Crohn’s disease – Symptoms, Diagnosis, and Complications

Introduction

Like Ulcerative colitis Crohn’s disease is also a bowel disease that is inflammatory, affecting any part from the oral cavity to the anus. It is different from ulcerative colitis in certain ways. There are no permanent cures for Crohn’s disease. Only lifestyle modifications and medications can be used to manage the condition.

Symptoms to look out for

• Mouth ulcers
• Diarrhoea  
• The sensation of the inability to empty the bowel completely
• Abdominal bloating
• Anal fissures
• Weight loss
• Low appetite
• Painful defaecation
• Dehydration
• Fever
• Nutritional deficiencies  
• Fatigue
• Gut ulcers
• Skin tags around the anus

The symptoms that occur during a flare-up episode due to trigger factors are

• Canker sores
• Acne
• Psoriasis
• Severe eczema
• Pyoderma gangrenosum – painful pus-filled lesion over the skin occurring post a skin injury
• Erythema nodosum – They are predominantly tiny, red and tender nodules over the shin area. It can also occur over the arms and ankles.
• Purpura over legs – can present with itchiness, with or without pain.

Predisposing factors for Crohn’s disease

There is no apparent reason for Crohn’s disease. Many types of research are ongoing to figure it out. For now, all we know is that genes play a major role. Few risk factors are

• Certain ethnic populations, such as Ashkenazi Jewish descent, have a very high rate of developing Crohn’s disease.
• Family history is a common reason, making up 30 per cent of Crohn’s disease.
• Crohn’s disease usually affects all age groups, the younger age groups below 30 are primarily affected. There can be a remission period and occur even at later stages of life.
• Other autoimmune conditions can also present with Crohn’s disease.
• Stressful situations such as fever, cold, anxiety, infectious conditions, sudden dietary changes and many more can trigger this inflammatory issue.  
• Smoking
• Non-steroidal anti-inflammatory drugs can worsen the inflammation in the gut of a patient with Crohn’s disease.

Diagnosis of Crohn’s disease

Initially, lab tests are done to rule out certain complications.

•  Blood tests are done to rule out anaemia and infections.

•  Stool samples are tested to check for parasites and blood that can only be seen microscopically.

Following lab tests, the principal confirmative diagnosis comes from endoscopy and biopsy.

 Colonoscopy  

This endoscopic test shows the inflammatory action in the whole colon. A slim tube that has a camera at one end is inserted via the anus, and a sample of the tissue is also taken for review in the laboratory to confirm the diagnosis.

 Flexible sigmoidoscopy

A very slim tube with a light and a camera is inserted to capture the rectum with the sigmoid colon instead of the whole colon, like in colonoscopy. A biopsy is also taken for diagnostic confirmation. Flexible sigmoidoscopy is preferred over colonoscopy in situations where there is severe inflammation of the colon.

Imaging procedures can also be done to rule out complications and assess the severity.

• X-rays can be done in severe conditions to rule out the perforated gut.
• CT scan can be done to assess the severity and spread of the inflammation.
• MR enterography or CT enterography is a non-invasive test to exclude inflammatory signs in the small intestine. If a radiation-free alternative option is required, MR enterography is preferred.

Management of Crohn’s disease

Diet plays a crucial role in managing the flares of Crohn’s disease. It is better to avoid certain foods since the weak gut cannot digest them smoothly. An anti-inflammatory diet is helpful. A food diary can be beneficial in figuring out the trigger foods. During a flare-up, a high-calorie diet that is liquid or semi-solid can be helpful.

Foods to avoid

• Caffeine
• Alcohol
• Dairy products
• Seed skins
• Fizzy drinks
• Sugary foods and beverages
• Raw vegetables
• Fried greasy foods
• Foods that are extra spiced up
• Dried fruits
• Cocoa
• Corn syrup
• Mayonnaise

Foods to consume

• Cooked vegetables
• Bananas
• Lean proteins such as fish and eggs
• Unsweetened foods
• Rice
• Oats
• Flax seed oil

There are also medications to manage Crohn’s disease. Always consult your doctor before starting medications. Self-treatment is harmful.

Conservative management under a doctor’s guidance can include antibiotics, aminosalicylates, corticosteroids, immunomodulators and biologics. Surgery is the last line in severe conditions when conservative management does not work.

Complications of Crohn’s disease

• Anxiety
• Anal fissures
• Depression
• Malnutrition
• Colorectal carcinoma
• Pyoderma gangrenosum
• Fistulas

Conclusion

Crohn’s disease is an inflammatory condition of the gut which can be managed by lifestyle modifications and medications in severe conditions.

Diet is the mainstay key to management. It can be passed down by family members and is not a communicable disease.

FAQ