Crohn's Disease

Symptoms

An individual's symptoms depend on where in the digestive tract the disease is flaring, and how severe it is [Table 1].

Most people have involvement of the ileum, the lower part of the small intestine, causing abdominal pain and diarrhea. Abdominal pain is common after eating, especially in the lower right area.

Diarrhea is often present, and tends to be urgent if the rectum is involved. Observable blood in the stool may occur intermittently, and can be serious and persistent enough to lead to anemia. Some people also experience low-grade fever, nausea, and vomiting. If the anus is involved, fissures or cracks may be evident, and fistulas and abscesses may form.

Some people also have inflammation in places other than their intestines, and may develop skin or mouth lesions, pains in the joints, and eye irritation.

With severe disease, weight loss and extreme fatigue due to nutrient and blood loss may develop, and may require hospitalization to stabilize the individual. High fever, vomiting, severe pain, and weakness can indicate an emergency, and may require immediate evaluation of an infection or an intestinal blockage or perforation.

In children, delayed development and poor growth may be evident before any other symptoms are apparent.

Risk Factors

Crohn's disease usually starts in childhood or early adulthood. It tends to run in families and has a high incidence in Jews. Most cases of Crohn's disease start before age 30, and a second smaller peak of incidence occurs when people are in their fifties and sixties. About 20% of people diagnosed have a relative who also has inflammatory bowel disease, most often a brother or sister.

Jewish people of European descent have a fourfold higher incidence than the general population.

Smoking is associated with an increased risk, especially of disease recurrence following surgery.