The sooner you have a diagnosis, the sooner you can start treatment.
An estimated 780,000 people in the United States live with Crohn’s Disease—an autoimmune disease that affects the digestive tract—according to the Crohn’s and Colitis Foundation. This gastrointestinal disease can have a major effect on quality of life, not to mention it comes with a risk of complications if it goes untreated.
Before starting treatment, of course, you need a diagnosis. Getting a diagnosis can help you and your doctor determine whether you have Crohn’s, what type of Crohn’s you have, and what the best treatment plan for you might be.
How Crohn’s Disease Affects the Body
Like other autoimmune diseases, Crohn’s disease means the immune system is attacking your own body—in this case, the digestive tract.
For people without Crohn’s disease, the digestive tract “works in a state of tolerance, so lots of things pass through [the] bowel, and it doesn't react to those triggers that are coming through,” says Benjamin Cohen, MD, gastroenterologist at The Mount Sinai Hospital.
“In a patient with Crohn's disease, the immune system will recognize those triggers as foreign, when maybe they shouldn't, and that can lead to an immune response, attacking the gut itself,” says Dr. Cohen. Even once the trigger passes out of the system, the immune response continues, leading to symptoms of Crohn’s disease, such as abdominal pain and diarrhea.
Steps to Diagnose Crohn’s Disease
To diagnose Crohn’s disease, doctors will typically begin by asking you about your medical history and family history. Then, your doctor will likely perform a physical exam—checking for abdominal bloating, listening to your stomach with a stethoscope, and tapping on your abdomen to check for pain or enlarged organs.
Next, your doctor may perform lab tests. “Crohn's disease is diagnosed through colonoscopy, generally,” says Dr. Cohen. “You can identify the inflammatory changes in the bowel and find typical features on biopsies that are consistent with Crohn's disease.”
A colonoscopy only examines the large intestine, which is commonly affected by Crohn’s disease. However, inflammation in the large intestine could also indicate ulcerative colitis. In many cases, you may also need an upper endoscopy, which helps examine the upper intestinal tract, or a CT scan, which can help your doctor see the structure of your digestive tract.
In some cases, your doctor may also want to take blood tests or stool tests, which can help confirm the presence of inflammation, or to rule out other potential diseases.
“Once we know what type of Crohn's that patient has, then we discuss what are the possible treatment options, and that's where it's important for a patient to be part of that discussion,” says David P. Hudesman, MD, associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
“With proper treatment for Crohn's, appropriate follow-up, the vast majority of people do very well with a great quality of life,” says Dr. Hudesman, “and there's no reason why that can't happen for any of our patients, as long as they're following up regularly and discussing their care with their physicians.”
00:00:00.633 --> 00:00:02.732
00:00:02.733 --> 00:00:08.499
So, in general, our bowel works in a state of tolerance,
00:00:08.500 --> 00:00:12.766
so lots of things pass through our bowel, and it doesn't react
00:00:12.767 --> 00:00:14.666
to those triggers that are coming through.
00:00:14.667 --> 00:00:19.499
In a patient with Crohn's disease, the immune system will recognize
00:00:19.500 --> 00:00:23.066
those triggers as foreign, when maybe they shouldn't,
00:00:23.067 --> 00:00:28.332
and that can lead to an immune response, attacking the gut itself.
00:00:28.333 --> 00:00:32.999
00:00:33.000 --> 00:00:36.599
If I was out to dinner, and I had pain and diarrhea,
00:00:36.600 --> 00:00:38.632
my body would sense something was wrong.
00:00:38.633 --> 00:00:42.432
It would cause inflammation to get rid of that problem,
00:00:42.433 --> 00:00:46.932
and when my body senses that problem's gone, it shuts off, it cools down.
00:00:46.933 --> 00:00:51.199
With Crohn's disease, once your body starts attacking, it doesn't stop.
00:00:51.200 --> 00:00:53.966
Your body keeps attacking, it keeps attacking,
00:00:53.967 --> 00:00:55.732
even though that trigger is gone.
00:00:55.733 --> 00:01:00.499
Typical symptoms of Crohn's would be abdominal pain, diarrhea,
00:01:00.500 --> 00:01:03.399
in some patients it may be constipation
00:01:03.400 --> 00:01:06.366
or blockage symptoms including bloating.
00:01:06.367 --> 00:01:11.566
Crohn's disease is diagnosed through colonoscopy, generally.
00:01:11.567 --> 00:01:14.666
You can identify the inflammatory changes in the bowel
00:01:14.667 --> 00:01:20.032
and find typical features on biopsies that are consistent with Crohn's disease.
00:01:20.033 --> 00:01:22.632
Because Crohn's disease can occur anywhere in the intestinal tract,
00:01:22.633 --> 00:01:25.599
sometimes colonoscopy is not enough to make the diagnosis,
00:01:25.600 --> 00:01:27.466
so we may do an upper endoscopy as well to make sure
00:01:27.467 --> 00:01:30.999
that there's not involvement of the upper intestinal tract,
00:01:31.000 --> 00:01:36.266
cross-sectional imaging such as a MR enterography, or a CT scan.
00:01:36.267 --> 00:01:39.332
Once we know what type of Crohn's that patient has,
00:01:39.333 --> 00:01:42.166
then we discuss what are the possible treatment options,
00:01:42.167 --> 00:01:45.866
and that's where it's important for a patient to be part of that discussion,
00:01:45.867 --> 00:01:47.199
part of that treatment plan.
00:01:47.200 --> 00:01:50.832
With proper treatment for Crohn's, appropriate follow-up,
00:01:50.833 --> 00:01:55.999
the vast majority of people do very well with a great quality of life,
00:01:56.000 --> 00:02:00.299
travel, have a family, and there's no reason why that can't happen
00:02:00.300 --> 00:02:03.832
for any of our patients, as long as they're following up regularly
00:02:03.833 --> 00:02:06.832
and discussing their care with their physicians.
00:02:06.833 --> 00:02:13.200
Diagnosis of Crohn’s disease. Bethesda, MD; National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on January 22, 2020 at https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/diagnosis.)
The facts about inflammatory bowel disease. New York, NY: Crohn’s & Colitis Foundation. (Accessed on January 22, 2020 at https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf.)