Crohn’s disease: symptoms, diagnosis and care

Crohn’s disease is an inflammatory bowel condition that can affect any part of the digestive tract.

Inflammation often involves the small bowel or large bowel and may occur in separate patches. It is a long-term condition, but its activity can change over time, with periods of active symptoms and periods when symptoms are quieter.

Abdominal pain, diarrhoea, blood in stool and unintentional weight loss are common presentations of Crohn’s disease. Urgency to pass stool, tiredness, poor appetite and fever may also occur. Symptoms can develop gradually or become more noticeable during a flare.

Seek prompt medical advice for significant bleeding, severe or worsening abdominal pain, repeated vomiting, a swollen abdomen, dehydration, or fever with marked illness. These symptoms need assessment because they can have several causes.

The exact cause is not fully understood. Crohn’s disease is thought to involve an immune response that causes ongoing inflammation in the digestive tract. Inherited tendency, the gut environment and environmental influences may contribute; it is not caused by a single food or by stress alone.

A flare is a period when inflammation and symptoms are active. Remission means symptoms are controlled and inflammation may be reduced. Keeping appointments and monitoring symptoms can help the care team adjust treatment before a flare becomes more disruptive.

Crohn’s disease can occur at different ages. Having a family member with inflammatory bowel disease may be relevant. Smoking can make Crohn’s disease harder to control, so support to stop smoking is an important part of care.

Diagnosis brings together your history, examination and tests. Blood and stool tests can look for inflammation, anaemia, infection or nutritional effects. A specialist may use endoscopy, scans or tissue samples to see where inflammation is located and to rule out other conditions.

Treatment aims to settle inflammation, maintain remission and manage complications. Depending on the bowel areas involved and severity, this may include anti-inflammatory medicines, medicines that alter immune activity, nutrition support or surgery. A gastroenterology team will tailor the plan and monitor for medicine effects.

Surgery may be considered for a narrowed bowel segment, fistula, abscess or symptoms that do not respond adequately to medical treatment. It can address a specific problem but does not remove the need for ongoing Crohn’s disease care.

A symptom and food diary can help identify patterns without unnecessarily restricting your diet. During a flare, ask the care team about hydration, nutrition and work or school adjustments. Vaccines, travel plans and pregnancy should be discussed early because some treatments affect these decisions.

Inflammation can sometimes narrow the bowel or form tunnels between tissues called fistulas. Anaemia, poor nutrition and abscesses can also develop. New severe pain, fever or drainage from around the anus should be reviewed promptly.

A GP can start an assessment and arrange referral to a gastroenterologist when inflammatory bowel disease is suspected. Seek urgent care for heavy rectal bleeding, severe abdominal pain, fainting, or signs of dehydration.