Crohn’s Disease: Symptoms, Complications, Diagnosis and Treatment

Crohn’s disease is a chronic, or long-lasting, disease that inflames the digestive tract. It can strike anywhere along that tract, from the mouth to the anus, but it most often affects the small intestine and the beginning of the large intestine.

It is one of the inflammatory bowel diseases (IBD). Ulcerative colitis and microscopic colitis are other common types.

Causes and risk

Nobody knows what causes Crohn’s disease. Researchers think an autoimmune reaction — the immune system attacking healthy cells in the body — may be one cause, and genes may play a part too, since the disease can run in families. Stress and certain foods do not cause it, though they can make symptoms worse.

Some things raise the chance of developing it:

• Family history — a parent, child or sibling with the disease.
• Smoking, which may double the risk.
• Certain medicines — antibiotics, birth-control pills and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen — which may raise it slightly.
• A high-fat diet, which may also raise it slightly.

Symptoms

Symptoms vary with where the inflammation is and how severe it is. The most common are diarrhea, cramping and pain in the abdomen, and weight loss. Others can include:

• anemia, having fewer red blood cells than normal;
• redness or pain in the eyes;
• fatigue and fever;
• sore or painful joints;
• nausea or loss of appetite; and
• red, tender bumps under the skin.

In some people, stress or foods such as fizzy drinks and high-fiber foods make symptoms worse.

Complications

Crohn’s disease can lead to other problems:

• intestinal obstruction, a blockage in the intestine;
• fistulas, abnormal connections between two parts inside the body;
• abscesses, pockets of pus from an infection;
• anal fissures, small tears in the anus that can itch, hurt or bleed;
• ulcers, open sores in the mouth, intestines, anus or perineum;
• malnutrition, when the body does not get the vitamins, minerals and nutrients it needs; and
• inflammation elsewhere in the body, such as the joints, eyes and skin.

Diagnosis

A health care provider draws on several things: a medical history, including symptoms; a family history; and a physical exam, which may involve checking the abdomen for bloating, listening to it with a stethoscope, and tapping on it to find tenderness and pain and to see whether the liver or spleen is abnormal or enlarged.

Tests may follow: blood and stool tests; a colonoscopy; an upper GI endoscopy, in which a scope is used to look inside the mouth, esophagus, stomach and small intestine; and imaging such as a CT scan or an upper GI series, in which the patient drinks a liquid called barium that makes the upper digestive tract show up more clearly on x-rays.

Treatment

There is no cure, but treatment can calm the inflammation, relieve symptoms and prevent complications. No single treatment works for everyone, so a patient and provider work out together what suits them.

• Medicines. Many reduce inflammation by damping down the immune system. Others help with symptoms or complications — NSAIDs, anti-diarrheal medicines, and antibiotics if the disease causes an infection.
• Bowel rest. When symptoms are severe, a patient may drink only certain liquids, or take nothing by mouth at all, so the intestines can rest. Nutrients come instead from a drink, a feeding tube or an intravenous (IV) line. It can happen in hospital or at home, and lasts from a few days to several weeks.
• Surgery. When other treatments are not helping enough, surgery removes a damaged part of the digestive tract to deal with fistulas, life-threatening bleeding, intestinal obstructions, medicine side effects that threaten health, or symptoms medicines have not improved.
• Diet. A provider may suggest avoiding fizzy drinks and high-fiber foods such as popcorn, vegetable skins and nuts; drinking more liquids; eating smaller meals more often; and keeping a food diary to find foods that cause trouble. Some people are asked to follow a special diet — high-calorie, lactose-free, low-fat, low-fiber or low-salt. Anyone not absorbing enough nutrients may need supplements and vitamins.

Sources

Based on "Crohn’s Disease," MedlinePlus, National Library of Medicine, with information from the National Institute of Diabetes and Digestive and Kidney Diseases; a work of the United States government in the public domain.