that affect the digestive tract and those that affect the
rest of the body.
The most common symptoms that affect the
digestive tract are:
chronic diarrhea, the most common symptom
abdominal pain or cramps, often in the lower right
portion of the abdomen
rectal bleeding
blood in the stool, black tarry stool
ulcers in the digestive tract, usually the in the intestine
fistulas, or holes in the intestine that connect the intes-
tine to other parts of the body such as the bladder,
stomach, vagina, or another section of bowel
nausea and vomiting , usually from Crohn’s disease
in the stomach
abscesses, fistulas, and ulcers around the anus, usu-
ally from Crohn’s disease in the colon. This occurs in
about 45% of patients
constipation, usually after many years when the
bowel has thickened and the diameter of the intestine
has narrowed
Symptoms of Crohn’s disease also appear in other
systems in the body. Some are the result of infection
when fistulas develop. Others come from poor absorp-
tion of nutrients in the intestine over a long period.
Some symptoms that occur outside the digestive tract
include:
persistent low-grade fever
loss of appetite and weight loss
fatigue
anemia from blood loss and/or poor iron absorption
skin infections
eye infections
arthritis and sore joints, usually in the large joints
such as the knees or hip
osteoporosis from poor calcium and vitamin D
absorption
poor blood clotting from inadequate vitamin K
absorption
stunted growth in children
delayed pubertyDiagnosis
Several gastrointestinal diseases can resemble the
more common symptoms of Crohn’s disease. These
include ulcerative colitis,irritable bowel syndrome,
intestinal parasites, and intestinal obstruction. Nor-
mally the physician will begin with a medical and
family history and standard blood and stool tests.The next step toward diagnosis is usually imaging
studies, most often an upper GI series. An upper GI
series, sometimes called a barium swallow, includes
x rays of the esophagus, stomach, and upper part of
the intestine. The patient drinks a solution of barium
to improve contrast on the x rays, thus the name
barium swallow.
An upper endoscopy or a colonoscopy is another
routine part of the diagnostic procedure. An upper
endoscopy is done if abnormalities appear to be in
the esophagus, stomach, or upper part of the small
intestine (the duodenum). A colonoscopy uses the
same technique examine the colon. These procedures
are usually performed in a doctor’s office or an out-
patient clinic under light sedation. A tube called an
endoscope is inserted down the throat and into the
stomach and duodenum or up the rectum and into
the colon. At the end of the endoscope is a tiny camera
that allows the doctor to see if there is damage to the
cells lining digestive tract. During this procedure, the
doctor also removes small tissue samples (biopsies) in
order to look for abnormal cells under the microscope.
Special blood tests are available that can help dif-
ferentiate between Crohn’s disease and ulcerative col-
itis. These tests may be done if the results of other tests
are questionable. According to the Crohn’s & Colitis
Foundation of America, in about 10% of patients, it is
quite difficult to tell these two diseases apart.Treatment
There is no cure for Crohn’s disease. Treatment is
aimed at controlling inflammation, preventingvitamins
and minerals deficiencies, and relieving symptoms.
Treatment options include a combination of drugs, bio-
logic therapies, nutritionalsupplements, and surgery.
Individuals with mild to moderate Crohn’s disease
are usually treated first with anti-inflammatory drugs
such as sulfasalazine (Azulfidine) or mesalamine (Asa-
col, Rowasa, Canasa). Individuals with moderate to
severe Crohn’s disease often are prescribed corticoste-
roid drugs. Prendisone (Deltasone, Orasone, Metic-
orten) is often the corticosteroid of choice. These
drugs have significant side effects and cannot be used
for long-term suppression of symptoms. Antibiotics
are used to treat infection that may develop, for exam-
ple, from fistula formation.
Biologic therapies use manmade antibodies.
Infliximab (Remicade) is a laboratory-made antibody
that blocks the production of an immune system fac-
tor that causes inflammation. This treatment is rela-
tively new, but appears to have a good success rate for
relieving symptoms. Additional biologic therapies forCrohn’s disease