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ABDOMINAL PAIN

Crohn's Disease: Symptoms, Treatment and Diagnosis

July 28, 2019

Symptom Guides > Abdominal Pain > Crohn's Disease: Symptoms, Treatment and Diagnosis

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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Crohn's disease is a chronic (long-term) inflammatory disease of the digestive tract. An estimated 565,000 people in the United States have Crohn's disease and more than 1.4 million Americans have some form of inflammatory bowel disease such as Crohn’s disease or Ulcerative Colitis. One in ten Crohn’s patients are under the age of 18. The exact cause of Crohn's disease is unknown but, according to the American College of Gastroenterology, it is likely caused by a combination of genetic, environmental, and immune system factors. 

 

While there is currently no cure for Crohn's disease, there are many things you can do to treat and manage your symptoms so you can live a full and normal life. In this article, I will cover the following topics:

• What Is Crohn’s Disease
• Crohn’s Disease Symptoms
• What Are the 5 Types of Crohn's Disease?
• Causes of Crohn’s Disease
• Crohn’s Disease Risk Factors
• Crohn’s Disease Diagnosis
• Treatments for Crohn’s Disease
• Preventing Crohn’s Disease: What You Can Do at Home
• Living with Crohn’s
• When to See a Doctor
• Crohn’s Disease Complications

What Is Crohn’s Disease

Crohn's disease is an inflammatory bowel disease (IBD) that causes irritation and inflammation along the length of the digestive tract, especially in the colon and small intestine, although inflammation can present anywhere from the mouth to the anus. The most common symptoms of Crohn’s disease are abdominal pain, severe diarrhea, fatigue, and weight loss.

 

No two patients experience Crohn’s in exactly the same way. The affected area of the digestive tract and the severity of inflammation will vary from person to person, resulting in different symptoms. Symptoms are often mild at first but can worsen over time. The inflammation often spreads into deeper layers of the bowel tissue making the symptoms more severe and causing complications, such as fissures and fistulas.

 

Crohn's disease can be painful and debilitating, but with careful management, you can live a normal life and enjoy long periods of remission.

Crohn’s Disease Symptoms

Aside from diarrhea, unexplained weight loss, and stomach pain or cramping, which are the most common symptoms of Crohn's disease, you may experience any of the following early warning signs of Crohn's disease:

 

  • Loss of appetite
  • Fever
  • Fatigue
  • Nausea
  • Eye pain or redness
  • Aching or painful joints
  • Bloody stool
  • Tender, red bumps on the skin

 

Less common symptoms include painful sores in your mouth, or near and around your anus. If you have a very severe attack of Crohn's disease, you may experience inflammation in other areas of skin around your body, in your eyes and joints, or in the liver or bile ducts (which may be discovered by your doctor during a scan).

 

If your child has any of the above symptoms in conjunction with delayed growth and/or delayed sexual development, this can be a sign of Crohn’s disease. Visit a doctor who can carry out further investigations.

 

The signs and symptoms of Crohn's disease range from mild to severe. For most people, they develop gradually, but they can also appear quickly and out of the blue. You may also experience periods of remission, when you have no symptoms at all. Symptoms often worsen with stress or after eating certain “trigger” foods.

What Are the 5 Types of Crohn's Disease?

There are five different types of Crohn’s disease, based on the location of the inflammation. Each type also has slightly different symptoms, which help doctors reach the correct diagnosis.

 

Here is an overview of the five types and their symptoms:

 

  • Ileocolitis: In this form of Crohn’s disease, both the large intestine and the end of the small intestine (the ileum) are affected. It is the most common form, with as many as 40 percent of Crohn's sufferers having ileocolitis. If you suffer from ileocolitis you will likely experience pain or cramping in the central or lower right region of the abdomen, often accompanied by diarrhea and sudden, unexplained weight loss.

 

  • Ileitis: This form of Crohn's results in inflammation of the ileum, the narrowest and final section of the small intestine. The symptoms are similar to those of ileocolitis, but you may also develop complications such as fistula or abscesses in the lower right part of the abdomen.

