According to The New York Times, Crohn's disease and related inflammatory bowel diseases currently affect more than 3 million Americans, and as of 2021, that number continues to rise. This common disease causes abdominal pain and is characterized by frequent trips to the bathroom. It's important to detect Crohn's disease early to mitigate its potential impact. Know the key early signs.
Early symptoms need to be distinguished; causes still unclear
"Frequent bowel movements can be a sign of active, ongoing inflammation," says Dr. Kim Isaacs. To date, medical experts do not know the cause of Crohn's disease, an inflammatory disease of the digestive tract. Crohn's disease is an incurable, lifelong disease. If left untreated, Crohn's disease can lead to life-threatening complications. Therefore, it's important to recognize the early signs of the disease. Medical News Today reports that "early signs and symptoms of Crohn's disease can be similar to other illnesses." Sethi, MD MPH believes that "early treatment can help control symptoms and prevent flare-ups and complications."
Doctors report underdiagnosis is a significant and ongoing problem
"It's an invisible disease…people think it's all in their heads, especially when there are no outward symptoms," says Dr. Frank J. Sileo, a Crohn's disease patient, psychologist, and author. The broad spectrum of symptoms makes it difficult for doctors to pinpoint the disease accurately. The final correct diagnosis brings tremendous emotional relief. Sileo confirms, "I kept thinking, 'Now it has a name.'"
Growing evidence suggests that symptomatic stages of Crohn's disease may go undetected for years. While the number of known cases in the Western world has increased dramatically over the past 50 years, the number of preclinical and missed cases is likely to have increased further. In his publication, "Preclinical and Undiagnosed Crohn's Disease: The Submerged Iceberg," Dr. Sorrentino, MD, states that known and diagnosed cases of Crohn's disease "represent only the tip of the iceberg."
Dr. Shamita Shah, MD, medical director of the Inflammatory Bowel Disease Program at Ochsner Health System in New Orleans, advises patients to discuss Crohn's symptoms openly with their medical team. "Talk about any symptoms you have, current or past, so your doctor can accurately identify signs of Crohn's."
Misdiagnosis is also a common problem for Crohn's patients
Dana Hartline was diagnosed and treated for ulcerative colitis for more than a year before her doctor discovered she was misdiagnosed and treated. Not only was she not diagnosed for her actual condition, but she was also receiving treatments designed for a disease with very different treatment requirements. Doctors made this common mistake because some of their symptoms, such as pain and diarrhea, are common to both diseases. In a recent survey, more than 10% of patients were misdiagnosed with ulcerative colitis. "There are many other symptoms that can also be associated with Crohn's, including joint pain, current mouth sores, and skin tags," says Dr. David Suskind, MD, director of clinical gastroenterology at Seattle Children's Hospital.
The following conditions may all be misdiagnosed as Crohn's:
- Celiac disease
- Food intolerances
- Irritable bowel syndrome
- Irritable bowel disease
- Colitis
- Diverticulitis
- Endometriosis
- Colon cancer
Early signs and symptoms of Crohn's
The Mayo Clinic reports that active symptoms of Crohn's come and go, so you may have had some symptoms in the past and then go through long periods of remission. (This means you still have the disease but may not realize it.) When active, you may notice common symptoms such as:
- Diarrhea
- Fever
- Fatigue
- Abdominal pain and cramping
- Blood in the stool
- Mouth ulcers
- Loss of appetite and weight loss
- Pain or discharge in or around the anus due to inflammation of skin tunnels (fistulas)
In severe cases, patients may also experience the following symptoms:
- Inflammation of the skin, eyes, and joints
- Inflammation of the liver or bile ducts
- Kidney stones
- Iron deficiency (anemia)
- Delayed growth or sexual development in children
In addition to the digestive tract, systemic symptoms can affect your overall health and quality of life, the Crohn's and Colitis Foundation reports. These symptoms may include:
- Redness or pain in the eyes or vision problems
- Swelling and painful joints
- Skin complications such as lumps, sores, or rashes
- Night sweats
- Loss of regular menstrual periods
- Osteoporosis
- Rare liver complications, including primary sclerosing cholangitis and cirrhosis
Both women and men can develop Crohn's disease, but women may experience unique symptoms, including menstrual cramps, anemia, decreased fertility, painful intercourse, and osteoporosis.
Diagnosis: There is no uniform test for Crohn's disease
Due to its similarities to other diseases, a proper diagnosis should be made by a competent physician. Your doctor will review your medical history and perform a physical examination. Your doctor may start with some lab tests, and may then order more detailed imaging of the gastrointestinal tract. Common lab tests may include an anti-Saccharomyces cerevisiae (ASCA) antibody test, a complete blood count (CBC) to detect low red blood cell counts (anemia), C-reactive protein to detect inflation, and electrolyte tests to detect minerals such as potassium. Imaging tests may include X-rays, CT scans, or MRIs. The main concern is to rule out other possible illnesses first. A good doctor will want to know about any of the above symptoms you may have experienced.
Treatment: Finally, there is good news
The goal of treatment for Crohn's disease is to maintain remission by eliminating active symptoms. This includes preventive treatment of disease flare-ups and control of inflammation. Of course, smoking cessation and monitoring the diet for foods that trigger acute attacks are recommended. Older treatments still leave some patients with severe, debilitating and painful illnesses.Thanks to a new class of highly effective treatments called biologics, the outlook for Crohn's patients is much brighter. "Before these biologic therapies, we had 20 to 25 patients with inflammatory bowel disease living in our wards. Now there are only a handful," says Dr. Stephen Hanauer, MD, gastroenterologist and medical director of the Northwestern Medicine Digestive Health Center. Treatments have advanced by leaps and bounds in the past year or two. "We've made tremendous progress," says Dr. David Rubin, MD, chief of the division of gastroenterology, hepatology and nutrition at the University of Chicago Medicine and co-director of the Digestive Diseases Center.
Conclusion: Recent medical advances mean remission for patients
These recent advances in biologic therapies mean that patients have a significantly improved quality of life compared to the past decade when they faced multiple, lengthy hospital stays. Today, things are different because these new biologic therapies can stop symptoms and maintain remission. "If we treat a Crohn's patient today, they should be in remission. "He should be comfortable and not have any major problems that impact his life," says Dr. Hanauer, MD.
