Crohn’s Disease: Symptoms, Causes, Treatment, and Management

The symptoms of Crohn’s disease vary depending on the location and severity of the inflammation. The most common symptoms are:

• diarrhoea, which may be bloody or contain mucus or pus
• abdominal pain and cramps
• weight loss and reduced appetite
• fatigue and tiredness
• fever and night sweats

Some people may also experience:

• anaemia, due to blood loss or poor absorption of iron
• mouth ulcers
• skin rashes or joint pain
• eye inflammation or redness
• anal fissures, fistulas or abscesses

The symptoms of Crohn’s disease may come and go, with periods of remission and flare-ups. Flare-ups can be triggered by factors such as stress, infection, smoking, certain foods or medications.

There is no single test that can diagnose Crohn’s disease. The diagnosis is based on a combination of:

• Medical history and physical examination.
• Blood tests - FBC check for signs of inflammation, infection, anaemia or malnutrition. Which type?
• Stool tests - rule out other causes of diarrhoea, such as infection or parasites
• Endoscopy - to look inside the digestive tract and take biopsies of the inflamed tissue
• Imaging tests - X-rays, ultrasound, CT scan or MRI, to show the extent and location of the inflammation and any complications, such as strictures, fistulas or abscesses.

How does Crohn’s disease differ from ulcerative colitis?

Crohn’s disease and ulcerative colitis are both types of inflammatory bowel disease, but they have some differences.

Crohn’s disease can affect any part of the digestive system, while ulcerative colitis only affects the colon and rectum. Crohn’s disease causes inflammation of the entire thickness of the bowel wall, while ulcerative colitis only affects the inner lining of the bowel. Crohn’s disease can cause patches of inflammation that are separated by normal tissue, while ulcerative colitis causes continuous inflammation that starts from the rectum and spreads upwards. Crohn’s disease is more likely to cause complications such as strictures, fistulas and abscesses, while ulcerative colitis is more likely to cause complications such as bleeding, toxic megacolon and colon cancer which can be diagnosed with a colonoscopy.

There is no cure for Crohn’s disease, but the aim of treatment is to:

• reduce or control the symptoms
• induce and maintain remission
• prevent or treat complications
• improve the quality of life

The main treatments for Crohn’s disease are:

• Medications, such as anti-inflammatory drugs, immunosuppressants, biologics, antibiotics and antidiarrhoeals.
• Nutritional supplements, such as liquid diets, vitamins and minerals.
• Surgery, to remove the diseased parts of the bowel or to repair complications, such as strictures, fistulas or abscesses.

The choice of treatment depends on the location and severity of the disease, the response to previous treatments, the side effects of the medications and the preference of the person. The treatment may change over time, depending on the course of the disease.

Crohn’s disease is a lifelong condition that can have a significant impact on the physical and mental health of the person. The prognosis of Crohn’s disease depends on several factors, such as:

• age at diagnosis
• location and extent of the disease
• frequency and severity of the flare-ups
• response to treatment
• development of complications
• lifestyle factors, such as smoking, diet and stress

Some people with Crohn’s disease may have a mild or moderate course of the disease, with few or no complications, and achieve long-term remission with treatment. Others may have a severe or aggressive course of the disease, with frequent or persistent symptoms, and require multiple surgeries or hospitalisations. Some people may also develop complications, such as bowel obstruction, perforation, bleeding, infection, malnutrition, osteoporosis, cancer or extra-intestinal manifestations.

When should a person see a doctor?

A person should see a doctor if they have symptoms that suggest Crohn’s disease, such as:

• persistent or recurrent diarrhoea, especially if it is bloody or contains mucus or pus
• abdominal pain or cramps that are severe or interfere with daily activities
• unintentional weight loss or reduced appetite
• fever or night sweats that are not explained by another condition
• anaemia or signs of low iron, such as paleness, weakness or shortness of breath
• mouth ulcers that do not heal
• skin rashes or joint pain that are not explained by another condition
• eye inflammation or redness that are not explained by another condition
• anal fissures, fistulas or abscesses that cause pain, bleeding or discharge

A person should also see a doctor if they have been diagnosed with Crohn’s disease and:

• their symptoms worsen or do not improve with treatment
• they develop new or unusual symptoms
• they have signs of a flare-up, such as increased diarrhoea, abdominal pain, fever or weight loss
• they have signs of a complication, such as severe bleeding, abdominal distension, vomiting, dehydration or infection
• they have questions or concerns about their condition or treatment.