Diagnosis and Complications of Crohn's Disease

Diagnosis of Crohn's Disease

Once transient infection has been ruled out and inflammatory bowel disease is suspected, it is important to make a correct diagnosis of either Crohn's Disease or ulcerative colitis. Tests done are :

Sigmoidoscopy : Sigmoidoscopy is more useful for diagnosing ulcerative colitis than Crohn's Disease. The test can rule out Crohn's Disease if the sigmoid colon shows clear signs of ulcerative colitis. 

Colonoscopy : A small set of forceps inside the colonoscope allows removal of small tissue samples for biopsy or to remove polyps. 

Barium enema : It is considered the 'gold standard' in distinguishing between Crohn's Disease and ulcerative colitis. 

Laboratory Tests of Crohn's Disease

Laboratory tests help to substantiate the diagnosis. In a patient of inflammatory bowel disease, the tests reveal:

1. Elevated white blood cell count (suggests infection) 
2. Raised ESR - Erythrocyte (red blood cell) Sedimentation Rate (suggests persistent inflammation)
3. Low haemoglobin and low red blood cell count (suggests anaemia). 

Complications of Crohn's Disease

As the inflammation in Crohn's Disease affects the entire thickness of the intestinal wall (rather than only the inner mucosal layer, as in ulcerative colitis), some additional complications that can occur as compared to ulcerative colitis are : 

Fistulas : Fistulas are openings that breach the intestinal wall and connect diseased intestinal tissue with another loop of intestine, another internal organ such as the bladder, or the skin through the abdominal muscle wall or near the anus. 

Fissures : Fissures are deep crevices in the skin around the anus. They make bowel movements painful. 

Other perianal complications include haemorrhoids and large external skin tags. 

Strictures and Obstructions: Strictures are areas of the intestine ( most often the small intestine ) that have been severely narrowed due to disease. 

Abscesses : These are pockets of infection that form outside the bowel wall near a portion of the diseased tissue. 

Malnutrition : Malnutrition is a greater risk for individuals with Crohn's Disease than for those with ulcerative colitis. Individuals with Crohn's Disease face the additional issue that their disease is often present in those portions of the small intestine where nutrients are absorbed. Therefore, they are generally treated with daily doses of folic acid and quarterly injections of vitamin B12.

Colon cancer risk : Individuals with Crohn's Disease have a slightly increased risk of developing colorectal cancer, although not as much of an increased risk as those with ulcerative colitis. Regular screenings - either a colonoscopy with biopsy or a barium enema - for early detection of cancer should begin about 8-12 years after initial diagnosis. 

Introduction of Crohn's Disease
Causes and Symptoms of Crohn's Disease
Diagnosis and Complications of Crohn's Disease
Treatment for Crohn's Disease