Crohn's Disease

Diagnosis

A clear diagnosis is sometimes difficult to obtain because symptoms overlap with symptoms of several other conditions. Diagnosis may involve numerous tests and time. The most common symptoms, intermittent diarrhea and pain, could also be caused by ulcerative colitis, irritable bowel syndrome, cancer, diverticular disease, or infectious agents. Bloody diarrhea can be caused by ulcerative colitis, diverticulosis or infection.

A complete history and physical are essential, including blood tests and stool samples.

An upper gastrointestinal series—x-rays taken after the patient drinks a substance called barium—is an important diagnostic procedure that may be used to identify the nature and extent of the disease. Barium is a chalky substance that appears white on x-rays . When barium is ingested, the stomach and small intestines can be seen on the x-ray. When barium is inserted into the rectum, the colon and the lowest part of the ileum can be seen. Barium x-rays may reveal typical features of Crohn's disease, including involvement of the lower part of the ileum, with narrowing, the formation of nodules, and deeply slit ulcers that give a cobblestoned appearance. A CT scan— a type of x-ray that allows doctors to see internal organs—may reveal bowel wall thickening and small abscesses. It is painless and only requires that the patient lay as still as possible for up to an hour.

Another important diagnostic procedure that may be done is a colonoscopy. This procedure allows the viewing of the interior lining of the large intestine (colon) using a colonoscope, a flexible fiber-optic tube. An eyepiece lets the doctor to see inside the body. Colonoscopy allows the doctor to examine and take biopsies of suspicious areas of the colon. This procedure is best performed when a patient's symptoms are in remission.

When a patient is critically ill with severe pain and weakness, an intestinal blockage or perforation (which may or may not be due to Crohn's disease) as well as appendicitis or diverticulitis must be considered and quickly diagnosed. A colonoscopy may be too risky to perform at such a time. An abdominal CT or ultrasound may be needed to determine if any of these conditions are present.

The diagnosis and treatment of Crohn's disease usually involves a team of health care providers, including the patient's primary-care doctor, a doctor who specializes in diseases of the digestive tract (gastroenterologist), and a surgeon if necessary. A dietitian and counselor can also be helpful.