How to Recognize the Symptoms of Crohn's Disease

Crohn's disease is a chronic inflammatory condition that can impact any organ in the digestive system—from the mouth to the anus and anywhere in between. As these delicate internal organs become inflamed, the ensuing pain can severely disrupt food intake, bowel movements and the daily life of an individual.

The condition afflicts about 750,000 Americans, and estimates place first-time annual diagnoses at roughly 33,000. The causes and reasons for its recent rise in frequency are not known, but ongoing current and future research will throw more light on this condition.

How to spot the early symptoms of Crohn's

Crohn's manifests differently for people, but the classic characteristics of the disease include the following:

• Abdominal pain and cramping
• Bloody stool
• Diarrhea
• Fatigue
• Fever
• Painful perineal fistulas or an anal boil or bump that may drain fluids
• Reduced appetite, malnutrition and weight loss
• Small, painful canker sores

Diarrhea is the common calling card of Crohn's, but the inflammation it causes may damage other seemingly disparate bodily functions:

• Delayed puberty in children
• Episcleritis, or a painless inflammation of the whites of the eyes that doesn't impact vision
• Eye inflammations that do impact vision, even leading to blindness
• Iron deficiency (anemia) from blood loss to Crohn's-caused fissures in the digestive tract
• Kidney stones from a hindered ability to absorb fats
• Primary sclerosing cholangitis (PSC) or inflammation of the bile duct and possibly gallbladder causing liver damage

Signs of Crohn's medical professionals look for

The initial course of action for a suspected case of Crohn's disease is to run a series of diagnostic tests.

Common tests used to diagnose Crohn's disease, according to Dung Trinh, M.D., the founder of the Healthy Brain Clinic in Long Beach, California, include the following:

• Blood tests to check for signs of inflammation or infection
• Stool tests to check for blood or other abnormalities
• Imaging tests such as X-rays or CT scans to examine the digestive tract for signs of inflammation or damage
• Endoscopy procedures such as colonoscopy or upper endoscopy to directly visualize the digestive tract and take tissue samples for further analysis

A colonoscopy is technically a type of endoscopy. The primary difference is that an endoscopy is an oral procedure and a colonoscopy is an anal one.

During an endoscopy, a tube is inserted in your mouth or you swallow a wireless camera (in the case of a capsule endoscopy) that sends images to a hard drive worn on the belt. An upper endoscopy photographs the esophagus, stomach and small intestines.

A colonoscopy uses a camera inserted through the anus to document the insides of your large intestine.

"The gold standard for diagnosis of Crohn's disease is a colonoscopy," said Pratima Dibba, M.D., a gastroenterologist at Medical Offices of Manhattan in New York. "It allows a gastroenterologist to visualize the colon and a part of the small bowel and take samples via biopsies to confirm or refute a diagnosis of Crohn's disease."

Some people can get anxious about a colonoscopy, but Dibba said that colonoscopies and false results are extremely unlikely. She also noted that other forms of testing are considered supplemental, but they are vital.

"Radiographic imaging and stool samples can help support the diagnosis or be used in monitoring response to therapy," she said. "Stool cultures that detect infection can exclude an overlapping bacterial illness or exclude Crohn's disease if all other tests rule out Crohn's disease [and are] useful in monitoring response to therapy."

Blood work and fecal tests may be utilized early in a person's Crohn's disease journey to eliminate other possibilities, but the same test can reappear later to test the efficacy of treatment.

"False positives [or] false negatives occur when some of the symptoms of Crohn's disease overlap with other conditions, such as ulcerative colitis or irritable bowel syndrome [IBS]," Trinh said. "Results from diagnostic tests such as blood tests or imaging studies may not always be definitive and may require further evaluation."

The bottom line is that you'll need a colonoscopy to obtain a Crohn's diagnosis.

When to seek help for Crohn's disease and who to see

There is a difference between diarrhea resulting from Crohn's disease and "normal diarrhea", according to Dibba.

"Patients with Crohn's disease typically have diarrhea," she said. "Sometimes, but not always, the stool can be pale, greasy, float or contain blood."

Check for this before flushing if you're concerned.

"It can be difficult to differentiate between a bad stomach ache and a more serious condition that requires medical attention, as some symptoms may overlap," she added.

Several signs indicate you need to see a doctor, according to Trinh:

• Blood in the stool. This may indicate a more severe condition such as inflammatory bowel disease or colon cancer and should be evaluated by a healthcare provider.
• Changes in bowel movements. Sudden changes in bowel movements, such as constipation or loose stools, are a possible indication there is an underlying condition.
• Fever. A fever accompanying stomach pain may indicate an infection that requires medical treatment.
• Severe pain. If you experience severe or persistent abdominal pain that does not improve with over-the-counter medication, seek medical attention.
• Vomiting or diarrhea. If you experience vomiting or diarrhea for an extended period, see a doctor to prevent dehydration and other complications.

M.D.s and D.O.s can diagnose and treat Crohn's disease. Since Crohn's is a complex condition that requires specialized care, Trinh added, it is often recommended to consult with a gastroenterologist as well.

Gastroenterologists have advanced training and expertise in the diagnosis and treatment of conditions that affect the digestive system, including Crohn's disease. They provide comprehensive care including medical management, nutritional counseling and surgical interventions, if necessary.

"With interventions ranging from holistic to surgical, medical aid is always advised when any symptoms persist," Trinh said.

What's the worst that can happen?

Long-term ramifications are possible if you fail to get diagnosed or try to "tough it out."

"If Crohn's disease goes undiagnosed and untreated, it can lead to a range of complications that can significantly impact a person's health and quality of life," Trinh said.

The most serious of these complications include:

• Intestinal damage. Over time, inflammation in the digestive tract caused by Crohn's disease can lead to scarring and narrowing of the intestinal walls. This can cause blockages or obstructions in the digestive tract that require surgical intervention.
• Malnutrition. Chronic inflammation in the digestive tract can interfere with nutrient absorption, leading to malnutrition and deficiencies in essential vitamins and minerals.

Short-term problems can manifest, too.

"Undiagnosed Crohn's disease is associated with complications of perianal disease, abscesses, small bowel obstructions requiring surgery and even colon cancer," Dibba said.

Whether it's your issue or that of a loved one, don't put off confronting Crohn's disease. You may have a journey ahead even when you do secure a diagnosis, but finding out early is always beneficial.