Crohn's Disease
Feature Siún Tobin, MPSI Senior Pharmacist, Our Lady's Hospice and Care Services. Specialising in cancer care, palliative care, and medicines information
TREATING AND MANAGING CROHN’S DISEASE AND UC
A clinical overview of Crohn’s disease and ulcerative colitis presentation and management strategies Crohn’s disease (CD) and ulcerative colitis (UC) are collectively known as inflammatory bowel disease (IBD). An estimated 40,000 people in Ireland live with IBD, most of whom are diagnosed between the ages of 15 and 35 years. The main symptoms of IBD include: Diarrhoea; cramping pains in the abdomen; tiredness and fatigue; feeling generally unwell; loss of appetite and loss of weight; anaemia; and mouth ulcers. These disorders have both distinct and overlapping pathologic and clinical characteristics. CD is an inflammatory condition of unknown aetiology that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. UC affects the colon
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exclusively and is characterised by inflammation of the mucosal layer, whereas CD is recognised by its transmural inflammatory nature. Although the pathogenesis of IBD remains undetermined, a number of risk factors have been identified, including male sex, genetic factors, and smoking. Crohn’s disease In people with CD, the immune system recognises the lining of the digestive tract as foreign and attacks it, causing inflammation. This inflammation causes the lining of the digestive tract to develop ulcers and bleed. The severity of CD varies greatly and depends on the site of inflammation and the extent
of inflammation. The vast majority of patients with CD (approximately 80 per cent) have small bowel involvement, with the remaining 20 per cent having disease limited to the colon. The mouth/oesophagus are less commonly considered as affected areas in CD but reportedly 5-to-15 per cent of patients have predominant involvement of the mouth or gastroduodenal area, while fewer patients have involvement of the oesophagus. Clinical manifestations It is common for patients to have persistent symptoms for many years prior to receiving a diagnosis of CD. The hall-
