The cardinal Crohn’s disease symptoms are chronic diarrhea, abdominal pain and fever.
Diarrhea
The diarrhea is mostly bloody, but is absent in 15 to 25% of cases. There is often pain in the pain right lower abdomen, which has to be delineated from other causes of abdominal pain such as appendicitis, ectopic pregnancy (tubal pregnancy) in women etc. About 25 to 30% have either a history or else have active perianal fistulas or ulcers.
When this occurs, it is a powerful pointer to Crohn’s disease. Histologically these perianal fistulas are the same granulomatous tissue as Crohn’s lesions inside the bowel wall. Other symptoms are associated with malabsorption syndrome or are due to other associated conditions that often are found alongside Crohn’s disease.
Anemia
The diarrhea is mostly bloody leading to anemia, but is absent in 15 to 25% of cases.
Pain
There is often pain in the pain right lower abdomen, which has to be delineated from other causes of abdominal pain such as appendicitis, ectopic pregnancy (tubal pregnancy) in women etc.
Fistulas
About 25 to 30% have either a history or else have active perianal fistulas or ulcers.
Malabsorption syndrome
For instance, Crohn’s disease anemia and growth retardation are due to malabsorption. The same is true for the higher incidence of kidney stones (change in metabolism of uric acid and increased absorption of oxalate) and gall stones (impaired absorption of bile salts).
Joint pains
However, symptoms of lower back pain and arthritic type joint pains point to a known association with ankylosing spondylitis. This inherited connective tissue disease is associated with a certain histocompatibility antigen (HLA antigen B27).
Weight loss
With chronic Crohn’s disease there is weight loss due to malabsorption. The scarring of the affected bowel area and internal fistula formations lead to more and more presentations to the surgeon and occasional surgeries will have to be done.
Bowel obstruction
The surgeon will like to avoid surgery as it is common knowledge that these patients do not heal well and will likely have new recurrences of fistulas and bowel obstructions with more and more difficult decisions in future how to handle this.
Crohn’s Disease Symptoms
References
1. M Frevel Aliment Pharmacol Ther 2000 Sep (9): 1151-1157.
2. M Candelli et al. Panminerva Med 2000 Mar 42(1): 55-59.
3. LA Thomas et al. Gastroenterology 2000 Sep 119(3): 806-815.
4. R Tritapepe et al. Panminerva Med 1999 Sep 41(3): 243-246.
5. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapters 20,23, 26.
6. EJ Simchuk et al. Am J Surg 2000 May 179(5):352-355.
7. G Uomo et al. Ann Ital Chir 2000 Jan/Feb 71(1): 17-21.
8. PG Lankisch et al. Int J Pancreatol 1999 Dec 26(3): 131-136.
9. HB Cook et al. J Gastroenterol Hepatol 2000 Sep 15(9): 1032-1036.
10. W Dickey et al. Am J Gastroenterol 2000 March 95(3): 712-714.
11. M Hummel et al. Diabetologia 2000 Aug 43(8): 1005-1011.
12. DG Bowen et al. Dig Dis Sci 2000 Sep 45(9):1810-1813.
13. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 31, page 311.
14. O Punyabati et al. Indian J Gastroenterol 2000 Jul/Sep 19(3):122-125.
15. S Blomhoff et al. Dig Dis Sci 2000 Jun 45(6): 1160-1165.
16. M Camilleri et al. J Am Geriatr Soc 2000 Sep 48(9):1142-1150.
More references
17. MJ Smith et al. J R Coll Physicians Lond 2000 Sep/Oct 34(5): 448-451.
18. YA Saito et al. Am J Gastroenterol 2000 Oct 95(10): 2816-2824.
19. M Camilleri Am J Med 1999 Nov 107(5A): 27S-32S.
20. CM Prather et al. Gastroenterology 2000 Mar 118(3): 463-468.
21. MJ Farthing : Baillieres Best Pract Res Clin Gastroenterol 1999 Oct 13(3): 461-471.
22. D Heresbach et al. Eur Cytokine Netw 1999 Mar 10(1): 7-15.
23. BE Sands et al. Gastroenterology 1999 Jul 117(1):58-64.
24. B Greenwood-Van Meerveld et al.Lab invest 2000 Aug 80(8):1269-1280.
25. GR Hill et al. Blood 2000 May 1;95(9): 2754-2759.
26. RB Stein et al. Drug Saf 2000 Nov 23(5):429-448.
27. JM Wagner et al. JAMA 1996 Nov 20;276 (19): 1589-1594.
28. James Chin, M.D. Control of Communicable Diseases Manual. 17th ed., American Public Health Association, 2000.
29. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157, page 1181.
30. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.
31. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.
32. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.
33. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
