- Genetic Predisposition: A family history of Crohn’s disease significantly increases the risk, suggesting a strong hereditary component.
- Immune System Dysfunction: An overactive immune response mistakenly attacks healthy cells in the digestive tract, leading to chronic inflammation and damage.
- Environmental Factors: Living in urban or industrialised areas is associated with a higher risk, possibly due to dietary habits, pollution, or exposure to certain microbes.
- Smoking: Active smokers are twice as likely to develop Crohn’s disease, and smoking worsens the condition’s progression and response to treatment.
- Age: While the condition can develop at any age, it is most commonly diagnosed between the ages of 15 and 35, during a period of heightened immune system activity.
Crohn’s Disesase

Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Crohn’s disease is a chronic inflammatory bowel condition that can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the layers of bowel tissue, causing ulceration, swelling, and scarring. This leads to a range of digestive problems and can affect nutrient absorption, resulting in various complications throughout the body.




Symptoms of Crohn’s Disease
The symptoms of Crohn’s disease vary depending on the affected part of the digestive tract. Common symptoms include:
- Abdominal Pain: Cramping sensations, typically in the lower right abdomen, often worsening after eating and ranging from mild to severe.
- Diarrhoea: Frequent loose, watery stools that may contain blood or mucus, often accompanied by urgency and unpredictability.
- Weight Loss: Unintentional weight loss due to reduced food intake, poor nutrient absorption, and increased metabolic demands from inflammation.
- Fatigue: Persistent tiredness caused by chronic inflammation, disrupted sleep, and potential anaemia from blood loss or nutrient deficiencies.
- Mouth Ulcers: Painful sores inside the mouth, often along the gums or inner cheeks, making eating and drinking uncomfortable.
- Joint Pain: Inflammation in major joints, such as the knees, hips, and lower back, causing stiffness, swelling, and discomfort, especially during movement.
- Skin Problems: Red, tender bumps or other skin lesions may appear, and existing skin conditions can worsen during flare-ups.
Causes and Risk Factors
The development of Crohn’s disease is influenced by a combination of genetic, immune, environmental, and lifestyle factors.
Types of Crohn’s Disease and Their Characteristics
Crohn’s disease can affect different parts of the digestive tract, each with distinct symptoms and complications.
Ileocolitis
This type affects the end of the small intestine (ileum) and the large intestine (colon). It causes pain in the lower right abdomen and often leads to weight loss. Diarrhoea and cramping are common symptoms, and complications like fistulas may develop.
Ileitis
This form occurs exclusively in the ileum. Patients may experience significant abdominal pain and cramping. In severe cases, complications such as fistulas or inflammatory abscesses in the right lower abdomen can develop.
Gastroduodenal Crohn’s Disease
This affects the stomach and first part of the small intestine (duodenum). Patients often experience nausea, vomiting, and weight loss. Food intake may be reduced due to stomach pain, and some people develop ulcers similar to those seen in peptic ulcer disease.
Jejunoileitis
This type appears in the middle portion of the small intestine (jejunum). Patients experience abdominal pain and cramping after meals. Chronic inflammation in this area can lead to complications such as fistula formation.
Diagnosis of Crohn’s Disease
Blood Tests
Blood tests assess for anaemia, infection markers, and antibodies associated with inflammatory bowel disease. Multiple blood samples may be taken over time to monitor disease activity and treatment response.
Stool Analysis
Laboratory tests examine stool samples for hidden blood, infection, or high levels of inflammatory proteins. These tests help differentiate between inflammatory bowel disease and other conditions.
Colonoscopy
A thin, flexible tube with a camera examines the entire colon and end of the small intestine. The doctor can view inflammation, take tissue samples, and assess disease severity.
MRI and CT Scans
These imaging techniques show detailed pictures of the bowel and surrounding tissues. They can reveal inflammation, abscesses, and fistulas that may not be visible through other methods.
Capsule Endoscopy
A small camera in pill form captures images of the small intestine. The device travels through the digestive tract, transmitting pictures to a recorder worn on the body.
Treatment Options
Treatment for Crohn’s disease focuses on reducing inflammation, alleviating symptoms, and preventing complications. Both non-surgical and surgical options are available, depending on the severity of the condition and individual needs.
Non-Surgical Treatment
- Corticosteroids: These medications rapidly reduce inflammation during flare-ups. They are typically prescribed for short-term use, lasting several weeks, with the dosage gradually tapered as symptoms improve. Long-term use is avoided due to potential side effects.
- Immunomodulators: These drugs suppress or modify the immune system to reduce chronic inflammation. They require regular blood tests to monitor for side effects such as liver toxicity or reduced white blood cell counts. Full therapeutic effects may take several months to become apparent.
- Biologics: These therapies specifically target proteins, such as tumour necrosis factor (TNF), that drive inflammation. They are administered via injection or intravenous infusion and require ongoing monitoring to evaluate effectiveness and minimise potential side effects, such as infections.
- Antibiotics: Antibiotics are used to treat infections and complications, including abscesses and fistulas. Some may also have an anti-inflammatory effect on the bowel, helping to reduce symptoms in certain cases.
Surgical Treatment
- Bowel Resection: Diseased sections of the intestine are removed, and the healthy ends are reconnected to restore normal digestive function. This is often necessary for patients with severe inflammation, fistulas, or blockages. While this procedure can relieve symptoms, it does not cure the disease, and inflammation may recur in other parts of the digestive tract.
- Strictureplasty: This surgery involves widening narrowed segments of the intestine (strictures) without removing any bowel tissue. It helps improve food passage and reduce symptoms like cramping and blockages. Multiple strictures can be treated in one operation, and the procedure is often used to preserve bowel length.
- Abscess Drainage: Abscesses (collections of infected fluid) are drained to alleviate pain, fever, and other symptoms of infection. This can be performed surgically or through minimally invasive techniques, such as inserting small tubes under the guidance of imaging (e.g., ultrasound or CT scan). In some cases, further surgery may be required to address the underlying cause of the abscess.
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Prevention and Management
Daily management involves dietary modifications, with some people finding relief by avoiding specific foods that trigger symptoms. Regular exercise helps maintain overall health and may reduce stress levels. Smoking cessation can significantly improve disease control and reduce flare frequency. Maintaining a food diary helps identify trigger foods, while staying hydrated and eating smaller, more frequent meals can ease digestive symptoms.
Frequently Asked Questions
Is Crohn’s disease life-threatening?
Crohn’s disease is usually not life-threatening. However, serious complications, such as severe infections, bowel perforation, intestinal obstructions, or malnutrition, can arise if the disease is not properly managed. Early diagnosis, regular monitoring, and adherence to treatment significantly reduce these risks.
Can Crohn’s disease increase cancer risk?
Yes, individuals with long-standing Crohn’s disease, especially when it affects the colon, have a higher risk of developing colorectal cancer. The chronic inflammation and damage to the intestinal lining over time increase the likelihood of precancerous changes.
How often should patients with Crohn’s disease undergo colonoscopy?
Patients with long-standing Crohn’s disease or those with an elevated risk of colorectal cancer are generally advised to have a colonoscopy every 1-2 years. This frequency allows for the timely identification of precancerous changes, inflammation, or other complications.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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