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Diagnosing Crohn’s Disease

Overview

Many people won't seek treatment for Crohn's disease for months, years, or in some cases, even decades. You might ignore your symptoms because they’re mild or you may mistake them for a less serious condition, such as lactose intolerance.

There aren’t any simple, definitive tests for Crohn’s disease. Talk to your doctor before trying to diagnose yourself with Crohn's. They’ll look for specific symptoms and perform in-depth testing to diagnose you properly.

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Symptoms

Symptoms of Crohn's disease

Crohn's is a chronic disease, which means that symptoms may go away for a long time and then reappear during flare-ups.

Crohn's disease shares symptoms with other conditions. However, you should keep an eye on a few symptoms in particular:

  • severe, crampy abdominal pain around the navel or right lower abdomen, or both (usually shortly after eating)
  • frequent diarrhea, with or without blood
  • blood or mucus in the stool
  • frequent, urgent bowel movements
  • weight loss due to nutritional deficiency
  • decreased appetite related to discomfort after eating
  • significantly increased gas
  • a persistent lack of energy
  • a firm swelling anywhere in the abdomen that is usually painful to the touch
  • perianal disease, with inflammation and a fistula that can cause abscesses around the anus

Your doctor will take any of these symptoms into account. They’ll likely order further diagnostic tests.

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Diagnosis

Procedures to test for Crohn’s disease

Your doctor may recommend various procedures or imaging scans to test for Crohn’s disease. These procedures can detect abnormalities in your intestines. They can also test for cell abnormalities that may indicate Crohn’s disease.

These tests can take several minutes or several days to produce results. Your doctor will also give you multiple tests to confirm that each test produces consistent results.

It might take weeks or months before your doctor can tell you whether you have Crohn’s disease. You might also need to wait a long time between doctor’s visits and tests.

Below are some of the tests your doctor may order.

Blood testing for Crohn’s disease

Your doctor may recommend blood tests for Crohn’s disease. These tests won’t diagnose the disease, but they can nonspecifically point out inflammation in the body. The inflammation may be related to a noninfectious or infectious cause. Examples of these tests include:

  • Complete blood count (CBC): This measures the amount of red blood cells, hemoglobin, white blood cells, and platelets you have in your body. A high white blood cell count could indicate possible inflammation.
  • Sedimentation rate (ESR) test: This measures possible inflammation by testing how quickly red blood cells clump together and fall to the bottom of a test tube within an hour. The faster the red blood cells travel to the bottom of the tube and form sediment, the more intense your body’s inflammatory response is at the time of the test.
  • C-reactive protein (CRP) test: This measures possible inflammation by indicating the level of CRP in your blood. The higher the CRP level, the more intense your body’s inflammatory response is at the time of the test.

Capsule endoscopy

This test involves swallowing a small, pill-like capsule with a camera inside of it. The capsule takes photos as it travels through your gastrointestinal (GI) tract. You eliminate the capsule painlessly during a bowel movement. Your doctor views the photos to find abnormalities in your intestinal lining.

Endoscopy

An endoscopy involves inserting a thin, lighted, fiberoptic tube with a camera on the end (known as a scope) into either your esophagus or anus. In an EGD, or upper endoscopy, the doctor moves the scope from your mouth through your esophagus, stomach, and small intestine. In a colonoscopy, they move the scope from your anus and through the rest of your colon.

Your doctor may take tissue samples from anywhere along your intestinal tract, searching for inflammatory changes such as ulcers, cancer tumors, or granulomas. The presence of granulomas can indicate Crohn’s disease. According to up to 20 percent of people with Crohn’s disease have granulomas.

Other imaging studies

Imaging tests include CT and MRI scans. Both tests can help your doctor find abnormalities in your bowels, such as abscesses, fistulas, perforations, and signs of inflammation. Your doctor considers the results of these and other tests when determining if you have Crohn’s disease.

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In children

Diagnosing Crohn’s disease in children

Children show many of the same symptoms of Crohn’s disease as adults, including:

  • constant diarrhea
  • abdominal cramping or pain
  • rectal urgency
  • abnormal weight loss
  • bleeding in the intestines
  • fever

Other symptoms you might see if your child has Crohn’s include:

  • red, itchy eyes
  • sores in the mouth or on the skin
  • kidney stones
  • pain or swelling in joints
  • stunted growth

If your child has these symptoms, take them to the doctor to get tested.

