- Crohn’s disease is not confined to one area of the gastrointestinal (GI) tract, so it can be difficult to diagnose.
- A person with Crohn’s disease of the small intestine may experience constipation rather than diarrhea.
- Many people who have Crohn's of the stomach or duodenum will experience no symptoms at all.
Crohn's disease is generally more difficult to diagnose than the other major inflammatory bowel disease, ulcerative colitis (UC). This is because Crohn's isn't confined to any one area of the gastrointestinal (GI) tract. UC is located in the colon, while Crohn's may appear anywhere from the mouth to the anus.
There are several different types of Crohn's disease, each with its own set of symptoms. You can better assist your doctor in making a proper diagnosis if you know what symptoms to watch out for.
A few symptoms are common among all types of Crohn's disease. These symptoms include:
- abdominal pain with cramps
- weight loss
- lack of energy
Pain usually begins within an hour of eating and is most often concentrated around the navel, the lower right abdomen, or both. Activities like jogging will often make the pain worse.
Swelling is a symptom of Crohn’s that differentiates it from UC. Swelling is usually located in the lower right part of the abdomen. The area of swelling is typically about the size and firmness of a small grapefruit. Tenderness around the swelling, which is easily felt, ranges from mild to extreme. Mild tenderness points to an inflamed intestine and enlarged lymph nodes. Extreme tenderness may be due to an abscess, in which case the skin may appear red and stretched. Moderate tenderness could signal a combination of the above.
About one-third of people with Crohn’s will also be diagnosed with perianal disease. Perianal disease can cause fistulas, fissures, abscesses, or skin tags. Fistulas create abnormal connections between different parts of your intestine, your intestine and your skin, or your intestine and other organs. Some people may have swollen skin tags around the anus as well.
Symptoms of Crohn's disease of the colon, Crohn's colitis, manifest differently depending on where the disease is located in the colon.
If the disease is on the right side of the colon, a person will generally have cramps and diarrhea. If it’s located on the left side or involves most of the colon, a person may experience blood in the stool in addition to the other symptoms.
If the disease is located in the rectum, symptoms will be similar to UC. Symptoms may also include bloody diarrhea or the feeling of having a bowel movement in which little or nothing comes out.
Those with Crohn's disease of the small intestine, small bowel Crohn's, will likely experience cramps, diarrhea, and weight loss.
Occasionally, a person with small bowel Crohn's will have constipation rather than diarrhea. Pain can be so extreme with this type of Crohn's that some people will avoid eating. This can cause weight loss.
The ileum is a portion of the small intestine. Someone with both Crohn's of the ileum and of the colon may experience symptoms associated with either disease or symptoms of both. This is because Crohn's of the ileum may flare up when the colonic disease is in remission, or vice versa.
The duodenum is the part of the small intestine closest to the stomach. Many people who have Crohn's of the stomach or duodenum will experience no symptoms at all.
If symptoms do occur, they’re likely to happen in the upper abdomen either during or immediately following a meal. A smaller percentage will experience nausea, vomiting, or both.
Weight loss is another common symptom. This is because people with Crohn’s of the stomach often avoid eating or consume less food to prevent pain and other symptoms.
In some cases, because of scarring, this type of Crohn's will cause a narrowing of the outlet of the stomach into the duodenum. If this happens, you will usually experience a decrease in appetite, a prolonged bloated feeling located in the upper abdomen, and nausea.
Crohn’s of the appendix, esophagus, and mouth are rare types of the disease.
Crohn's disease of the appendix may mimic appendicitis and can be present without any other unique symptoms.
Crohn's of the esophagus may cause pain behind the breastbone while swallowing. If the esophagus has become narrowed due to scarring, a person may have trouble swallowing or food may become stuck on the way down. Contact your doctor immediately if you have these symptoms.
Signs and symptoms of Crohn's of the mouth normally consist of large, painful sores in the mouth. If you have this symptom, contact your doctor.
Clinical research into Crohn’s is ongoing. There have been several exciting developments over the past several years. These studies are small but offer potential new directions for the study of Crohn’s and its complications. One study found that Crohn’s disease may be influenced by childhood health events. These include events like having your tonsils removed and having chickenpox.
New treatment options are also being explored. A 2016 study found hyperbaric oxygen therapy to be a satisfactory treatment for some types of skin complications related to Crohn’s. In 2014, the FDA approved a new prescription drug to help with symptoms. This drug is approved for patients who have not responded to other commonly used therapies. The medication, Entyvio, blocks the interaction between inflammatory cells and blood vessels, preventing the inflammatory cells from entering into the gastrointestinal track. It is these inflammatory cells that are believed to cause Crohn’s symptoms.
According to a review of several studies on the role of physical exercise in inflammatory bowel diseases like Crohn’s, physical exercise is useful in improving immune function as well as the overall health of patients.
One team has identified a hormone receptor in intestinal cells that is involved in inflammation and fibrosis when activated. They are working on ways to shut down that receptor.
Other research has found an abnormal response to normal intestinal yeast in people with Crohn’s disease. An abnormal response to normal intestinal bacteria is already known to occur in Crohn’s patients. The discovery of an abnormal response to intestinal yeast may lead to some new types of antimicrobial therapy for Crohn’s patients.
Finally, an enzyme has been identified that inhibits the formation of Paneth cells in the gut. Paneth cells produce antimicrobial proteins and are known to be deficient in people with Crohn’s disease. Scientists think a new method of treating Crohn’s disease may involve inhibiting this enzyme.