How Is Crohn's Disease Diagnosed?

A variety of diagnostic procedures and laboratory tests are used to distinguish Crohn's disease from other inflammatory gastrointestinal conditions like ulcerative colitis.

First, your doctor will review your medical history. A specialist called a gastroenterologist may perform a colonoscopy or sigmoidoscopy to obtain bowel tissue for analysis. Other tests your health care provider may order include:

• Blood tests, including blood counts (often high white blood cell counts -- a sign of inflammation -- and low red blood cells counts a sign of anemia from blood loss -- are present).
• Stool samples to rule out infections as the cause of diarrhea.
• Special X-ray of both the upper and lower GI tract may be ordered as well to confirm the location of the inflammation.

Grades of Crohn's Disease

According to the American College of Gastroenterology, Crohn's disease activity is characterized as:

• Mild-moderate disease: Being able to eat with no evidence of dehydration, severe illness (fevers, significant weight loss, abdominal pain, nausea, vomiting) or severe anemia.
• Moderate-severe disease: Those who have failed to respond to treatment for mild-moderate disease or those with fevers, weight loss, abdominal pain, nausea, vomiting or significant anemia.
• Severe-fulminant disease: Those with symptoms despite taking corticosteroid treatment (see below), or individuals with high fevers, persistent vomiting, evidence of obstructed intestines, severe weight loss or major infection.
• Remission: no symptoms are present

What Triggers a Worsening of Crohn's Disease?

Crohn's disease is characterized by periods of being symptomatic, which can last for days or weeks, interspersed with periods of remission (no symptoms are present). Remissions can last days, weeks or even years.

Factors that worsen Crohn's disease include:

• Infections (including the common cold)
• Cigarette smoking
• Certain anti-inflammatory drugs (such as aspirin and ibuprofen)

How Is Crohn's Disease Treated?

Though treatments cannot cure Crohn's disease, they can help most people lead normal lives.

Medication

Crohn's disease is treated primarily with medications, including:

• Anti-inflammatory drugs, such as salicylates. Examples include Azulfidine (sulfasalizine), Dipentum, and Pentasa. Side effects include gastrointestinal upset, headache, nausea, diarrhea, or rash.
• Corticosteroids, a more powerful type of anti-inflammatory drugs. Examples include prednisone or Solu-Medrol, and Entocort. Side effects, if taken for long periods of time, can be severe and may include bone thinning, muscle loss, skin problems, increased risk of infection. Entocort has fewer side effects.
• Immune system modifiers such as azathioprine (Imuran) or methotrexate. It can take up to six months for these drugs to work. These medications are associated with increased risk for infections that can be life-threatening.
• Antibiotics such as Flagyl, Cipro and others. Flagyl can cause a metallic taste in the mouth, nausea and tingling or numbness of the hands and feet. Cipro can cause nausea and has been associated with rupture of the Achilles tendon.
• Antidiarrheal drugs
• Biologic therapy, such as Remicade. Remicade neutralizes the activity of a substance called tumor necrosis factor alpha (TNF-alpha). This substance is overproduced by people with Crohn's and plays an important role in causing the inflammation associated with Crohn's disease. The drug is given intravenously (through the vein). Side effects include life-threatening infection, infusion reaction, headache, stomach upset, fatigue, fever, pain, dizziness, rash, and itching.

Response to therapy is evaluated within several weeks of starting treatment. Treatment is continued until remission is obtained (at which time, the health care provider may consider maintenance therapy). No improvement calls for more aggressive therapy. Nutritional supplements may also be recommended by your doctor.

Surgery

Surgery is required in about one-half of people with Crohn's disease to treat complications of the disease, such as, fistulas, abscesses, hemorrhage, and intestinal obstructions. Surgery may also be necessary in people who do not respond to medications.