If your child is diagnosed with Crohn’s, your doctor may recommend medication to help keep their Crohn’s in remission. An anti-inflammatory drug such as sulfasalazine (Azuldifine) or mesalamine (Asacol HD) works in the large intestine and may help keep flare-ups from being painful. Corticosteroids such as budesonide can also help with inflammation. Other immune system suppressants such as azathioprine or adalimumab may help reduce inflammation and prevent the immune system from producing chemicals that cause inflammation.

Different drugs may be prescribed based on the areas affected by Crohn’s. It’s important to get an accurate diagnosis from a doctor to decide which treatment is best.

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Similar conditions

Conditions similar to Crohn's disease

Some conditions are similar to Crohn’s disease, but aren’t quite the same thing. Crohn’s disease is an inflammatory bowel disease (IBD), and its symptoms overlap with several other conditions. These include:

Condition Description Signs and symptoms that overlap with Crohn’s Prevalence
ulcerative colitis an IBD that affects only the large intestine, caused by an abnormal immune system response abdominal pain or cramping, diarrhea, and abnormal weight loss in North America, occurs in
celiac disease a malabsorption condition that affects the small intestine and is caused by an inability to digest gluten and where the immune system reacts abnormally diarrhea, gas, stomach cramping, and abnormal weight loss relatively common, affecting of the U.S. population
Behçet's disease a disease of vasculitis (inflammation of the blood vessels) that happens throughout the body ulcers in the mouth, anus, or rectum; (rarely) a “cobblestone” look in affected areas found in only in the United States, but much more common in countries in East Asia and the Middle East
irritable bowel syndrome (IBS) isn’t a disease, per se, and typically doesn’t cause any long-term damage abdominal pain, discomfort, and diarrhea alternating with constipation due to abnormal shifts in bowel movements affects around of the world’s population
diverticulitis a condition caused by inflammation of the diverticula, small tubular outpouches in your digestive tract; can be treated with antibiotics and bowel rest abdominal pain or cramping, fever, and abnormal bowel movements more common in older people, affecting up to of people older than 85 years, but as low as 5 percent of people younger than 40 years
 

If you believe you might have Crohn’s disease, talk to your doctor about getting tested for these other conditions. Some symptoms or signs, such as inflammation in only certain areas of the digestive tract, can distinguish a condition from Crohn’s.

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Treatment and outlook

What to do if you’re diagnosed with Crohn’s disease

Most people with Crohn’s disease lead active and productive lives, despite the lack of a cure.

With effective therapy, the disease may remain in remission for long periods. Flare-ups might only occur every few months or years. Advancements in treatments help even those with severe symptoms manage the disease better than ever before.

Surgical advances also make it possible to remain disease-free for years at a time.

Other effective treatment options for managing your Crohn’s and its complications include:

  • antidiarrheal medication
  • pain relievers for pain associated with Crohn’s
  • vitamin B-12 shots to prevent vitamin deficiency
  • iron, calcium, and vitamin D supplements
  • following a special diet based on your nutritional needs (for example, eliminating dairy, eating small meals, and drinking plenty of liquids)
  • antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) to help treat bacterial infection and possible related fistulas and abscesses

If you have Crohn’s disease, quit smoking tobacco. Some also suggests that keeping your stress levels low helps prevent flare-ups. Light exercise can help reduce stress and depressive symptoms. It can help keep your bowel movements regular as well.

Many daily choices can help you manage your Crohn’s disease. Talk to your doctor to see what treatments will help you maintain your highest quality of life.

Article resources
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  • Crohn’s disease and ulcerative colitis: A guide for parents. (2016).
  • da Silva BC, et al. (2014). Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis. DOI:
  • Diagnosis and managing IBD. (2011).
  • Gujral N, et al. (2012). Celiac disease: Prevalence, diagnosis, pathogenesis and treatment. DOI:
  • Irritable bowel syndrome. (2015).
  • Mayo Clinic Staff. (2016). Behcet’s disease: Symptoms and causes.
  • Mayo Clinic Staff. (2014). C-reactive protein test: Definition.
  • Mayo Clinic Staff. (2014). Crohn’s disease: Tests and diagnosis.
  • Mayo Clinic Staff. (2014). Diverticulitis: Definition.
  • Mayo Clinic Staff. (2016). Sed rate (erythrocyte sedimentation rate).
  • Stress may be an IBD trigger. (2010).
  • Weizman AV, et al. (2011). Diverticular disease: Epidemiology and management.
  • What is Crohn's disease? (n.d.).
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