Crohn’s disease varies in how severe it is and which part of the digestive system it affects. Treatment at The London Clinic is tailored carefully to each individual patient.

Diagnosis of Crohn’s disease: what to expect

At The London Clinic, our consultant gastroenterologists start by taking a complete medical history, noting the pattern of symptoms, and will do a detailed physical examination. They will perform appropriate blood and stool tests and will arrange other investigations that can include:

  • Gastroscopy: an endoscopic examination of the upper digestive system, including the oesophagus, stomach and the first part of the small intestine.
  • Colonoscopy: an endoscopic examination of the lower bowel and the last part of the small intestine.

Because these techniques only view a small proportion of the small bowel, additional tests may be necessary to examine the area more thoroughly.

Another way of examining the small bowel is to do a capsule endoscopy. This involves swallowing a capsule containing a tiny camera that transmits images as it passes all the way through the small bowel. This is a lot less invasive than a colonoscopy or gastroscopy but it provides additional information rather than being an alternative; you may need endoscopy examinations as well.
Close monitoring of your disease and response to treatment is required and therefore some of these tests may need to be repeated over time.

Lifestyle changes

The most important change that smokers diagnosed with Crohn’s can do is to stop smoking as it is known to make Crohn’s disease worse. Stopping smoking may not only decrease the chances of the disease deteriorating, but may also make it better.

Dietary therapy

Dietary therapy can help in some patients with Crohn’s disease; polymeric or elemental liquid diets have been shown to improve symptoms. We have specialist dietitians who can provide detailed advice.

Medical treatment

  • Steroids, such as prednisolone and budesonide, are highly effective for treating flare-ups and getting the disease back into remission. Steroids cannot be used for long periods because they can sometimes cause adverse and they do not keep the disease in remission.
  • Immunosuppressants: these include azathioprine, methotrexate and mercaptopurine. Immunosuppressants reduce the activity of the immune system which improves inflammation in the digestive system. Once you start therapy, it may take two-three months for the drug to start having an effect, so persistence and patience are important.
  • Biological therapy: These drugs inhibit tumour necrosis factor alpha, an important stimulator of the inflammatory response. They has been available for over 10 years now and treatment with infliximab and adalimumab are routinely used in severe cases of Crohn’s disease..
  • Antibiotics such as ciprofloxacin and metronidazole: used to treat abscesses and fistulas. Antibiotics may also have a slight effect on bowel inflammation.

Follow-up and monitoring

Monitoring your health and your condition is important whatever treatment you are taking. Like many drugs, immunosuppressants and anti-TNF alpha inhibitors are generally very well tolerated but are rarely associated with serious side effects. You will receive regular check-ups and we can adjust your dose and your treatment as necessary.

As Crohn’s disease affects the large bowel, we offer all patients screening colonoscopies to check for bowel cancer. Patients with extensive colonic Crohn’s disease have a slightly increased risk of developing colon cancer, and we recommend that checks begin around eight years after you are first diagnosed.

Surgery for Crohn’s disease

Crohn’s disease is best managed in combination by a consultant gastroenterologist and a consultant colorectal surgeon who have a specific interest in inflammatory bowel disease. They normally work as a close team and, together with the patient, decide upon the best course of treatment..
Surgery may be needed in specific circumstances:

  • If you develop a severe narrowing of your intestine that leads to a blockage. The affected part of the bowel may need to be removed.
  • If you have a perianal fistula. Perianal disease is normally assessed by an examination under anaesthetic. This allows the surgeon to ensure that any abscesses are drained such that drug treatments have the best chance of healing the area.
  • If you have areas of Crohn’s disease that are not responding to treatment. If drug treatment is not effective, having an operation to remove an area of inflamed bowel surgery is sometimes the best option.

Trade names quoted are given as examples only of the drug types described, alternatives may be available.