn’s Disease

Several tests are used to assess inflammation and rule out other conditions when diagnosing Crohn’s disease:

Physical Examination

The abdomen is palpated to check for swelling, tenderness, or masses, which may indicate inflammation or bowel obstruction. A review of the patient’s medical history helps identify risk factors such as family history and symptom patterns.

Blood Tests

Blood tests assess for elevated inflammatory markers and check for anaemia caused by chronic inflammation or blood loss. Elevated white blood cell counts may also indicate active inflammation or infection.

Stool Tests

Analysing stool samples helps detect infections, blood, or inflammatory markers to differentiate Crohn’s disease from other gastrointestinal disorders. These tests also assess faecal calprotectin, an indicator of intestinal inflammation.

Imaging Tests

CT scans, MRIs, and ultrasound are used to visualise the digestive tract, identifying inflammation, strictures, abscesses, or fistulas. These imaging methods provide non-invasive insights into the location, severity, and potential complications of the disease.

Colonoscopy and Endoscopy

These procedures allow a detailed look inside the digestive tract. A colonoscopy examines the colon, with biopsies often taken to confirm inflammation. Endoscopy focuses on the upper digestive tract (oesophagus, stomach, or duodenum) to detect any inflammation or ulcers not visible through other tests.

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Treatment Options for Crohn’s Disease

While there is no cure for Crohn’s disease, treatments aim to manage symptoms and prevent complications.

Non-Surgical Treatment
Anti-inflammatory Drugs

Medications like aminosalicylates (5-ASA) and corticosteroids reduce inflammation in the digestive tract, easing symptoms during flare-ups. Corticosteroids are used short-term due to side effects, while 5-ASA is typically for milder cases.

Immunosuppressants

These medications suppress the immune system to prevent it from attacking the digestive tract. They help maintain remission and reduce the frequency of flare-ups.

Biologic Therapies

Biologic therapies such as TNF inhibitors (infliximab, adalimumab) target specific immune proteins to control inflammation. They are used for moderate to severe cases or when other treatments are ineffective.

Antibiotics

Antibiotics treat infections and abscesses related to Crohn’s disease. They can also help manage fistulas by reducing bacterial overgrowth and inflammation.

Surgical Treatment
Bowel Resection

When medication is ineffective, bowel resection may be necessary to remove diseased sections of the intestine. This surgery can alleviate symptoms and prevent complications like strictures or obstructions, though the disease may recur in other areas over time.

Strictureplasty

This procedure widens narrowed areas of the intestine caused by chronic inflammation, improving bowel function without removing any intestinal sections. It is often used to preserve intestinal length, especially when multiple strictures are present along the digestive tract.

Fistula Repair

Surgery may be necessary to repair fistulas (abnormal connections between organs or tissues) caused by Crohn’s disease, preventing infections and further complications. Depending on the severity, the procedure may involve closing the fistula and draining any associated abscess to promote healing and prevent recurrence.

Preventing Flare-ups

Managing Crohn’s disease involves adopting healthy habits to reduce flare-ups.

Avoiding trigger foods, staying hydrated, quitting smoking, and following prescribed treatments can help maintain remission.

Incorporating stress management techniques, such as yoga or meditation, also supports overall well-being and minimises symptom severity.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    Can Crohn’s disease affect other parts of the body?

    Yes, Crohn’s disease can cause inflammation beyond the digestive tract, affecting the eyes, skin, and joints. In some cases, it can also lead to kidney stones, liver conditions, or other complications involving the bile ducts, particularly during periods of disease activity.

    Can Crohn’s disease lead to long-term complications?

    Yes, if not managed properly, Crohn’s disease can lead to complications such as bowel obstructions, fistulas, abscesses, and malnutrition. The condition can also increase the likelihood of developing colon cancer over time, making regular monitoring, treatment adjustments, and preventive care necessary.

    Can Crohn’s disease be managed without medication?

    While lifestyle changes and dietary adjustments can help reduce symptoms, most individuals with Crohn’s disease require medications to control inflammation and maintain remission. Some patients may also need occasional antibiotics or biologics for specific complications.

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