Crohn’s disease can affect any part of the digestive tract.
It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is extreme), vomiting, or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.
Crohn’s disease can be in multiple places in the digestive tract at the same time.
Crohn’s is considered one of the main causes of Short Bowel Syndrome.
Sign’s & Symptoms
In cases of Crohn’s disease, patients often experience frequent loose or watery bowel movements. The stool is occasionally accompanied by thick, dark blood (not bright red smears of blood, which usually result from a bleeding hemorrhoid). There is less mucus or pus in the stool than in cases of ulcerative colitis.
Patients may experience crampy, achy, or even sharp pain in the affected area. Most often, patients with Crohn’s disease feel pain on the lower right side of the abdomen (lower right quadrant) and just below the bellybutton. This is because the majority of cases of Crohn’s disease involve disease in the terminal ileum, where the small intestine meets the large intestine. The terminal ileum crosses from left to right just above the beltline, and joins the large intestine in the lower right quadrant.
The type of pain associated with Crohn’s disease depends on what part of the GI tract is affected. Disease in the terminal ileum generally causes sharp pain, while disease in the colon causes more crampy pain, similar to that that of ulcerative colitis. Pain is sometimes relieved (temporarily) after a bowel movement.
Crohn’s is an inflammatory disease, and one of the key characteristics of the inflammatory process is fever. (The others are pain, swelling, and redness.) Some individuals with Crohn’s disease suffer a high fever, especially during the acute phase of a flare-up. Others run a persistent, low-grade fever. Fever may be accompanied by irritability and fatigue. Sometimes, the fever recurs each day, especially late in the day, then repeatedly breaks during sleep, causing night sweats.
Signs and Symptoms Unrelated To The GI Tract
A number of signs and symptoms that do not involve the gastrointestinal tract can occur with Crohn’s disease. These may occur at the same time as the intestinal symptoms, or may be experienced weeks or even months before any intestinal symptoms are noticed. If your doctor suspects inflammatory bowel disease, he or she will ask you detailed questions about whether or not these extra-intestinal symptoms have appeared:
- Reddening and inflammation of the eye (iritis)
- Joint pain (usually in the large joints of the knees, ankles, elbows, wrists, and shoulders), which sometimes migrates from one joint to another (migrating arthralgia)
- Skin lesions, including tender red nodules on the shins or calves (erythema nodosum)
- Sores inside the mouth (aphthous ulcers)
Described as an “idiopathic” disease. It is known that inflammation is part of the body’s immune response, and an immune response is usually triggered by something. But to date no specific “trigger” has been found to cause the inflammatory response seen in Crohn’s disease.
There is some evidence that Crohn’s disease has a genetic component. While there is no simple correlation from parent(s) to offspring, the disease tends to “run” in families. As many as 20 to 25 percent of patients with Crohn’s disease have a relative with CD or ulcerative colitis. There is also a higher incidence among certain ethnic groups.
In addition, some possible environmental factors have been linked to initial episodes or relapses. Crohn’s disease appears to be a disease that primarily affects those living in Western, industrialized societies. Whether this is due to some condition of the environment in which people live or their diet has not been determined.
The patient will likely undergo a number of laboratory tests and one or more imaging procedures that allow a doctor to visually evaluate the intestine. Laboratory tests include blood tests and stool cultures. They are used to evaluate the inflammatory process and to provide clues about the cause. There are three common imaging procedures. One is a type of X-ray, and the others use endoscopy, allowing the doctor to actually look inside the body.
Other Types of Imaging studies include:
These studies are useful in the determination of what type of Crohn’s Disease the patient lives with.
Types of Crohn’s Disease
Gastroduodenal CD – Gastroduodenal Crohn’s disease, which affects the stomach and the duodenum (the highest, or beginning, portion of the small intestine), is often misdiagnosed as ulcer disease. The correct diagnosis frequently is not made until various ulcer treatments have failed, or until Crohn’s disease is identified farther down the gastrointestinal tract. Symptoms of gastroduodenal CD include loss of appetite, weight loss, nausea, pain in the upper middle of the abdomen, and vomiting.
Jejunoileitis – Jejunoileitis is Crohn’s disease of the jejunum (the longest portion of the small intestine), which is located between the duodenum and the ileum. Symptoms include mild to intense abdominal pain and cramps after meals, diarrhea, and malnutrition caused by malabsorption of nutrients. (The majority of nutrients are absorbed in the jejunum.) Fistulas (abnormal openings in the intestinal tract) may form. These can link a diseased area of the small intestine to another area of the intestine or another organ, such as the bladder. Fistulas may increase the risk of developing infections outside of the GI tract.
Ileitis – Ileitis affects the ileum (the lowest, or last, part of the small intestine). Symptoms include diarrhea and cramping or pain in the right lower quadrant and periumbilical (around the bellybutton) area, especially after meals. Malabsorption of vitamin B12 can lead to tingling in the fingers or toes (peripheral neuropathy). Folate deficiency can hinder the development of red blood cells, putting the patient at higher risk of developing anemia. Fistulas can develop, as can inflammatory masses.
Ileocolitis – Ileocolitis is the most common type of Crohn’s disease. It affects the ileum (the lowest part of the small intestine) and the colon (the large intestine). Often, the diseased area of the colon is continuous with the diseased ileum, and therefore involves the ileocecal valve between the ileum and the colon. In some cases, however, areas of the colon not contiguous with the ileum are involved. Symptoms of ileocolitis are essentially the same as those present in ileitis. Weight loss is also common.
Crohn’s Colitis (Granulomatous Colitis ) – Crohn’s colitis affects the colon. It is distinguished from ulcerative colitis in two ways. First, there are often areas of healthy tissue between areas of diseased tissue; ulcerative colitis is always continuous. Second, while ulcerative colitis always affects the rectum and areas of the colon beyond the rectum, Crohn’s colitis can spare the rectum, appearing only in the colon.
Medical management of Crohn’s disease focuses on reducing symptoms and bringing on a remission. Once this is accomplished, the goal is to maintain remission for as long as possible. Most of the medications used to treat Crohn’s disease are generally safe for long-term use. Many doctors keep individuals on maintenance doses of medications indefinitely.
Medications commonly used to treat Crohn’s disease include:
- 5-ASA compounds
- Medications that suppress the immune system
- Infliximab (Remicade)
- Experimental treatments
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