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What are the symptoms of Crohn's disease?

The symptoms of Crohn's disease can vary from mild to severe. Abdominal pain and diarrhea are the most common symptoms of Crohn's disease. However, GI bleeding, nausea, weight loss, fever, and fatigue can also be seen. Crohn's disease can also affect other parts of the body, including the joints, skin, liver, and eyes. These are called extraintestinal manifestations (see below) and are rarely the first symptom with which a Crohn's disease patient presents. Children can present with delayed development and growth. Approximately 1/3 of Crohn's patients will develop symptoms around the anus (perianal), including skin tags, fissures (tears in the anal skin), fistulae (abnormal connection between the intestine and the anus), or abscesses (collections of pus or infected fluid).

Common symptoms of Crohn's Disease

  • Diarrhea
  • Abdominal pain and tenderness
  • Loss of appetite and weight
  • Fever
  • Fatigue
  • Rectal bleeding
  • Perianal lesions
  • Stunted growth in children
  • Complications - fistula, perforation, abscess
  • UGI symptoms
  • Extraintestinal manifestation

Differential Diagnoses

The symptoms described above, however, are not specific for Crohn's disease and can be seen in many other conditions. The following is a partial list of other conditions that may mimic Crohn's disease, also known as a list of differential diagnoses.

  • Infection - bacterial, viral, or parasitic infection
  • Ischemia - low blood flow to the small intestine or colon, usually seen in older patients
  • Medication - non-steroidal anti-inflammatories, antibiotics, birth control pills
  • Diverticulitis - infection of a diverticulum (outpouching of colon) that can present with left lower quadrant pain and fever
  • Appendicitis - usually presents with right lower quadrant abdominal pain and fever
  • Irritable bowel syndrome - can cause severe diarrhea and abdominal pain
  • Lactose intolerance - can cause diarrhea, bloating, and abdominal pain. Patients with Crohn's disease can also have lactose intolerance.
  • Celiac disease - sensitivity to gluten (wheat) which can cause diarrhea and bloating
  • Gallstones
  • Cancer, lymphoma
  • Diseases that affect other organs in the abdomen also need to be considered such as:
    • Endometriosis, pelvic inflammatory disease, ectopic pregnancy, ruptured ovarian cyst
    • Kidney stones, bladder or kidney infections

Symptoms alone are not enough to diagnose someone with Crohn's disease. Patients require further workup or testing (see  How is Crohn's diagnosed?) Even patients with well established Crohn's disease, it is important to remember that not all abdominal symptoms are related to their Crohn's disease. Patients with Crohn's disease are just as susceptible to the development of GI infections, kidney stones, gallstones, etc., as are patients without Crohn's disease.

Because Crohn's disease can affect any part of the GI tract and any layer of the intestinal wall (transmural), the symptoms are quite variable and often depend on the location (see What are the types of Crohn's disease?). Although the location of Crohn's disease varies from patient to patient, it often remains constant within a given patient. In other words, it would be extremely rare for a patient with pure ileitis (small intestine) to suddenly develop Crohn's disease involvement in their colon (large intestine) as well. While the location of disease tends to remain constant, the type and severity of Crohn's disease can change over time as a result of persistent inflammation. For example, many patients with inflammatory disease will eventually go on to develop either fibrostenosing or perforating disease (see What are the types of Crohn's disease?).

Contact Information

Inflammatory Bowel Disease Program
Digestive Disease Center
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215