Crohn's disease

Crohn’s disease is a chronic inflammatory bowel disease characterised by:

• the thickening of areas of the gastrointestinal tract wall
• inflammation of all layers
• deep ulceration and fissures in the mucosa
• the presence of granulomas (National Institute for Health and Care Excellence (NICE), 2023a).

It can affect any area of the gastrointestinal tract, from the mouth to the perianal area (Reese et al, 2022) and exists interspersed with normal tissue. Crohn’s disease is most often present in the terminal ileal and perianal regions of the gastrointestinal tract (Reese et al, 2022).

As Crohn’s disease can affect different areas of the gastrointestinal tract it can cause different symptoms and treatments, which nurses need to consider when supporting people living with Crohn’s disease. Affected individuals may have disease in one area or a combination of areas. This includes:

• terminal ileum and ileocaecal (common)
• small bowel, ileitis or jejunoileitis (more common in children and

The symptoms of Crohn’s disease often occur as periodic attacks. This includes:   

• right lower quadrant abdominal pain
• chronic diarrhoea
• fever
• weight loss
• rectal bleeding (Reese et al, 2022; NICE, 2023a)

Other symptoms arise as a result of complications and include:

• intestinal strictures
• abscesses in the wall of the intestine or adjacent structures
• fistulae (where the lesions cause sinuses that burrow through the layers of the bowel)
• anaemia
• malnutrition
• colorectal and small bowel cancers (Reese et al, 2022; NICE 2023a)

Extraintestinal manifestations of Crohn’s disease include:

• arthritis
• osteoporosis
• dermatological conditions, e.g. erythema nodosum, pyoderma gangrenosum
• oral aphthous ulcers
• eye conditions, e.g. episcleritis, uveitis, iritis
• hepatobiliary conditions, e.g. primary sclerosing cholangitis (Nakase et al, 2023)

Nurses working with people living with inflammatory bowel diseases, such as Crohn’s disease need to be aware of the education and support needs that patients and their families have. This includes being able to talk about

Crohn’s disease is most often diagnosed in those aged 15–40 or 50–60 years old. It is more prevalent among:

This suggests that while the aetiology of the disease is uncertain, there is a genetic propensity towards Crohn’s disease (Michail et al, 2013). This is thought to make the individual more susceptible to microbiological, immunological and environmental factors which can cause the individual’s immune system to react against their own gastrointestinal tract when triggered by certain microbial antigens (Michail et al, 2013).

A suspicion of Crohn’s disease arises from the clinical presentation including intestinal and extraintestinal signs and symptoms. The disease is confirmed on colonoscopy with ileoscopy and tissue biopsy (Reese et al, 2022). Some patients with Crohn’s disease confined to the small bowel cannot be diagnosed using endoscopy because the affected areas of the bowel are outside of the range of the ileocolonoscopy. Therefore, computerised tomography imaging of the small bowel in addition to an ileocolonoscopy (Lamb et al, 2021).

Early diagnosis is associated with better patient outcomes, i.e. sustained remission, and so it is important that nurses, or other clinicians seeing patients with suspected inflammatory bowel disease refer them on immediately for specialist investigations including ileocolonoscopy (Lamb et al, 2021).

The patient must be central to decision-making about their treatment and must be aware of the potential effects and side-effects (NICE, 2019). The aim of treatment for people living with Crohn’s disease is to attain and maintain remission from an attack (Torres et al, 2020). Discussions about management should include information about issues such as:

• diet and nutrition
• fertility
• sexual relationships
• prognosis
• cancer risk
• quitting smoking

One of the roles of the nurse is to coordinate access to the various members of the multidisciplinary team including specialist nurses, who can have these discussions with patients (Kemp et al, 2018).