The following symptoms and complaints may indicate the onset of Crohn’s disease:
- Abdominal pain (abdominal pain/abdominal tenderness) in the right lower abdomen and periumbilical (around the umbilicus) (approximately 80%)
- Diarrhea (about 70%), possibly with mucus admixtures; hemorrhagic diarrhea (bloody diarrhea), possibly with mucus admixtures (45% / 35%).
- Fatigue
- Growth retardation: weight stagnation (in children) or weight loss (45% / 65%) possibly also pubertal delay.
- Performance kink (30% / 40%)
- Anorexia (loss of appetite) (25%)
- Fever (20% / 15%)
- Leukocytosis – increase in white blood cells.
(At diagnosis: < 10 years in % of cases / > 10 years in % of cases).
Note: 19% of all Crohn’s disease patients are under 20 years of age, occasionally the disease begins in infancy, then a growth disorder is often groundbreaking. Notice. Because of these symptoms, the disease can easily be confused with appendicitis.Symptoms that may be added later in the course of the disease are:
- Possibly palpable resistance in the lower abdomen.
- Iron deficiency anemia (form of anemia caused by iron deficiency).
- Perianal abscesses and fistulas /anal fistulas (about 40% of cases first symptom of the disease).
- Intestinal stenosis (intestinal narrowing: risk of ileus / risk of intestinal obstruction).
- Subileus – incomplete intestinal obstruction
Extraintestinal manifestations (signs of illness outside the gastrointestinal tract; up to 40% of cases,)
- Respiratory system:
- Fibrosing alveolitis – disease of the lung tissue and alveoli (air sacs).
- Eyes and eye appendages:
- Episcleritis – inflammation of the connective tissue between the sclera and conjunctiva of the eye.
- Iridocyclitis – inflammation of the iris (iris) and ciliary body (anatomy: corpus ciliare (ciliary or ray body).
- Uveitis, anterior (inflammation of the anterior vascular ocular structures) (6%).
- Blood, hematopoietic organs – immune system:
- Anemia (iron and B12 deficiency; most common manifestation).
- Autoimmune hemolytic anemia – anemia resulting from breakdown of red blood cells by autoantibodies.
- Endocrine, nutritional, and metabolic diseases:
- Amyloidosis – systemic disease with deposition of proteins (albumen) in various organ systems.
- Skin and subcutaneous tissue:
- Erythema nodosum (EN; synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) – granulomatous inflammation of the subcutis (subcutaneous fat), also known as panniculitis, and painful nodulation (red to blue-red color; later brownish). The overlying skin is reddened. Localization: both extensor sides of the lower leg, on the knee and ankle joints; less frequently on the arms or buttocks (6%).
- Psoriasisform manifestations (therapy-induced) (2%).
- Pyoderma gangraenosum (PG) – painful disease of the skin in which ulceration or ulceration (ulceration or ulceration) and gangrene (tissue death due to reduced blood flow or other damage) occurs over a large area, usually in one place (2%)
- Clock glass nails – Bulging nails.
- Zinc deficiency dermatitis
- Cardiovascular system:
- Perimyocarditis (inflammation of the heart muscle).
- Deep vein thrombosis (DVT; patients <40 years of age have a two-and-a-half-fold increased risk)
- Liver/biliary tract/pancreas:
- Cholangitis (inflammation of the bile duct): primary sclerosing cholangitis (PSC) (1%).
- Cholelithiasis (gallstone formation) – risk increased by a factor of 5.
- Pancreatitis (inflammation of the pancreas).
- Steatosis hepatis (fatty liver)
- Mouth, esophagus (food pipe), stomach and intestines:
- Stomatitis aphtosa (oral thrush) – disease of the oral mucosa and gingiva (gums) caused by herpes virus (herpes simplex virus type 1 (HSV-1)) (8%; oral manifestation may be the first symptom of Crohn’s disease).
- Musculoskeletal system and connective tissue:
- Arthralgia (joint pain)
- Arthritis* (joint inflammation): poly-/monoarhtitis (30%).
- Osteoporosis (bone loss)
- Bekhterev’s disease (ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”) – chronic inflammatory rheumatic disease with pain and stiffening of joints (6%).
- Back pain (lumbalgia / lumboischialgia / lumbago).
- Sacroiliitis – inflammatory change in the lower spine (joints between the sacrum and ilium, sacroiliac joints).
- Urogenital system:
- Nephrolithiasis (kidney stones).
- Cystitis and pyelonephritis (urinary tract infections).
* Joint involvement may occur concurrently with Crohn’s disease, but may precede or follow it by years. A distinction is made between:
- Type I: <5 joints affected; usually large joints, course strongly associated with disease activity.
- Type II: > 5 joints affected, mostly symmetrical involvement of finger joints, rather chronic and independent of disease activity
Risk assessment for inflammatory bowel disease (IBD) or colorectal cancer (CRC) (in patients <50 years) [2}
Common features of CED and CRC) are rectal bleeding, abdominal pain (abdominal pain; abdominal pain), diarrhea (diarrhea), weight loss, and iron deficiency anemia. According to one study, 10 parameters are considered significantly associated with CED or CRC:
- Rectal bleeding (positive predictive value (PPV): 1%).
- Altered bowel habits (PPV: 1%).
- Diarrhea (diarrhea)
- Increased inflammatory markers
- Thrombocytosis (abnormal increase in platelets (thrombocytes)).
- Abdominal pain
- Low mean cell volume (MCV)
- Low hemoglobin
- Increased leukocyte count
- Increased liver enzymes
Constellations
- Altered bowel habits + low hemoglobin (PPV: 9.6%).
- Diarrhea + thrombocytosis (PPV: 6.9%).
- Rectal bleeding + thrombocytosis (PPV: 5.3%).
- Rectal bleeding + increased inflammatory parameters (PPV: 5.2%).
Authors recommend:
- Wait-and-see attitude: <1
- Calprotectin determination: 1 – 3 %.
- Colonoscopy (colonoscopy): > 3 %.