Pro tennis player, Alexandre Muller has struggled most of his life with Crohn’s disease (CD). He takes an injection every two weeks to manage the chronic inflammatory bowel disease (IBD).
Diagnosed at the age of 14, Muller has struggled with persistent inflammation and pain, along with frequent restroom visits and unexplained weight loss.
Today, at age 26, he has competed against some of the big names in tennis including Novak Djokovic. In recent interviews he has been forthcoming about his CD status stating that it has not been easy for him to compete at the professional level.
While it is a great feat to play tennis at the highest level, having CD can be a challenge affecting a person’s quality of life.
What is Crohn’s disease?
“Crohn’s disease is a type of IBD which may affect any part of the gastrointestinal tract,” says Dr Vishal Sharma, associate professor of Gastroenterology at the Postgraduate Institute of Medical Education and Research (PGIM) in Chandigarh.
According to Dr Sharma, CD comes in three main types:
- Inflammatory type: Mainly shows up as diarrhoea.
- Stricture-forming type: People with this type experience abdominal pain and blockages in their intestines.
- Fistulising type: Individuals develop fistulas, which are unusual tunnels between organs or the skin. The symptoms depend on where these fistulas occur.
The initial diagnosis of CD can be challenging as the symptoms may look non-specific. This could lead to a delay in diagnosis, says Dr Sharma.
“There is no single test to make a diagnosis of CD,” he says. “A diagnosis is made looking at a combination of factors including symptoms, endoscopic findings, and results of histology on biopsies,” he adds.
Symptoms of Crohn’s
Dr Sharma says that the most common symptoms of CD include:
- abdominal pain
- loose stools
- passage of blood in stools
- loss of weight
- perianal fistula
Treating Crohn’s Disease
“Like many other chronic diseases, CD may require lifelong therapy. The goal of treatment is to maintain the disease in remission, ensure a good quality of life for the individual, and avoid complications,” says Dr Sharma.
This can include the short-term use of steroids as well as immune-modulating medication to manage the condition.
“If these do not work or if the disease is believed to be high-risk, biological therapies may be required,” says Dr Sharma.
These are targeted therapies that act by blocking specific sites or mediators of the inflammatory process. However, they are costly, and many individuals are unable to afford them, says Dr Sharma.
He does add that newer therapies are emerging in the form of small molecules, which should hopefully be available in India soon.
For now, surgery seems to be the most promising option for the management of CD where removal of the affected tissue can help with inflammatory symptoms.
Other interventions include enteral nutrition – a type of dietary strategy that involves delivering liquid nutrients directly into the gastrointestinal tract through a tube. It has been shown to be as efficacious as drug therapy, especially in paediatric CD.
Unique challenges for CD in India
Tuberculosis, including gastrointestinal tuberculosis, is common in South Asia including India, says Dr Sharma, adding that its symptoms can be a close clinical mimic of CD.
Dr Sharma says that doctors worry about mistakenly diagnosing CD when an individual has gastrointestinal tuberculosis. This is concerning because if they treat it as CD instead, it could lead to the spread of tuberculosis throughout the body.
If a clear diagnosis cannot be made even after a thorough evaluation, then treatment of gastrointestinal tuberculosis is often given first, says Dr Sharma. “A relative lack of availability of colonoscopy and delay in presentation may also contribute to delay in diagnosis,” he adds.