 

  • Colitis: Also referred to as granulomatous colitis, this form of Crohn’s disease only affects the large intestine (colon). Common symptoms are ulcers, lesions, and abscesses in the anal region, joint pain, diarrhea and bloody stools.

 

  • Gastroduodenal Disease: In this type of Crohn's disease, the stomach and the first part of the small intestine become severely inflamed. According to Johns Hopkins Medicine, around one-third of young people with Crohn's disease develop ulcers in this part of the digestive tract. Other symptoms include loss of appetite, weight loss, nausea, and vomiting.

 

  • Jejunoileitis: This rarer from of Crohn’s disease affects the upper half of the small intestine, known as the jejunum. If you have Jejunoileitis, you may get frequent severe diarrhea, stomach cramping and discomfort after eating. If you have a severe form, you may also develop fistulas.

 

Your doctor can help diagnose your disease correctly and set you on a path towards managing your symptoms.

Causes of Crohn’s Disease

Researchers have yet to fully understand all the factors that lead to Crohn’s disease, however current research suggests several contributing factors (shown below):

 

  • Immune system response: Medical professionals believe that Crohn’s might be an autoimmune disease. In autoimmune conditions, the body attempts to defend itself from a perceived attack and can end up attacking healthy cells as well as the rogue ones triggering the disease. In the case of Crohn’s, the immune system is triggered to attack otherwise healthy intestinal tissue.

 

  • Genetics: Because Crohn's is more common in people who have a family history of the disease, researchers think there might be a strong genetic element. However, this does not explain every case, as most people who get Crohn's disease have no family history.

Crohn’s Disease Risk Factors

You may be at greater risk of developing Crohn's disease if any of the following factors apply to you:

 

  • Age: If you are below the age of 30 you are at higher risk, as Crohn’s most commonly presents in people between the ages of 20 and 29. If you are looking after a child below the age of 15, note that this group has a very high risk. Approximately one-sixth of people develop symptoms before the age of 15. It is possible to develop Crohn’s at any age, so consult with a doctor if you are experiencing symptoms.

 

  • Ethnicity: Crohn's disease used to be more prevalent among Caucasians, however in recent years the incidence of Crohn's has been increasing among black people from North America and the United Kingdom. People of Eastern Eropean (Ashkenazi) Jewish descent have the highest incidence of the disease. 

 

  • Family History: If a close relative, such as a parent, sibling or child, suffers from Crohn’s, you are at a higher risk. If one of your parents suffers from Crohn's you have a 7 to 9 % lifetime risk of developing the condition and a 10 % chance of developing another form of inflammatory bowel disease such as ulcerative colitis. If both your parents suffer from an inflammatory bowel disease, your risk of developing Crohn’s increases by as much as 35 percent.

 

  • Smoking: Cigarette smokers have a higher risk of being diagnosed with Crohn’s. If you have already been diagnosed, be aware that smoking can make your symptoms more severe and raise your chances of needing surgery. Quitting smoking is probably the best course of action, especially if you have many risk factors for Crohn’s.

 

  • NonSteroidal Anti-Inflammatory Medications: If you regularly take nonsteroidal anti-inflammatory medications–such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren)–you are at risk of causing bowel inflammation. While these medications do not actually cause Crohn's disease, they can trigger a flare-up or make the disease worse if you are already a sufferer. 

 

  • Location - If you live in an urban or highly industrialized area where air-pollution is a problem, you are at greater risk for developing Crohn's disease

Crohn’s Disease Diagnosis

There is no single test to diagnose Crohn's disease so your doctor will likely order a combination of tests to help confirm your diagnosis. Your doctor may also carry out certain tests to rule out the possibility that another condition is causing your symptoms.  Here is an outline of the most common blood tests your doctor may order:

 

  • Routine blood tests: A blood test will reveal if you have anemia (low levels of hemoglobin in the blood). This can be a sign of Crohn’s, and is triggered by blood loss from the bowel. Your doctor may also order a blood test to rule out the possibility of an infection being the cause of your symptoms.

