Crohn’s Disease and related inflammatory bowel diseases now effect over 3 million Americans. To this day, medical experts do not know what causes Crohn’s disease, an inflammatory disorder of the digestive tract. Crohn’s is a life-long condition that cannot be cured. Left untreated, Crohn’s can lead to life-threatening complications. It is therefore important to catch early signs of the disease. Medical News Today reports that, “The early signs and symptoms of Crohn’s disease can resemble those of other conditions.” Additionally, Dr Sethi, MD MPH confirmed that, “Early treatment can help address symptoms and prevent flares and complications.”
Doctors Report Underdiagnosis a Serious and Ongoing Concern
“It’s an invisible illness … people think it’s all in your head, especially if there are no outer symptoms,” says Frank J. Sileo, PhD, Crohn’s patient, psychologist, and author. The wide range of symptoms make it difficult for doctors to pinpoint the disease. A final and correct diagnosis brings a tremendous amount of mental relief. Sileo confirms that, “I just kept thinking, ‘Now it has a name.’”
Increasing evidence suggests the symptomatic phase of Crohn’s Disease can go undiagnosed for years. While known cases have risen drastically in the western world over the last 50 years, the number of preclinical, and underdiagnosed cases may have risen even further. In his publication, “Preclinical and Undiagnosed Crohn’s Disease: The Submerged Iceberg” Dr Sorrentino MD, says known and diagnosed cases of Crohn’s Disease “represents the classic tip of the iceberg.”
Dr Shamita Shah, MD, medical director of the inflammatory bowel disease program at Ochsner Health System in New Orleans, advises that patients should be vocal about their Crohn’s symptoms with their medical team. “Speak up about all of your current or past symptoms so your doctor can pinpoint Crohn’s clues.”
Misdiagnosis Also a Common Problem for Suffers of Crohn’s
Dana Hartline was diagnosed and treated for ulcerative colitis for over a year before yet more doctors found that she had been misdiagnosed and incorrectly treated. Not only had her true condition not been diagnosis, but she was given therapies that were designed for a disorder with very different treatment needs. Doctors made this common error because some of the symptoms she had like pain and diarrhea can be seen in both conditions. In a recent survey over 10% of patients were misdiagnosed with ulcerative colitis. “There are a lot of other symptoms that can be associated with Crohn’s as well, including joint pain, current oral ulcers and skin tags,” said Dr David Suskind MD, Director of Clinical Gastroenterology at Seattle Children’s Hospital.
The following are all potentially misdiagnosed as Crohn’s Disease:
- Coeliac disease
- Food Intolerances
- Irritable bowel syndrome
- Irritable bowel disease
- Colitis
- Diverticulitis
- Endometriosis
- Colorectal cancer
Early Signs and Symptoms of Crohn’s Disease
The Mayo Clinic reports that active symptoms of Crohn’s Disease come and go, so that you could have some symptoms in the past, and then experience long periods of remission. (You would still have the disease and potentially not know it.) In the active state, you may notice any of these common signs such as:
- Diarrhea
- Fever
- Fatigue
- Abdominal pain and cramping
- Blood in your stool
- Mouth sores
- Reduced appetite and weight loss
- Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)
In severe cases, patients may also experience:
- Inflammation of skin, eyes and joints
- Inflammation of the liver or bile ducts
- Kidney stones
- Iron deficiency (anemia)
- Delayed growth or sexual development, in children
The Crohn’s & Colitis Foundation reports that beyond the digestive tract, systemic symptoms can affect your overall health and quality of life. These can symptoms include:
- Redness or pain in the eyes, or vision changes
- Swollen and painful joints
- Skin complications, such as bumps, sores, or rashes
- Night sweats
- Loss of normal menstrual cycle
- Osteoporosis
Rare liver complications, including primary sclerosing cholangitis and cirrhosis
Diagnosis: No Single Test for Crohn’s Disease
Due to the similarity to other conditions, proper diagnosis should be made a competent medical professional. Your doctor may review your history and perform a physical exam. It is likely that your doctor may want to start out by ordering some lab tests then perhaps more in-depth imaging of the GI tract. Common lab tests may include antibody testing for Anti-Saccharomyces cerevisiae (ASCA), a complete blood count (CBC) to check for low red-blood cells (anemia), C-reactive protein to check for inflation, and an electrolyte panel to check for minerals potassium. Imaging tests may include X-rays, CT scans or MRIs. It will be of chief concern for your healthcare provider to rule out other potential conditions first. A good doctor will want to know about any of the above symptoms that you may have experienced.
Treatments: Finally, Some Good News
The goal of Crohn’s treatment is to maintain remission through a lack of active symptoms. It involves preventative treatment of flareups and controlling inflammation. It is recommended to stop smoking and monitor diet for food that cause flareups. With older treatments, disease management will still leave some individuals with debilitating, and distressing disease severity. Thanks to a new class of highly effective therapies called biologics, the outlook for Crohn’s patients is much more promising. “Before these biologic therapies, we had an inpatient unit of 20 to 25 patients with inflammatory bowel disease. That’s down to a handful now,” says Dr Stephen Hanauer, MD, gastroenterologist, and medical director of the Digestive Health Center at Northwestern Medicine. Treatments have advanced by leaps and bounds over the last decade or two. “We’ve made tremendous progress,” Says Dr David Rubin MD, section chief of Gastroenterology, Hepatology and Nutrition and co-director of the Digestive Diseases Center at University of Chicago Medicine.
In Conclusion: Recent Advances Spell Relief For Patients
These recent advances in biologic therapies mean patients have experienced a great amount of lifestyle improvement than those suffering in just the last decade when patients could expect to have numerous, lengthy hospital stays. Now things are different, due to these new biologic therapeutics that stop symptoms and maintain remission. “In the current era, when we treat someone with Crohn’s, they should expect to be in remission. “They should expect to feel well and not to have significant problems that affect their life,” says Dr Hanauer MD.