Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract. Though the exact cause of Crohn’s is still unclear, researchers are making significant progress toward understanding the disease. But, despite our advancing knowledge of Crohn’s disease, it is hard to predict how the disease will affect each person. The type and severity of symptoms, the location of the inflammation in the gastrointestinal (GI) tract and the response to treatment all vary from person to person. So, to better understand how Crohn’s specifically affects you and what you can do to effectively manage your unique symptoms, you need to learn as much as you can. Not only will this deeper knowledge empower you in your management choices but it will also enhance your ability to communicate with your Crohn’s healthcare team. Let’s start by distinguishing the different types of Crohn’s disease.
Types of Crohn’s disease
Though Crohn's is typically discussed as if it is one disease, there are different types of Crohn's disease. One could classify it by the location of the inflammation within the digestive tract. Your symptoms and possible complications may differ depending on which part of the GI tract is affected.
- Ileocolitis. This is the most common type of Crohn's disease, accounting for about half of all cases. It affects the lower portion of the small intestine (known as the terminal ileum) and the colon. People who have ileocolitis may experience considerable weight loss, diarrhea, and cramping or pain in the middle or lower right part of the abdomen.
- Ileitis. This type of Crohn's disease also affects the ileum. It accounts for about a third of cases. Symptoms are the same as those for ileocolitis.
- Crohn’s colitis. This type of Crohn’s affects only the colon (large intestine) and accounts for about 20% of cases. Symptoms may include skin lesions, joint pains, diarrhea, rectal bleeding, and the formation of ulcers, fistulas, and abscesses around the anus.
- Gastroduodenal Crohn’s. This type affects the stomach and duodenum (the first portion of the small intestine). People with this type of Crohn's disease suffer nausea, weight loss and loss of appetite. In addition, if the narrow segments of bowel are obstructed, the person may experience vomiting.
- Jejunoileitis. This form of the disease causes areas of inflammation in the jejunum, which is the upper half of the small intestine. Symptoms include cramps after meals, diarrhea, and abdominal pain that can become intense.
The different ways Crohn’s progresses
Crohn’s disease can also be categorized by the way the disease behaves as it progresses. There are three categories that describe the different ways that Crohn’s presents.
- Inflammatory behavior. This progression can cause inflammation anywhere in the gastrointestinal tract (which includes your mouth, esophagus, stomach, large intestine and small intestine). Symptoms may range from mild to severe. This inflammation will cause periods in which the disease flares up (is active) and causes symptoms. In between flares, you may experience no symptoms (called remission) that can span months or even years.
- Stricturing behavior. This progression of Crohn’s causes narrowing of the intestine that can lead to bowel obstruction (a blockage that keeps food or liquid from passing through your intestines).
- Penetrating behavior. The final type of progression creates abnormal passageways (called fistulas) between the intestine and bladder, vagina or skin. Approximately 20-40% of people develop fistulas at some point.
Differences in Crohn's treatment approaches
Because Crohn’s disease manifests differently in each person, there is also no one treatment that fits everyone. Each approach to treatment must be individualized. Many individuals with Crohn’s respond well to medical treatment that involve one or more medications and never need surgery. Others may go on to develop complications that will require surgery at some point in their lives (typically stricturing and penetrating types of Crohn’s disease are most at risk for surgery).
Crohn’s disease needs to be approached as a disease that can manifest in any number of ways. The symptoms, progression of the disease and treatment approach that applies to one person may be very different for someone else. You may even find that what works for you now may need to be modified over time due to complications that develop. But, the more you know, the greater your confidence will be that you can still live well with Crohn’s disease.