 

  • Fecal occult blood test: You may be asked to provide a stool sample so that your doctor can test for hidden (occult) blood in your stool, the presence of which can indicate Crohn’s disease.

 

Your doctor may also order one or a combination of the following procedures:

 

  • Colonoscopy: A test in which a thin, flexible, lighted tube with an attached camera is inserted into your colon. This allows your doctor to view your entire colon right up to the end (your ileum). During this procedure, your doctor may take small samples of tissue (biopsy) for laboratory analysis, which will help confirm a diagnosis. If your doctor finds clusters of inflammatory cells called granulomas, this will help him confirm the diagnosis of Crohn's.

 

  • Computerized Tomography (CT): CT scans provide a higher level of detail than a standard X-ray. Your CT will look at the entire bowel, as well as at tissues outside the bowel. Your doctor may order a CT enterography, which is a specialized CT scan that allows better images of the small bowel to be taken.

 

  • Magnetic Resonance Imaging (MRI): MRIs use a magnetic field to create detailed images of organs and tissues. An MRI is particularly useful for examining fistulas around the anal area or in the small intestine.

 

  • Capsule endoscopy: For this test, you will be asked to swallow a small capsule that has a camera inside it. As it travels through your small intestine, the camera takes pictures and transmits them to a computer from where they can be analyzed for evidence of Crohn’s disease. The camera will painlessly exit your body in your stool after the test.

 

  • Balloon-assisted enteroscopy: This test enables the doctor to look further into the small bowel than where a standard endoscope can reach. This technique may be called for when the capsule endoscopy shows abnormalities, but the diagnosis is still in question.

Treatments for Crohn’s Disease

Medical Treatments for Crohn’s Disease

 

There is no single cure for Crohn's disease, but there are several drugs available that can provide relief from specific symptoms, improve your quality of life, and keep complications at bay. With proper medications, you may enjoy long periods of remission from Crohn’s. Keep in mind, however, that the disease activity can sometimes flare up for no obvious reason, and will require proper medical management throughout your life.

 

Crohn's is a chronic and progressive condition, so the best results are achieved when treatment begins as soon as possible after diagnosis. There is no one-size-fits-all treatment. Your doctor will develop a treatment plan tailored to your individual case.

 

Here is a summary of the most commonly prescribed medications for Crohn’s:

 

  • Anti-Inflammatory Medications: You may be prescribed aminosalicylate drugs such as sulfasalazine or mesalamine. These drugs inhibit some of the pathways in the body that produce inflammatory substances and are effective in treating mild-to-moderate cases of Crohn’s disease. They might also be used as part of a maintenance plan to prevent relapses. Aminosalicylates work best in the colon area and are less effective if the disease is mostly present in the small intestine.

 

  • Corticosteroids: If you have moderate to-severe Crohn’s disease, you may be prescribed a Corticosteroid such as prednisone and budesonide. This class of drug affects the body’s ability to launch and maintain the inflammatory process. As they suppress the immune system and can cause side effects such as brittle bones, these drugs will only be prescribed for short-term use. Because of their effect on the adrenal glands, steroids cannot be stopped abruptly.

    It you are finding it hard to come off steroids without a relapse of symptoms, your doctor may add other medications to help manage your disease.

 

  • Immunomodulators: These medications, which include cyclosporine A and azathioprine, suppress the body’s immune system response, thereby decreasing inflammatory activity. You may be prescribed an immunomodulator if aminosalicylates have proven ineffective for you. They may also be prescribed if you have a fistula (abnormal passages in the intestine caused by Crohn’s). Your doctor may recommend immunomodulatory drugs to make other medications, such as biologics, more effective or to help you wean off corticosteroids. You may have to take immunomodulators for several weeks or months before you notice an improvement.

