CMScript 2 of 2025: Focus on Crohn’s Disease

Crohn’s disease is a long-term condition where the immune system mistakenly attacks the digestive tract, causing inflammation, pain, and digestive issues. It is one of the most common inflammatory bowel diseases (IBD) and is often diagnosed between the ages of 15 and 35, though it can affect anyone. Living with Crohn’s can be challenging, but the right information and support can help you manage it and maintain a good quality of life. Our latest CMScript simplifies everything you need to know about Crohn’s disease, including the symptoms, treatment, and your medical scheme benefits.

Signs & symptoms of Crohn’s disease

Crohn’s symptoms vary, but common ones include:

• Nausea and vomiting
• Persistent diarrhoea (lasting more than seven days)
• Abdominal pain & cramping
• Unintentional weight loss & loss of appetite
• Fatigue & fever
• Bloody stools & rectal bleeding
• Abscesses or infections around the anal canal

Some people may also experience joint pain, skin rashes, or eye inflammation due to the immune system’s overactive response.

What causes Crohn’s Disease?

The exact cause is unknown, but risk factors include:

• Abnormal immune reaction: The immune system gets triggered and mistakenly attacks bacteria in the intestines, causing inflammation.
• Genetics: A family history of Crohn’s increases the likelihood of developing the disease.
• Smoking: Studies have found that it doubles the risk and may lead to more severe disease.
• Stress: Constant physical and psychosocial stress may trigger or worsen flare-ups.
• Location: People living in developed countries and urban areas have a higher risk than those living in less developed countries and rural areas.
• Gut microbiome: Differences in gut bacteria that help digestion may play a role, though research is ongoing.

Doctors diagnose Crohn’s disease by reviewing medical and family history, conducting a physical exam, and performing diagnostic tests to confirm inflammation and rule out other conditions.

Common tests include:

• Stool tests: To check for bleeding, infection, or inflammation.
• Imaging scans (X-ray, CT, MRI): To assess the digestive tract.
• Endoscopy: A flexible tube with a camera is inserted through the mouth or rectum to examine the intestines. A biopsy (small tissue sample) may be taken for further analysis.

Managing Crohn’s disease and what your medical scheme covers

Crohn’s disease is a Prescribed Minimum Benefit (PMB) condition, which means your medical scheme is required to cover the diagnosis, treatment, and care of the disease in full. Effective management focuses on reducing inflammation, controlling symptoms, and preventing complications.

What is covered under PMBs?

Your medical scheme must cover the following as part of the prescribed level of care:

Consultations with healthcare providers – Visits to GPs, gastroenterologists, and other specialists for diagnosis and ongoing management.
Diagnostic tests – Blood tests, pathology, stool analysis, and imaging (X-rays, CT, MRI, and endoscopy) to confirm diagnosis and monitor disease progression.
Medication for treatment & symptom management – Includes corticosteroids, immunosuppressants, and other prescribed medicines.
Surgical procedures – If medically necessary, such as in cases of bowel obstructions, perforations, or severe complications.

Biological treatments are not automatically covered under PMBs. Check with your medical scheme regarding available benefits and any required approvals.

Download the full CMScript here.