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Complications and co-morbidities

Crohn’s disease can cause strictures in the bowel, and if an obstruction forms in them, the symptoms include pain that comes and goes in waves, constipation, gurgling in the bowel, nausea and vomiting. The doctor must be contacted immediately. Fistulas (passages) can form through the intestinal wall to the skin, between parts of the bowel or to adjacent organs. Fistulas can ooze continuously or occasionally pus, stool or even blood. A rare complication is a perforation of the bowel, which requires urgent surgery because a peritonitis can develop quickly.

Fissures are painful, chronic ulcers in the anal area. They can excrete blood or interstitial fluid. In Crohn’s disease patients, any ulcer in the anal area can develop into a chronic fissure, which is why unnecessary procedures in the area must be avoided.

In all phases of Crohn’s disease the patient may have various joint symptoms, most often arthralgia (joint pain). Sacroilitis (inflammation of the joints where the lower spine and pelvis connect) and ankylosing spondylitis can show symptoms independent of the phase of the illness. Arthritis (joint inflammation) is usually only present in the active phase of IBD. When joint symptoms appear, the possibility of other rheumatic diseases is ruled out.

Skin and eye ailments are also possible. Erythema nodosum causes purple, tender lumps especially in the legs and arms. Pyoderma gangrenosum is rarer and causes deep ulcers on the skin. Eye ailments include episcleritis (inflammation of the thin layer of tissue covering the white part of the eye) and iritis (inflammation of the colored ring surrounding the pupil).

Other possible co-morbidities are pancreas inflammations and kidney changes. Crohn’s disease patients also have a higher risk of venous thrombosis, pulmonary embolism and pericarditis. A chronic inflammation in the large intestine can increase the risk of colon cancer. This is why it is important to have regular colonoscopies even if the illness causes no symptoms. The most common liver ailment is primary sclerosing cholangitis (PSC), which causes scarring within the bile ducts.

Crohn’s disease in or removal of the end of the small intestine often causes diarrhea due to bile acid malabsorption and anemia and nervous symptoms due to vitamin B12 deficiency. Bile acid diarrhea can be managed with medication and vitamin B12 can be given as injections.

Active IBD that causes mucosal bleeding may often lead to iron deficiency anemia. Iron can be taken as tablets or given intravenously.