 

  • Biologic medicines: These medications are expensive, and doctors will generally only prescribe them if no other medications have been effective. Biologics contain antibodies that block certain proteins in the body from causing inflammation. Examples include infliximab and adalimumab. They are offered given as injection, or through an intravenous infusion. Another class of biologic medications that your doctor might prescribe are called biosimilars.

 

  • Antibiotics: You may be prescribed an antibiotic if you develop an infection, such as abscesses, of if you have fistulas around the anal canal or vagina in women.

 

  • Future therapies: There is currently a lot of active research into Crohn’s management and many new therapies are under investigation. To get a clear picture of what is available, it is best to discuss this with your doctor or medical team.

 

 

Surgical Procedures for Crohn’s Disease

 

If your symptoms are severe, doctors may recommend you undergo surgery to remove some of the damaged parts of your intestine. This is especially true if you have a blockage or fissure. Surgery may also be the only option when medical interventions no longer provide relief.

 

Statistics gathered by the Crohn's & Colitis Foundation suggest that approximately 70 percent of Crohn’s sufferers will need surgery at some point, and often more than once. Recurrences of complications are very common and affect up to 60 percent of sufferers within 10 years of the original surgery.

 

 

Alternative Treatments for Crohn’s Disease

 

Many Crohn’s sufferers turn to complementary medicine and alternative treatments to help them manage their condition. There have not yet been many well-designed studies into the effectiveness of such treatments but there is a lot of anecdotal evidence to support them. Always discuss with your doctor if you are thinking of trying a new treatment.

 

  • Biofeedback: In this stress-reduction method, electrical sensors placed on your body give you information about your heart rate, breathing, brain waves, and other feedback. With the help of a trained biofeedback therapist, you learn how to control your physical reactions with your thoughts and willfully enter a more relaxed state where you are better able to cope with stress and, according to some reports, keep Crohn’s symptoms at bay.

 

  • Acupuncture: This is a traditional Chinese practice, where a qualified practitioner inserts narrow needles into specific points in the body. Some people have found it alleviates Crohn’s symptoms. If you want to explore this option, you should make sure you see a certified practitioner.

Preventing Crohn’s Disease: What You Can Do at Home

While there is no guaranteed way to prevent Crohn’s disease, taking the following actions can help reduce the symptoms of the condition.

 

  • Quit Smoking: Smoking increases your risk of developing Crohn's disease, and once you have it, smoking can make it worse. If you have Crohn's disease and smoke you are more likely to have relapses, need more medications and need repeat surgeries. Quitting smoking can help you achieve better overall digestive health, as well as provide many other health benefits.

 

  • Reduce Stress: Although stress doesn't cause Crohn's disease, it can make your symptoms worse, and may also trigger a flare-up. Anything you can do to alleviate stress will be a useful part of your disease management. Learning relaxation techniques, meditation or taking up a gentle form of exercise - such as walking or swimming - can be very beneficial. As can making time for activities you find enjoyable and relaxing.

 

  • Yoga: Many Crohn’s sufferers have reported that this popular practice, which focuses on postures and breathing, helps them better cope with their condition.

 

 

Nutritional Supplements for Crohn’s Disease

 

Many Crohn's sufferers claim to get relief from taking certain nutritional supplements. While there are not enough studies to support these claims, you may want to explore some of these options. Some natural herbs and supplements can have side effects or interact badly with drugs your doctor has prescribed, so always discuss with your doctor first if you are planning to try out a new herbal supplement.

 

  • Probiotics - The healthy gut is naturally full of bacteria, but in people with Crohn’s, the balance may be off. Taking Probiotics tablets or capsules helps restore that balance by introducing large volumes of healthy bacteria - especially Bifidobacterium - into your gut. These supplements are usually safe but can have mild side effects, like gas and bloating.

 

  • Prebiotics - Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plant foods, such as bananas, onions, leeks and artichokes. Prebiotics feed the beneficial intestinal bacteria and help them multiply. Some people find that eating prebiotic-rich food alleviates their symptoms, however official studies are inconclusive.

