Last week I discussed causes and symptoms of Crohns; this week I discuss complications. Complications may occur in the intestinal tract or other areas of the body. Complications in the intestinal tract may include strictures, perforations and fistulas.
Complications of Crohn’s disease affecting the intestinal tract
Ongoing inflammation and then healing in the bowel may cause scar tissue to form. This can create a narrow section of the bowel, known as a stricture. A stricture can make it difficult for food to pass leading to a blockage. Symptoms include severe cramping abdominal pain, nausea, vomiting and constipation. The abdomen may become bloated and distended and may make loud noises. Strictures are usually treated surgically mainly with operation known as a stricturoplasty.
Very occasionally, a severe blockage caused by a stricture may lead to a perforation or rupture of the bowel, making a hole. The contents of the bowel can leak through the hole and form an abscess. This causes pain and a fever.
A fistula can form when inflammation in Crohn’s spreads through the whole thickness of the bowel wall and continues to tunnel through the layers of other tissues. These tunnels or passageways can connect the bowel to other loops of bowel, to the surrounding organs, such as the bladder and vagina, or to the outside skin, including the skin around the anus. Fistulas may be treated medically or with surgery.
Complications of Crohn’s disease affecting other parts of the body
Crohn’s disease can also cause problems outside the intestinal tract.
Inflammation of the joints (arthritis) affects up to one in three people with IBD. Arthritis is more commonly associated with Crohn’s colitis (Crohn’s disease in the colon). The inflammation usually affects the large joints of the arms and legs, including the elbows, wrists, knees and ankles. Fluid collects in the joint space causing painful swelling, although there can be pain without obvious swelling. Symptoms generally improve with treatment for intestinal symptoms and there is mainly no lasting joint damage. Medication and physiotherapy can be helpful.
Crohn’s can cause skin problems. The most common skin problem is erythema nodosum, which affects about one in seven people with Crohn’s. Painful red swellings appear, usually on the legs, and then fade leaving a bruise-like mark. This condition tends to occur during flare-ups and generally improves with treatment for the Crohn’s. More rarely, a skin condition called pyoderma gangrenosum affects people with Crohn’s disease. This starts as small tender blisters, which become painful, deep ulcers. These can occur anywhere on the skin, but most commonly appear on the shins or near stomas. It is treated with steroids or immune-suppressants but may need biological therapy.
Eye problems affect approximately one in 20 people with Crohn’s. The most common condition is episcleritis, which affects the layer of tissue covering the sclera (the white outer coating of the eye) making it red, sore and inflamed. Two other eye conditions associated with Crohn’s are scleritis (inflammation of the sclera itself) and uveitis (inflammation of the iris). These conditions can usually be treated with local steroid drops, although uveitis and scleritis may need treatment with stronger immune-suppressants or biologic drugs.
Crohn’s increases risk of bone thinning; this is mainly due to poor absorption of calcium or the use of steroid medication. Calcium supplementation and sometimes specialist osteoporosis drugs like alendronates is needed.
About one in four people with Crohn’s develops gallstones. These are small ‘stones’ made of cholesterol which can get trapped in the gallbladder (just under the liver) and can be painful. Several factors linked with Crohn’s can make gallstones more likely including poor absorption of bile salts often caused by inflammation. Bile salts help to digest fats during digestion. Drugs used to treat Crohn’s such as azathioprine and methotrexate may increase liver problems.
Crohn’s disease doubles the risk of blood clots in the veins, including DVT (deep vein thrombosis) in the legs. Risk is highest during a flare-up or if confined to bed. Warning symptoms include pain, swelling and tenderness in the leg, or chest pains and shortness of breath.
Anaemia means fewer red blood cells and/or lower levels of haemoglobin in the blood. Haemoglobin is a protein in red blood cells that carry oxygen. People with inflammatory bowel disease are most likely to develop iron deficiency anaemia. Another type of anaemia is vitamin deficiency anaemia, caused by a low intake or poor absorption of certain vitamins, such as vitamin B12 or folic acid. This particularly affects people with Crohn’s who have had sections of the small intestine removed. Some of the drugs used for Crohn’s such as sulphasalazine and azathioprine can also cause anaemia. Symptoms of anaemia include tiredness and fatigue and if not treated can lead to shortness of breath, headaches and general weakness. Depending on the cause of anaemia, iron, B12 or folic acid supplements are the most common treatments.
Diarrhoea, abdominal pain, and weight loss lasting for several weeks or longer indicate Crohn’s is a possibility. Tests and physical examinations can confirm diagnosis. These include:
- Blood Tests and Stool Tests
- Barium X-ray Tests
- MRI and CT Scans
Could symptoms be IBS (Irritable Bowel Syndrome)
Irritable Bowel Syndrome (IBS), which tends to be more common in people with Crohn’s than in the general population. There is no blood loss in IBS, but it can cause abdominal pain, bloating and a varying bowel habit with diarrhoea and/or constipation. If you are having these symptoms and tests do not show active inflammation or infection, then it may be IBS. Treatment varies from changing diet to over the counter products like peppermint oil and mebeverine.
To be continued…next week I discuss treatment
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended
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