On this page we will be featuring general questions about Crohn’s disease and Ulcerative Colitis that are put to doctors at meetings.

Question: There appears to have been a big increase in the 70s of Crohn’s Disease and there is talk about triggers, multiple triggers and genetic predisposition. Are there any statistical studies to identify what may be the cause and the reason for the sudden increase in the 70s?

Answer: If you look at the situation in the 1920s there were only about 11 cases of Ulcerative Colitis in children in the whole world. In the 1960s in Sweden they were describing many cases of Ulcerative Colitis, but in Sweden now the dominant clinical pattern is Crohn’s Disease. It seems to be Ulcerative Colitis in adults then Crohn’s Disease in adults, then Ulcerative Colitis in children, then Crohn’s Disease in children. There is a correlate with affluence and prosperity and the history of paediatric gastroenterology. In the late 60s the first text book in the United States highlighted Crohn’s Disease and yet we in Britain in the early 70s had hardly seen it.

It is unlikely that our genetic make-up has changed over the last 30 years but there are other illnesses that have become more frequent such as allergies, asthma, eczema, hayfever and food intolerances. It may well be that with environmental changes, more antibiotic use, changes in diet, so called "clean child" hypothesis, we are not exposed to the same amount of parasites or bacterial infections early in life – all that has changed dramatically over the last 20/30 years and is likely to be related to the way we live, in addition to the genetic make up and the trigger we have. We know there are differences north to south in developing countries and east to west, so there is a lesser incidence of Inflammatory Bowel Disease in the former eastern European countries but that is changing as their life style becomes more like our own.

Question: I have a daughter who has Oral Crohn’s and has great difficulty cleaning her teeth because her mouth is swollen and painful. She also has crusts around her mouth making it difficult for her to open her mouth.

Answer: This could be a problem as not only the gums but lips, cheeks and occasionally the tongue could be affected. Over the counter toothpaste could be a problem as some children appear to have a sensitivity to a component in normal toothpaste (lauryl-sulphate). It is best to use just a soft brush and go to the dentist regularly to have fissures sealed. This makes teeth less prone to caries. With some children swelling of the lips is made worse by certain foods and if these can be eliminated it will help. If the crusts around mouth are yellow this is a secondary infection which needs sorting out first.

A large number of children with swelling of the mouth have parents who say that the child eats a lot of tomato sauce and that seems to cause the swelling. They often patch test children for all dental materials in the European series and to additives in foods, flavourings and fragrances. If the child reacts then parents can remove the offending item and in some children this will make a huge difference