 

 

  • Turmeric - The key compound in this spice is curcumin, which appears to have strong inflammation-fighting powers. In a few early studies, it seemed to be an effective treatment for Crohn’s or ulcerative colitis. Taking curcumin long-term can cause digestive problems.

 

  • Pineapple Extract - Bromelain, which comes from the stems of the pineapple, may have anti-inflammatory properties that can ease Crohn’s symptoms. So far, this has only been tested in a laboratory and more studies involving real people are needed.

 

 

Crohn’s Disease Diet - What to Eat

 

What you eat does not cause Crohn’s, however certain foods and beverages can aggravate your symptoms, especially during a flare-up. It can be helpful to keep a food diary to keep track of what you're eating, as well as how you feel. If you discover some foods are causing your symptoms to flare, try eliminating them. While some specialized diets may be helpful for some patients, no one plan has been proven effective in preventing or controlling Crohn’s.

 

Your healthcare team, including a registered dietitian specializing in Crohn’s, may recommend a diet based on your symptoms. It can take a period of trial and error to arrive at the best diet for you. Here is an outline of some of the dietary approaches that have proven helpful to Crohn’s sufferers:

 

  • Carbohydrate exclusion diets: These diet plans limit or totally exclude grains, fiber, and certain sugars. This diet can cause your body to run low on B vitamins, calcium, vitamin D, and vitamin E, so stay in close contact with your healthcare team to make sure you remain nutritionally healthy.

 

  • Semi-vegetarian diet: This diet calls for limited animal proteins—fish once a week and meat once every two weeks. One study found that patients on a semi-vegetarian diet were less likely to relapse into a flare after two years, compared to patients who did not follow this diet.

 

  • Mediterranean diet: This diet is rich in fiber and plant-based foods, including olive oil, low-fat dairy, herbs, and spices. There is little to no red meat in this diet, and poultry, eggs, cheese, and yogurt are recommended in moderation.

 

  • Low-fiber diet: This diet is recommended to reduce both cramping and excessive bowel movements. You must avoid green leafy vegetables, nuts, seeds, popcorn, whole grains, and raw fruits with peels. Eating a low-fiber diet can be especially helpful when you have a stricture or bowel obstruction, or after surgery when your gut may need extra time to recover before returning to your regular diet.

 

  • Low-FODMAP diet: FODMAP is an acronym for Fermentable, Oligo-, Di-, Monosaccharides and Polyols. it is a diet that cuts back on a group of sugars that can be poorly absorbed by your GI tract. This includes foods containing fructose, lactose, sugar polyols (sorbitol and mannitol), fructans (found in garlic, leeks, artichokes, and wheat), and galacto-oligosaccharides (found in lentils, chickpeas, and green peas). A low-FODMAP diet should only be practiced for a short time. A doctor or dietician may recommend this diet to help reduce your Crohn’s symptoms although the research into its effectiveness in treating Crohn’s inflammation is inconclusive.
  • Gluten-free diet: This diet cuts out gluten, a protein found in wheat, barley, and rye. Some Crohn’s patients have found that a gluten-free diet reduces their symptoms. Your doctor may want to test you for celiac disease before starting you on a gluten-free diet.

 

  • Limit dairy: Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. If you know you are lactose intolerant (where your body can't digest the milk sugar in dairy foods) taking an enzyme product like Lactaid may help.

 

  • Eat low-fat foods: If you have Crohn's disease, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestines, making your diarrhea worse. Try avoiding butter, margarine, cream sauces and fried foods.

 

  • Avoid “problem” foods: Spicy foods, alcohol, and caffeine can make your symptoms worse so pay attention to what triggers a flare-up for you and be sure to avoid those foods.

 

Other suggested dietary modifications to ease the symptoms of Crohn’s disease are:

 

  • Eat small meals: You may feel better eating five or six small meals a day rather than two or three larger ones.

 

  • Drink plenty of liquids: Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.

 

  • Take a multivitamin: Because Crohn's disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.

