Crohn’s disease (CD) is a chronic disease that can cause inflammation anywhere along the digestive tract from the mouth to the anus. Of all cases of CD, 45% occur in ileum and colon, 35% in just the ileum, and 20% in just the colon. Unlike ulcerative colitis (UC), which only affects the inner layer, CD commonly involves all layers of the intestinal wall. CD and UC are collectively called inflammatory bowel disease.
What are the symptoms of CD?Common symptoms of CD include chronic diarrhea fever, abdominal pain, weight loss, and lack of appetite. Frequent diarrhea can lead to dehydration and nutritional deficiencies. Because the colon is inflamed, it is not as efficient at absorbing water and nutrients from food. Fever is a characteristic of the inflammatory process, may be either high or low-grade, and presents especially during periods of active disease. Night sweats are caused by a fever spiking repeatedly during the night.
Extra-intestinal symptoms include eye inflammation, joint pains, skin rashes or lesions, fistulas and fissures. It is unclear why symptoms develop outside the digestive tract, but they often decrease in severity along with flare-ups.
Eye conditions that can occur with CD include conjunctivitis, episcleritis, uveitis, iritis and keratopathy. Most eye conditions will improve when progress is made in treating the underlying CD, but some may require treatment. Conjunctivitis, or “pink eye,” is an inflammation of the tissue covering the eye and inner surface of the eyelid and may be treated with antibiotics. Uveitis is the inflammation of the middle layer of the eye wall and symptoms include light sensitivity, pain, redness, blurred vision and headaches. Uveitis is commonly treated with corticosteroids; if left untreated it could result in glaucoma or detached retina. Inflammation in the white of the eye is called episcleritis: symptoms include pain and reddening, and treatment is with a vasoconstrictor or corticosteroid. Iritis is inflammation in the iris and symptoms include pain, light sensitivity, blurred vision, redness, decreased pupil size, and floaters. Steroids and antibiotics may be used to treat iritis. Keratophaty is an irregularity in the cornea that does not cause pain or loss of vision, and is therefore usually not treated.
Joint pains may be peripheral arthritis, which causes pain, swelling, and stiffness in the joints. The pain can migrate from one joint to the next and may last for several days or even weeks. Peripheral arthritis does not cause permanent damage to joints and will often improve when the CD is successfully treated. Treatment includes resting painful joints and applying moist heat. Other forms of arthritis may also occur with CD.
Erythema nodosum and pyoderma gangrenosum are skin conditions that may occur before or during a CD flare-up and improve with remission. Erythema nodosum are painful red nodules that develop on the arms or lower legs that affects more women than men. Pyoderma gangrenosum may appear as a blister on the legs or arms, usually at the site of a minor trauma such as a cut. The blister may progress into an ulcer that requires treatment with steroids or antibiotics.
A fissure is a tear or ulcer in the lining of the anal canal and symptoms include painful bowel movements, bright red blood in toilet bowel or on paper, anal lump, and swollen skin tag. Acute fissures may be treated with Sitz baths, fiber to create softer stools, stool softeners, topical hydrocortisone, zinc oxide, petroleum jelly and topical anesthetics. A chronic fissure may need more aggressive treatment including surgery.
A fistula is an abnormal tunnel connecting two body cavities or a body cavity to the skin. Approximately 30% of people with Crohn's Disease develop fistulas. Treatments include antibiotics, immunosuppresants, Remicade, liquid nutrition to replace solid food and surgery.
