Crohn’s disease (CD) is an extremely complex disorder, made more so by the fact that the symptoms and complications can take different forms, depending on which part of your intestine is inflamed. While CD can affect any part of the intestine, certain areas are affected more typically than others. Your physician may refer to your condition based on the primary area involved in your case.
The most common forms are:
- Ileocolitis
- Ileitis
- Crohn's (granulomatous) colitis
- Gastroduodenal CD
- Jejunileitis
Each form has a distinct presentation, differing symptoms, and a set of commonly associated complications.
Ileocolitis
The most common form is ileocolits, which occurs in about 45 percent of people with CD. This form of CD affects the ileum (lower end of the small intestine) and the colon (large intestine). Symptoms of this type of CD can include diarrhea, cramping pain in the lower right or the middle abdomen, and significant weight loss. In some cases, the diseased areas in the ileum and the colon may be contiguous, affecting the valve that connects the small intestine to the large intestine, called the ileocecal valve.
Treatment for this form of CD often includes a maintenance drug for continuation of remission, such as a 5-ASA (5-aminosalicylic acid) drug or sulfasalazine. Other drugs that may sometimes be used include an antibiotic and/or a steroid drug such as prednisone and, for severe cases, a drug that suppresses the immune system. Additionally, severe ileocolitis may require more intense treatment administered in the hospital setting, such as bowel rest (nothing to eat or drink) and enteral feeding (nutrition through a nasogastric tube) or parenteral feeding (intravenous nutrition).
Ileitis
Ileitis is the second most common form of CD, affecting about 35 percent of patients with CD. This type, also known as fistulizing or perforating CD, affects only the ileum (the last part of the small intestine). Diarrhea, weight loss, cramping pain in the lower right or middle abdomen, and discomfort a few hours after eating a meal are common symptoms.
This type of CD can cause malabsorption of vitamins or minerals. Two common nutritional deficiencies are the lack of vitamin B12 and the lack of folate. A lack of folate may prevent the creation of new red blood cells and therefore result in anemia. A vitamin B12 deficiency can result in a tingling in the fingers or toes (peripheral neuropathy) and can also contribute to the development of anemia.
Complications from ileitis can include fistulas or abscesses in the right lower quadrant.
Gastroduodenal CD
Gastroduodenal CD, along with jejunileitis, make up about 5 percent of all CD cases. This form of CD affects the stomach and duodenum (the first part of the small intestine). Symptoms include loss of appetite, weight loss, nausea, vomiting and pain in the upper middle abdomen. Vomiting may be a sign that there is an obstruction in a narrowed portion of the small intestine. This form of CD is sometimes misdiagnosed as an ulcer, with the CD only being discovered after treatment for the “ulcer” does not relieve symptoms or if active CD is discovered in another section of the gastrointestinal tract.
Jejunoileitis
This form of CD is characterized by intermittent areas of inflammation in the jejunum, which is the middle, and longest, section of the small intestine. The jejunum is responsible for absorbing most nutrients from food. Symptoms include crampy pain after meals, diarrhea, and abdominal pain that can vary from mild to intense. Complications of jejunoileitis include fistulas (an abnormal tunnel connecting two body cavities) and malnutrition caused by the poor absorption of nutrients.
Crohn's Colitis
Crohn's colitis (CC), sometimes called granulomatous colitis, is a form of CD that affects only the colon. This type of CD affects 20 percent of patients. CC is often confused with ulcerative colitis (UC), but there are two distinct differences between CC and UC:
- Inflammation in UC is always contiguous, while in CC it is intermittent throughout the colonl
- UC always affects the rectum while CC may not.
Symptoms of CC include diarrhea, bleeding from the rectum, and abscesses, fistulas, or ulcers around the anus. Peripheral arthritis and skin conditions associated with inflammatory bowel disease are found more frequently with CC than the other types of CD.
Sources:
Crohn’s and Colitis Foundation of America. "About Crohn's Disease." Crohn’s and Colitis Foundation of America 2007. 11 May 2007.
Mark A Peppercorn, MD. "Patient information: Crohn's disease." UpToDate.com 2 Apr 2003. 11 May 2007.
Abbott Laboratories. "About Crohn's Disease." Abbott Laboratories 2006. 11 May 2007.
