Crohn’s Disease – Symptoms and Causes
Crohn’s disease is a chronic inflammatory bowel condition that affects the digestive tract. Today, more than half a million Americans live with this condition, which can cause significant discomfort and complications.
Though there’s no cure yet, proper diagnosis and treatment can help manage symptoms and enhance quality of life. The inflammation from Crohn’s disease can occur anywhere along the gastrointestinal (GI) tract, from mouth to anus.
Unlike some other bowel conditions, Crohn’s often penetrates deep into the tissue layers of the affected areas. It commonly targets the large and small intestines, but can appear in one specific area or in multiple segments simultaneously.
Signs and Symptoms
Crohn’s disease typically develops slowly, but can sometimes appear suddenly. People with this condition may experience periods without symptoms, known as remission.
Common symptoms include:
- Loose, watery stools
- Elevated body temperature
- Extreme tiredness
- Stomach discomfort and spasms
- Bloody bowel movements
- Ulcers in the mouth
- Decreased hunger and weight reduction
- Discomfort or drainage around the anus from fistulas (abnormal tunnels in the skin)
Crohn’s disease can affect any section of the small or large intestine. It could consist of distinct sections or form a single, uninterrupted space. Most commonly, it affects the end part of the small intestine. Some people only have the condition in their colon.
Additional Symptoms
People with severe Crohn’s disease might also experience problems outside the digestive tract:
- Swelling in the skin, eyes, and joints
- Inflammation affecting the liver or bile ducts
- Formation of kidney stones
- Low iron levels (anemia)
- Slowed growth or delayed sexual development in children
When to Contact a Healthcare Provider
Contact a healthcare professional if you notice lasting changes in your bowel habits or experience any of the following symptoms:
- Persistent stomach pain
- Blood in your stool
- Feeling sick to your stomach with vomiting
- Diarrhea that continues for more than two weeks
- Unintentional weight loss
- Fever, along with any other symptoms
Causes
The exact cause of Crohn’s disease remains unknown. Diet and stress are now seen as factors that worsen symptoms of the condition, rather than causes of the disease.
Research indicates that an abnormal immune response might mistakenly attack harmless gut bacteria and damage healthy tissue. This immune dysfunction, along with genetic and environmental factors, is believed to contribute to the development of Crohn’s disease.
Risk Factors
Several factors may increase a person’s chance of developing Crohn’s disease:
Genetic and Family History
Having a close relative (parent, sibling, or child) with Crohn’s disease significantly raises the risk. About 20% of people with Crohn’s disease have a family member with the condition.
More than 200 genes have been linked to Crohn’s disease, though their exact roles are still being studied. Some genetic variations may increase susceptibility.
Immune System Dysfunction
Crohn’s disease may result from an abnormal immune response in which the body mistakenly attacks healthy digestive tract cells.
Environmental factors, bacteria, or viruses can trigger an immune overreaction, leading to chronic inflammation and intestinal damage.
Age Considerations
Most people are diagnosed before age 30, though Crohn’s disease can develop at any age.
Ethnic Background
Risk varies among ethnic groups:
- White people have the highest risk, particularly those with Eastern European (Ashkenazi) Jewish ancestry
- Increasing rates are being seen in Black populations in North America and the United Kingdom
- Growing numbers of cases in Middle Eastern populations and among immigrants to the United States
Lifestyle and Environmental Factors
- Smoking: This is the most significant controllable risk factor. Smoking raises the risk of Crohn’s disease, worsens symptoms, and increases the likelihood of surgery.
- Certain Medications: NSAIDs such as ibuprofen, naproxen sodium, and diclofenac sodium do not cause Crohn’s disease but can aggravate bowel inflammation in those who already have it.
Diagnosing Crohn’s Disease
Diagnosing Crohn’s disease often requires multiple tests since no single diagnostic method exists. Doctors typically begin with a comprehensive medical history and may order:
- Blood Tests: To check for anemia and infection markers.
- Stool Studies: Designed to identify the presence of blood and eliminate the possibility of pathogens.
- Colonoscopy: Allows visual examination of the colon and collection of tissue samples.