 

  • Liquid diet for bowel rest: If you’re in the middle of a flare up, you may find that consuming only liquids for a couple of days and up to a week will give your digestive system a chance to reset. Drink fluids that contain nutrients such as bone broth and vegetable juices to ensure you do not become nutrient deficient. It is best to try this under your doctor’s guidance.

Living with Crohn’s

Crohn's disease doesn't just affect you physically, it can take an emotional toll too. If you have a severe case, you may find that your life revolves around constant trips to the toilet. But even if your symptoms are mild, gas and abdominal pain can make it difficult to go out in public which can negatively impact your life and cause depression.

 

Be aware of your moods and reach out to people for help if you are having trouble coping. Here are some ideas of things that might help:

 

  • Join a support group: These can provide valuable information about your condition as well as emotional support. Group members tend to know about the latest medical treatments and therapies and may have practical advice. You may also find it reassuring to be among other Crohn's sufferers. Try to find an online support group on Facebook or another platform if that’s easier for you.

 

  • Talk to a therapist: You may find it helpful to consult a mental health professional who is familiar with Crohn’s disease and the emotional difficulties it can cause. A trained therapist will give you the space to express your feelings and can help you develop coping strategies.

When to See a Doctor

You should go and see your doctor if you notice a change in your usual bowel habits or if you experience any of the following Crohn’s symptoms:

 

  • Abdominal pain
  • Blood in your stool
  • Ongoing bouts of diarrhea that you have been unable to treat successfully with over-the-counter (OTC) medications
  • Unexplained or sudden weight loss
  • Unexplained fever lasting more than a day or two

Crohn’s Disease Complications

In some sufferers, the inflammation can also occur in other parts of the body aside from the digestive tract. Common areas where inflammation can spread are the eyes, joints, skin, and liver. Other possible complications of Crohn’s disease include:

 

  • Ulcers: These are open sores in the GI tract.

 

  • Abscesses: These collections of pus often develop in the abdomen, pelvis, or around the anal area.

 

  • Fistula: These are sores, or ulcers, that form abnormal tunnels through the intestine and into the surrounding tissue, particularly around the anus and rectum. A fistula is often the first sign of Crohn's disease. They may become infected and often, are only noticed after they break through the skin surface.

 

  • Blockage of the digestive tract: The chronic intestinal inflammation that characterizes Crohn's disease may also lead to the development of scar tissue in your intestines. As the cycle of inflammation and scarring continues, part of the intestinal tract may become narrowed forming a stricture, or stenosis.  If enough pressure builds up, your intestine can rupture, leaking harmful intestinal contents and bacteria into your abdominal cavity.

 

 

  • Joint problems: Arthritis, or inflammation (pain with swelling) of the joints, is the most common complication of Crohn’s affecting as many as 30% of people with Crohn's disease or ulcerative colitis. In addition to joint pain, arthritis also causes swelling of the joints and a reduction in flexibility.

 

  • Anal fissure: This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It's often associated with painful bowel movements and may lead to a perianal fistula.

 

  • Malnutrition: Diarrhea, abdominal pain and cramping may make it difficult for you to absorb enough nutrients to keep you nourished.

 

  • Colon Cancer: As a Crohn’s sufferer you may have a higher risk of colorectal cancer than the general population — especially if you’ve had the disease for 8 to 10 years. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy every 10 years beginning at age 50. Colorectal cancer is highly treatable when found early so speak to your doctor to find out whether you should get tested sooner and have more frequent screening.

 

 

What is the life expectancy of someone with Crohn's disease?

 

Crohn's disease is characterized by intermittent flares, but should not shorten your life expectancy, and most people with Crohn's disease enjoy full and rewarding lives. Sticking to your treatment plan and making healthy lifestyle choices, like quitting smoking, will improve the likelihood of remaining healthy with your disease.

 

 

Do you think you might have Crohn's Disease?

 

Download the K Health app to learn more and chat with a doctor.

“No two patients experience Crohn’s in exactly the same way...the best results are achieved when treatment begins as soon as possible after diagnosis.”

Think you might have Crohn’s Disease? K Health can help.

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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