Patient discussions

The following points should be covered in a discussion with patients diagnosed with Crohn's disease (CD).[107][213]​ [214][215][216][311][312][313][314][315][316][317] Crohn’s and Colitis UK Opens in new window NHS: Crohn's disease Opens in new window Crohn's and Colitis Foundation Opens in new window

  • Stop smoking - severity of CD tends to lessen in patients who stop smoking, and the need for corticosteroids and immunosuppressants decreases. Smoking cessation reduces the complications experienced by patients and the risk of disease recurrence.

  • Dietary advice - many patients with CD avoid eating as it worsens diarrhoea and cramps. This may lead to malnutrition, with its serious consequences; thus, patients should maintain a healthy and balanced diet as directed by a dietician.

    • Fibre supplementation is possibly beneficial for patients with colonic disease, whereas a low-residue diet is indicated for patients with obstructive disease.

    • A high-fibre diet can improve remission rates in patients with CD who do or do not receive other treatments.

    • CD of the small bowel is often complicated by lactose intolerance; therefore, dairy products should be avoided if symptoms improve with lactose exclusion.

    • Patients with extensive resection of the terminal ileum should be on a low-fat diet with supplementation of medium-chain triglycerides.

    • In those with a surgical resection planned, preoperative nutrition is of high importance, where optimised nutrition may reduce postoperative complications. This may be by enteral or parenteral routes depending on the individual, extent of disease, and operation planned.

  • Regular exercise helps to maintain general health.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as they may worsen the course of CD.

  • Female patients with CD desiring oral contraception should consider the various options with their clinician. It has been suggested that the oral contraceptive pill (particularly the combined oral contraceptive pill) may be linked to an increased risk of requiring surgery in established CD. Further evidence is needed; therefore, a risk-benefit analysis must be made in each individual case.

  • Patients should be advised regarding age-appropriate routine preventative vaccinations, particularly if immunosuppressive therapy is planned in the future. The American College of Gastroenterology recommends non-live vaccines including trivalent inactivated influenza vaccine (annually), pneumococcal vaccination (PCV13 and PPSV23), hepatitis A, hepatitis B, Haemophilus influenzae B, human papilloma virus, tetanus, and pertussis. Live vaccines should generally be avoided in those on immunosuppressants.​

  • Patients with CD should seek medical advice if they have any of the following signs or symptoms:

    • Fever or chills

    • Bloody stools

    • Severe abdominal pain

    • Abdominal bloating and inability to pass stool or gas

    • Dizziness

    • Dehydration

    • Pus draining from the anal area or abdominal wall

    • Intractable vomiting

    • Worsening of the usual symptoms of CD

    • Weight loss.

  • Patients should be advised of the availability of local support groups and educational sources.

Patients should be advised regarding the specific adverse effects and monitoring required for the drug therapy they are prescribed. People taking methotrexate should be told to immediately report any sore throat, bruising, mouth ulcers, nausea, vomiting, abdominal discomfort, dark urine, and shortness of breath that may be indicators of serious adverse drug effects. Methotrexate must be stopped in women planning pregnancy.

Before commencing azathioprine or mercaptopurine, the patient should be informed of the risk of serious adverse events (including overwhelming sepsis), and be made aware of the importance of close monitoring of blood counts and liver function tests during treatment. It is advisable to provide information regarding possible side effects and specific instructions, such as the avoidance of live vaccination.

Long-term health

Some patients with CD may benefit from additional support with managing their long-term health condition. Suggested interventions include focus on patient education, guided self-management programmes (both contact and distance programmes), individual psychotherapy, and guidance according to an individual symptom diary. One meta-analysis showed that self-management interventions may have some positive effect on quality of life in patients with inflammatory bowel disease, but the most appropriate content and best approach for delivery of these interventions remains to be determined.[318]

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