Diagnosing Crohn's DiseaseCrohn's disease is relatively easy to identify with a colonoscopy -- a medical procedure in which doctors insert a long and flexible electronic tube into the colon (large intestine) and the rectum and examine the inner lining of those organs. Crohn's patients have inflammations covering the entire depth of the intestinal wall. In particularly bad cases, there may be ulcers as well.
If the doctor performs a biopsy, by removing a sample of the inflamed tissue from the colon and examining it under a microscope, she/he will be able to detect inflammation of the mucus, characterized by focal infiltration of neutrophils, a type of inflammatory cell, into the epithelium. This typically occurs in the area overlying lymphoid aggregates. These neutrophils, along with mononuclear cells, may infiltrate into the crypts leading to inflammation (crypititis) or abscess (crypt abscess). In 50% of Crohn's Disease cases, doctors will also find Granulomas, aggregates of macrophage derivatives known as giant cells. Biopsies may also show that Crohn's patients suffer from chronic damage of the intestinal walls; for example, the villi, tiny hairlike protrusions from the intestinal wall, may be blunted instead of sharp.
The signs of Crohn's disease are many, and painful. The most common symptoms are abdominal pain and diarrhea, but there are many others. The full list of symptoms is in itself long and detailed enough to cause nausea; it includes fever, fatigue, loss of appetite, chronic watery diarrhea and pain while passing stool, bloody stool, rectal bleeding, gas, constipation, inflammation in the eye, infected areas in the anus known as "fistulas," bleeding in the intestine, paint in the joints, kidney stones, inflammation of the liver, abdominal cramps, a sensation of fullness in the abdomen, skin rashes, swollen gums and, unsurprisingly, weight loss. The rectal bleeding may be serious and persistent, leading to anemia. Children with Crohn’s disease, in particular may suffer delayed development and stunted growth.
Crohn's disease leads to many complications, but the most common is a blocked intestine. The wall of the intestine thickens because of swelling and scar tissue, and the intestinal passage becomes too narrow for all the waste to pass. As if that were not bad enough, Crohn’s sometimes causes sores, or ulcers, that burrow their way through the affected area into surrounding tissues, such as the skin, bladder, vagina, rectum and anus. These tunnels, called fistulas, often become infected. They can sometimes be treated with medicine, but particularly big ones may require surgery to remove. The lining of the anus may also develop rips and tears, known as fissures.
Perhaps as a result of the damage that Crohn's does to the gastro-intestinal system, people with the disease often become malnourished; their bodies run low on proteins, calories, and vitamins. These deficiencies could have many causes; Crohn’s patients may not be eating enough, because food makes them feel sick, or their intestines may lose protein to the inflamed areas, or the scar tissue and swelling may prevent nutrients from getting absorbed.
That is not all. Crohn’s disease is also associated with arthritis, skin problems, inflamed eyes and mouth, kidney stones, gallstones, and liver disease. Although the treatment of symptoms in the digestive system may resolve some of these problems, others require separate treatment. . Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.
Given the sheer magnitude of Crohn's symptoms, their similarity to the signs of many other common diseases, and the fact that Crohn's can affect just small patches of the gastrointestinal tract at first, rather than the entire intestine, it is hardly surprising that many people with Crohn's disease have symptoms for years before they get diagnosed. Usually, the disease first hits victims between 15 and 30 years old, although it can occur at any age. However, the disease can also subside and then reappear (flare up) again years later.
Fortunately, not every one with Crohn's' has all of these problems all the time. Depending on what part of the gastrointestinal tract is affected, the symptoms can range from mild to severe, and can come and go with periods of flare-ups.
The most common way to check for Crohn's Disease is a full physical examination. Blood tests can reveal anemia, which is often a result of bleeding inside the intestines, or a high white blood cell count, which is a sign that some part of the body has inflammation. A colonoscopy lightens up the interior of the anus and intestine and sends enlarged images to a TV or computer monitor, where the doctor can check the mucosal lining for fissures, swelling, bleeding or inflammation. A sigmoidoscopy works the same way, on a smaller scale, for the lower part of the large intestine. The physical might also reveal extra mass or tenderness in the abdomen -- which suggests inflammation and scar tissue --, a skin rash, a mouth ulcer or swollen joints. Among the many other tests used to diagnose the disease, in addition to the colonoscopy and sigmoidoscopy described above, are a barium enema, a biopsy (see above), a CT scan of the abdomen, an MRI of the abdomen, a series of x-rays of the small bowel, or a stool culture.
Crohn's disease, in sum, is chronic. No cure exists. It can also be extremely painful and have multiple complications. However, a thorough medical examination can detect the most dangerous symptoms, such as inflammations, which are amenable to treatment although the disease that produces them will never go away for good.
*This article is based on the information at AARP Health Tools , Wikipedia and National Institutes of Health: Crohn's Disease Page |
