Clinical features

This is a chronic, relapsing and remitting disease that has symptomatology dependent on the site of involvement of the GI tract. The commonest site at presentation is the terminal ileum and proximal colon.

Typically the disease has an insidious onset but occasionally the presentation may be fulminant (1). Various symptoms occur in most patients, common presenting features are:

• diarrhoea – chronic or nocturnal (1)
• abdominal pain
• weight loss
• fatigue (2)

Other symptoms and signs of Crohn’s disease are:

• systemic features like anorexia or fever
• an abdominal mass or tenderness
• intestinal obstruction – caused by strictures, fistulae (often perianal), or abscesses (3)

Special note must be taken that:

• Crohn's disease may present with an acute onset of abdominal pain that may mimic acute appendicitis or yersinia ileitis.
• common features in active disease are lassitude, anorexia, malaise, and fever.
• in adolescents, a presentation with weight loss alone (without abdominal pain or diarrhoea) may be misdiagnosed as anorexia nervosa.

A patient with Crohn’s may have acute flares of the disease in between periods of remission or less active disease (4).

Reference:

• (1) Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104(2):465-83
• (2) Cummings JR, Keshav S, Travis SP. Medical management of Crohn's disease. BMJ. 2008;336(7652):1062-6
• (3) Carter MJ et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53 Suppl 5:V1-16
• (4) National Institute for Health and Clinical Excellence (NICE) 2010. Infliximab (review) and adalimumab for the treatment of Crohn’s disease