Crohn’s Disease: A Guide to Symptoms, Diagnosis and Management
What is Crohn’s Disease (CD)?
Crohn’s disease is a type of inflammatory bowel disease (IBD) and refers to a chronic condition where part of the gut becomes inflamed, swollen, and ulcerated.1 This swelling can occur in any part of the digestive system, from the mouth all the way to the anus, but commonly affects the end of the small bowel (also known as the ileum) and the beginning of the colon.12 Though the exact cause is unknown, CD occurs when the immune system breaks down and the body begins to attack itself, causing painful ulcers and inflammation in the gut.1
There are different types of CD, depending on what part of the gastrointestinal (GI) tract is affected. Sometimes it can affect more than one part. The most common types are:1
Upper part of the gut, including the oesophagus, stomach, or the first part of the small bowel known as the duodenum.
Inflammation of the small bowel (ileum or jejunum), depending on the part of the small bowel affected.
Bowel inflammation at the end of the small intestine. If it also affects the beginning of the large intestine, it is known as ileocecal.
Bowel inflammation confined to the colon.
Continuous inflammation in the area around the anus.
CD that affects the mouth.
Crohn’s Disease Symptoms
The symptoms of CD depend on the part of your digestive tract that is affected by the disorder and severity.1
The likelihood of developing CD is seen to be almost the same for women and men, therefore, may not be linked to biologic gender.3
You can be diagnosed with CD at any age, though it is most commonly diagnosed between the ages of 15-30.4 There also seems to be a slight increase in diagnosis in people over the age of 60.4
The main symptoms of CD are:1
- Severe stomach pain
- Feeling like you need the toilet right away
- Fever
- Diarrhoea with blood, mucus, or pus
- Bowel obstruction
- Fatigue (tiredness)
- Loss of appetite and weight loss
- Generally feeling discomfort or weakness
However, the symptoms that occur in people living with CD are very diverse. At the beginning of the disease, there may only be unspecific symptoms in the gastrointestinal area that seem harmless. If they occur more frequently and with increasing intensity, they can also be serious signals of CD.4 Some people may also develop anaemia (a low number of red blood cells) or have problems with their joints, skin and eyes.1
Though these symptoms and complications can be serious, most people with CD are able to control their symptoms and live active lives.5 You may even find that you change your diet in times of remission and flare-ups, where your diet can also play a role in ensuring that people living with CD remain in remission.6
Find out more about how diet affects CD:
How is Crohn’s Disease Diagnosed?
Due to inflammation in CD affecting any part of the gastrointestinal tract (GI), the symptoms can often resemble other conditions such as ulcerative colitis (UC), diagnosis can be complicated.7 As a result, your healthcare team may perform a combination of tests and procedures to confirm the diagnosis.
Medical History
Your healthcare team will take a full medical history including information about your overall health, diet and nutrition, when your symptoms first started, what medication you have taken and your family history.18
Physical Examination
Following the medical history, your healthcare team will carry out a physical examination of the body. This can include your general wellbeing, measuring your heart rate, blood pressure, as well as an abdominal examination.18
Blood and Stool Test
A full blood test can show whether you have inflammation anywhere in your body and if you are anaemic. Your stool can also be tested for signs of bleeding or inflammation, and to check whether an infection is causing diarrhoea. A faecal calprotectin test detects whether you have inflammation in your gut.18
Endoscopy and Biopsy
Two further tests are performed to determine the cause of the symptoms and establish a diagnosis: endoscopy and a biopsy.8 Endoscopy is the umbrella term for a group of medical procedures that use an endoscope, a long, thin tube with a small camera, that is inserted into the body through a natural opening like the mouth or the anus.1910 It is considered guideline-backed for measuring disorder activity in IBD, playing an important role in diagnosis, management, and treatment of IBD.11
Endoscopic healing refers to the absence of ulcers and erosions in the gut lining during an endoscopy. It is a sign that the inner lining of your intestines is healing, even if symptoms have improved.12
During an endoscopy, a tissue sample from your colon may also be taken, which is known as biopsies. These are sent to the laboratory to be examined under a microscope to check for any inflammation.8
Click here to learn more about why endoscopic healing is so important.
MRI and CT scans
Imaging tests, including magnetic resonance imaging (MRI), computer tomography (CT), or an ultrasound, can also be used to aid diagnosis and help monitor the disorder and locate areas of inflammation.18
Treating Crohn’s Disease
Though there is currently no cure for CD, there are treatments available to help keep symptoms at bay.1 Because CD is a lifelong disorder, you may experience periods of good health referred to as remission.1 Treatment for CD will depend on how severe symptoms are and how much of the digestive tract is affected.13
Surgery
In some cases, surgery may be offered if other treatments are not controlling your symptoms or if you develop severe complications.14
Many of the common surgeries carried out for CD can be done by keyhole (laparoscopic) surgery, which allows faster recovery. Common types of surgery for people with CD include strictureplasty, bowel resection (with or without a stoma), and surgery for abscesses and fistulas.14 However, it is important to remember that while surgery can help manage symptoms and improve quality of life, it does not provide a permanent cure for CD.1
Remember to always talk to your healthcare professional to get advice if you are experiencing symptoms, especially if there has been a sudden change.
It is important to remember that you are not alone, and there is support available to help you. Click below to visit the IFCCA website to explore resources and connect with others.
Visit the IFCCA website to explore resources and connect with others: Go to IFCCA Website
IFCCA
The International Federation of Crohn's & Ulcerative Colitis Associations (IFCCA) represents 46 national Crohn’s and Ulcerative Colitis (IBD) patient associations. IFCCA are an organization of people united in our commitment to improve the life of over 10 million people living with IBD worldwide (3.4 million in Europe alone) and to give them a louder voice and more visibility. Want to find out more about how to manage your IBD?
Living with Inflammatory Bowel Disease (IBD)
Daily Life, Diet and Support
Treating Inflammatory Bowel Disease
Understanding Your Options for Relief and Long-Term Management
What Is Endoscopic Healing?
Procedure, Purpose and What to Expect
