Crohn's disease history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Many people with Crohn's disease have symptoms for years prior to the diagnosis. The usual onset is between 15 and 30 years of age but can occur at any age. Abdominal pain may be the initial symptom of Crohn's disease. Crohn's disease, like many other chronic, inflammatory diseases, can cause a variety of systemic symptoms. In addition to systemic and gastrointestinal involvement, Crohn's disease can affect many other organ systems.[1]
History and Symptoms
- Many people with Crohn's disease have symptoms for years prior to the diagnosis.[2]
- The usual onset is between 15 and 30 years of age but can occur at any age.[3]
- Because of the patchy nature of the gastrointestinal disease and the depth of tissue involvement, initial symptoms can be more vague than with ulcerative colitis.
- People with Crohn's disease will go through periods of flare-ups and remission.
Gastrointestinal Symptoms
- Abdominal pain may be the initial symptom of Crohn's disease. The pain is commonly cramp-like and may be relieved by defecation.
- Diarrhea, which may or may not be bloody, though diarrhea is not uncommon especially in those who have had surgery.
- The nature of the diarrhea in Crohn's disease depends on the part of the small intestine or colon that is involved.
- Ileitis typically results in large-volume watery feces. Colitis may result in a smaller volume of feces of higher frequency. Fecal consistency may range from solid to watery.
- In severe cases, an individual may have more than 20 bowel movements per day and may need to awaken at night to defecate.[4]
- Visible bleeding in the feces is less common in Crohn's disease than in ulcerative colitis, but may be seen in the setting of Crohn's colitis. Bloody bowel movements are typically intermittent, and may be bright or dark red in colour.
- In the setting of severe Crohn's colitis, bleeding may be copious.[5] Flatus and bloating may also add to the intestinal discomfort.
- Symptoms caused by intestinal stenosis are also common in Crohn's disease. Abdominal pain is often most severe in areas of the bowel with stenoses. In the setting of severe stenosis, vomiting and nausea may indicate the beginnings of small bowel obstruction.[5] Crohn's disease may also be associated with primary sclerosing cholangitis, a type of inflammation of the bile ducts.
- Perianal discomfort may also be prominent in Crohn's disease. Itchiness or pain around the anus may be suggestive of inflammation, fistulization or abscess around the anal area or anal fissure. Perianal skin tags are also common in Crohn's disease.[6] Fecal incontinence may accompany peri-anal Crohn's disease. At the opposite end of the gastrointestinal tract, the mouth may be affected by non-healing sores (aphthous ulcers). Rarely, the esophagus, and stomach may be involved in Crohn's disease. These can cause symptoms including difficulty swallowing (odynophagia), upper abdominal pain, and vomiting.[7]
Systemic Symptoms
- Crohn's disease, like many other chronic, inflammatory diseases, can cause a variety of systemic symptoms.
- Among children, growth failure is common. Many children are first diagnosed with Crohn's disease based on inability to maintain growth.[8] As Crohn's disease may manifest at the time of the growth spurt in puberty, up to 30% of children with Crohn's disease may have retardation of growth.[9]
- Fever may also be present, though fevers greater than 38.5 ˚C (101.3 ˚F) are uncommon unless there is a complication such as an abscess
- Among older individuals, Crohn's disease may manifest as weight loss. This is usually related to decreased food intake, since individuals with intestinal symptoms from Crohn's disease often feel better when they do not eat and might lose their appetite.[8] People with extensive small intestine disease may also have malabsorption of carbohydrates or lipids, which can further exacerbate weight loss.[10]
Extraintestinal Manifestations
In addition to systemic and gastrointestinal involvement, Crohn's disease can affect many other organ systems.[1]
- Eyes: Inflammation of the interior portion of the eye, known as uveitis, can cause eye pain, especially when exposed to light (photophobia). Inflammation may also involve the white part of the eye (sclera), a condition called episcleritis. Both episcleritis and uveitis can lead to loss of vision if untreated.
