Crohn’s disease is chronic inflammation of the intestines closely related to another condition which involves only the colon called Ulcerative Colitis. Both these conditions together are referred to as Inflammatory Bowel Disease, IBD. Crohn’s disease most commonly affects the distal small intestine and proximal colon, but can affect any area of the gastrointestinal tract from the oesophagus to the anus. Its clinical manifestations are ultimately the result of activation of inflammatory cells with elaboration of inflammatory mediators that cause non-specific tissue damage. This condition was first described by Crohn, Ginzburg, and Oppenheimer in 1932. It is a burdensome condition and it is important to be aware of ways to take control of your health if you suffer from this condition.
The exact aetiology of Crohn’s disease is unknown. The main factors considered to be responsible include genetic, microbial, immunologic, environmental, dietary, vascular, and psychosocial factors – including smoking, oral contraceptives, and non-steroidal anti-inflammatory agents (NSAIDs). Patients have a genetic predisposition and an inherited susceptibility for an immunological response to these factors.
It is a life-long condition; however it usually appears during the late teens and early twenties. The natural progression of the disease depends not on the age at diagnosis but the actual time of onset of the disorder. The symptoms that lead a person to visit a specialist includes diarrhoea, abdominal pain and weight loss, but these are not always universally present. Sometimes, only a single symptom, most commonly, abdominal pain may be evident and enough to cause concern if present recurrently. The process may then lead to extra intestinal findings and if left untreated or undiagnosed, this condition can cause life-threatening consequences. Patients with long-standing Crohn’s disease may have a higher risk of developing cancer of the small intestine and colon. Therefore, if the usual symptoms or even the extra-intestinal symptoms are present then early diagnosis is important to prevent further complications of the disease.
Extra-intestinal complications:
- Skin: Painful red raised spots on the lower extremities.
- Eyes: Visual difficulties
- Joints: Arthritis causing pain, swelling and stiffness of the joints of the extremities.
- Inflammation of the lower back: Sacroiliac joint arthritis and ankylosing spondylitis can cause pain and stiffness of the spine. This is an important clinical feature as this might be the only symptom present.
- Inflammation of the liver (hepatitis)
The clinical course of Crohn’s disease is variable; often there are periods of exacerbations and remissions, with symptoms being related to the location of the lesions. The common symptoms include:
- Intermittent diarrhoea
- Colicky pain usually in the lower right quadrant of the abdomen
- Weight loss
- Loss of appetite
- Fluid and electrolyte disorders
- Malaise
- Low-grade fever
- Blood in the stools
- Nutritional deficiencies
- In childhood, one of the major manifestations may be retardation of growth and physical development
Patients with Crohn’s disease are suffering from a life-long condition which may affect their lifestyle in many different forms. As practitioners, we must be aware of the symptoms for Crohn’s disease because for these patients we may be the first port of entry into the health care system and they may be unaware of their condition. Therefore, when they present to us with symptoms suggestive of Crohn’s disease, we must have a high index of suspicion and be able to refer them onto specialist medical care for their condition.
Dr Sarkaw Mohammad