- Imaging Tests: CT scans or MRIs to examine bowel tissue and surrounding areas.
- Capsule Endoscopy: A swallowed camera captures images throughout the digestive tract.
- Balloon-Assisted Enteroscopy: Helps access deeper areas of the small intestine
Treatment
Treatment aims to reduce inflammation, relieve symptoms, and prevent complications. Available therapies include:
| Treatment Type | Examples | Primary Benefits |
|---|---|---|
| Anti-inflammatory drugs | Corticosteroids | Reduce acute inflammation |
| Immune suppressants | Azathioprine, methotrexate | Decrease immune response |
| Biologics | TNF inhibitors | Target-specific immune proteins |
| Antibiotics | Metronidazole, ciprofloxacin | Treat infections and fistulas |
| Symptom management | Antidiarrheals, pain relievers | Address specific symptoms |
| Nutritional therapy | Special diets, supplements | Support nutritional needs |
In cases where medication proves ineffective, surgery may be necessary to remove damaged tissue. About 70% of people with Crohn’s disease eventually need surgical intervention, though this doesn’t cure the condition.
Managing Crohn’s extends beyond medical treatment. Lifestyle modifications can significantly impact symptom control:
Diet Management
- Keep a food diary to identify personal triggers
- Consider limiting dairy products
- Eat smaller, more frequent meals
- Stay well-hydrated
- Avoid caffeine, alcohol, and carbonated drinks
- Consult with a registered dietitian
Mental Health Support
- Learn stress management techniques
- Practice relaxation methods
- Consider therapy with professionals familiar with inflammatory bowel disease
- Join support groups to connect with others experiencing similar challenges
Complications
Crohn’s disease can lead to several health complications throughout the body. Understanding these potential issues helps patients and healthcare providers develop appropriate management plans.
Intestinal Blockages
The inflammation from Crohn’s disease can affect the entire wall of the intestine. Over time, scarring can narrow sections of the bowel, creating strictures that block the normal flow of digestive contents.
Ulcers and Fissures
Ongoing inflammation can create open sores (ulcers) anywhere in the digestive tract, including the mouth, anus, and genital area.
Anal fissures are small tears in the anus lining that can cause pain during bowel movements and raise the risk of infection.
Fistulas and Abscesses
When ulcers extend completely through the intestinal wall, they can create abnormal connections called fistulas between different body parts.
These tunnels can form between loops of the intestine, from the intestine to the skin, between the intestine and bladder, or between the intestine and vagina. Fistulas near the anal area are most common.
When fistulas develop inside the abdomen, they can lead to infections and pus collections (abscesses) that may become life-threatening without treatment.
Nutritional Problems
Malnutrition is a serious concern for people with Crohn’s disease. Symptoms like diarrhea and abdominal pain can make eating difficult.
The damaged intestine may also struggle to absorb nutrients properly. Many patients develop anemia due to low iron or vitamin B12 levels.
Cancer Risk
Having Crohn’s disease that affects the colon increases colon cancer risk. People with extensive colon involvement typically need cancer-screening colonoscopies about eight years after diagnosis, with follow-up exams every 1–2 years.
This differs from general guidelines for people without Crohn’s disease, who typically begin screening at age 45.
Skin Disorders
Many Crohn’s patients develop skin problems. Hidradenitis suppurativa is a related condition causing painful nodules and abscesses in areas like the armpits and groin.
Some treatments for Crohn’s disease can also increase skin cancer risk.
Other Body Systems Affected
Crohn’s disease can impact multiple body systems beyond the digestive tract. It can affect the bones (osteoporosis), joints (arthritis), kidneys (kidney stones), eyes (inflammation), and the liver and gallbladder.
Medication Side Effects
Treatments for Crohn’s disease carry their own risks. Immune-suppressing drugs can increase the risk of infection, lymphoma, and skin cancer. Meanwhile, corticosteroids can lead to osteoporosis, cataracts, glaucoma, diabetes, and high blood pressure.
Blood Clot Risk
People with Crohn’s disease face an increased risk of blood clots forming in both veins and arteries. This risk should be discussed with healthcare providers, especially during disease flares or hospitalizations.