- Rheumatology: Crohn's disease is associated with a type of rheumatologic disease known as seronegative spondyloarthropathy. This group of diseases is characterized by inflammation of one or more joints (arthritis) or muscle insertions (enthesitis). The arthritis can affect larger joints such as the knee or shoulder or may exclusively involve the small joints of the hand and feet. The arthritis may also involve the spine, leading to ankylosing spondylitis if the entire spine is involved or simply sacroiliitis if only the lower spine is involved. The symptoms of arthritis include painful, warm, swollen, stiff joints and loss of joint mobility or function. Finally, Crohn's disease may cause osteoporosis, or thinning of the bones. Individuals with osteoporosis are at increased risk of bone fractures.[11]
- Endocrine system: Crohn's disease may also involve the skin, blood, and endocrine system.
- Hematology: Crohn's disease also increases the risk of blood clots; painful swelling of the lower legs can be a sign of deep venous thrombosis, while difficulty breathing may be a result of pulmonary embolism. Autoimmune hemolytic anemia, a condition in which the immune system attacks the red blood cells, is also more common in Crohn's disease and may cause fatigue, pallor, and other symptoms common in anemia.
- Neurology: Crohn's disease can also cause neurological complications (reportedly in up to 15% of patients).[12] The most common of these are seizures, stroke, myopathy, peripheral neuropathy, headache and depression.[12]
- Clubbing, a deformity of the ends of the fingers, may also be a result of Crohn's disease.
- Crohn's patients often also have issues with small bowel bacterial overgrowth syndrome, which has similar symptoms.
References
- ↑ 1.0 1.1 Danese, Silvio. "Extraintestinal manifestations in inflammatory bowel disease". World Journal of Gastroenterology. 11 (46): 7227–7236. PMID 16437620. Retrieved 2006-07-02.
- ↑ Pimentel, Mark. "Identification of a prodromal period in Crohn's disease but not ulcerative colitis". American Journal of Gastroenterology. 95 (12): 3458–62. doi:10.1111/j.1572-0241.2000.03361.x. PMID 11151877.
- ↑ Crohn Disease Overview
- ↑ Mueller, M. H. "Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn's disease". British Journal of Surgery. 89 (8): 1027–31. doi:10.1046/j.1365-2168.2002.02173.x. PMID 12153630.
- ↑ 5.0 5.1 Gopal, Latha (2006-05-23). "Crohn Disease". eMedicine. Retrieved 2006-07-02.
- ↑ Taylor B, Williams G, Hughes L, Rhodes J (1989). "The histology of anal skin tags in Crohn's disease: an aid to confirmation of the diagnosis". Int J Colorectal Dis. 4 (3): 197–9. PMID 2769004.
- ↑ Fix OK, Soto JA, Andrews CW, Farraye FA (2004). "Gastroduodenal Crohn's disease". Gastrointest. Endosc. 60 (6): 985. PMID 15605018.
- ↑ 8.0 8.1 Beattie, R.M. "Inflammatory bowel disease". Archives of Disease in Childhood. 91 (5): 426–32. doi:10.1136/adc.2005.080481. PMID 16632672.
- ↑ Büller, H.A. "Problems in diagnosis of IBD in children". The Netherlands Journal of Medicine. 50 (2): S8–S11. doi:10.1016/S0300-2977(96)00064-2. PMID 9050326.
- ↑ O'Keefe, S. J. (1996). "Nutrition and gastrointestinal disease". Scandinavian Journal of Gastroenterology Supplement (220): 52–9. PMID 8898436.
- ↑ Bernstein, Michael. "Maintenance infliximab treatment is associated with improved bone mineral density in Crohn's disease". The American Journal of Gastroenterology. 100 (9): 2031-5. doi:10.1111/j.1572-0241.2005.50219.x. PMID 16128948.
- ↑ 12.0 12.1 Crohn's disease. professionals.epilepsy.com. Retrieved on July 13, 2007.