You have to remember that CreateTable it's already doing the columns update for you, because internally it calls a method called MigrateTable.
However you could have to handle more advanced modification to your database, like adding triggers or something similar.
In that case i suggest you to perform modifications manually.
In Xamarin Forms i've ended up with this:
https://gist.github.com/matpag/b2545cc22c8e22449cd7eaf6b4910396
Could not be the best strategy ever but seems to work for me.
Summarizing :
You have to save the database version in an internal flag of the SQlite database called user_version accessible with PRAGMA keyword.
Every time you get the database connection, you have to perform a check and see if the current database version is the same as the app last database version.
If not you need to perform a database update and set the new current version.