Complications of Crohn's Disease
1995 Crohn's & Colitis Foundation of America, Inc. Publication 1006

What are complications of Crohn's Disease?
Complications in general can be defined as events that make a simple matter more complex. In uncomplicated Crohn's Disease, appropriate treatment of inflammation results in clinical improvement. When a complication takes place however, improvement is delayed.

How are complications categorized?
Complications are usually categorized as local or systemic. The term local refers to a complication involving the intestinal tract itself. The term systemic refers to complications involving other organs or complications that affect the patient as a whole rather than the bowel locally.

What are some of the more important local complications of Crohn's Disease and Ulcerative Colitis?
Local complications include profuse bleeding from deep ulcerations, perforation (rupture) of the bowel, marked dilatation (termed toxic megacolon if the patient is seriously ill), or simply failure of the patient to respond appropriatly to the usual medical treatments.

What are the systemic complications of Crohn's Disease and Ulcerative Colitis?
Systemic complications include fever, weakness, and loss of appetite. In addition, a small percentage of patients with inflammatory bowel disease suffer from certian types of arthritis, skin conditions, inflammation of the eye, and liver dysfunction.

What causes these systemic complications?
The cause is not known, but it is believed that all of these manifestations represent disturbances in the immunologic system (that is, the body's defense systems against the inflammatory process or against abnormal products of intestinal metabolism).

What joints are usually involved? How can my doctor tell that this problem is connected with the intestinal condition?
Distal joints are most commonly involved (small joints of the fingers, hands, feet, ankles, and knees). Some patients also experience arthritis of the lower spine and sacroiliac joints. A more severe form of spinal arthritis (termed ankylosing spondylitis) is a rare complication. It is not always easy to determine whether the arthritis is connected with the intestinal condition. In general, the arthritis that complicates IBD is not usually as severe as rheumatoid arthritis, and the joints do not ordinarily undergo destructive changes. Aside from anklosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve.

What are some of the skin disorders?
One skin disorder is erythema nodosum ("red bumps"). These tender red nodules usually occur over the shins or ankles and improve when the bowel disease is brought under control. Another is pyoderma gangrenosum (pus in the skin associated with deep ulcerations). These are deep, chronic ulcers especially on the shins or ankles that may heal as the IBD comes under control. A third is inflammation of the lining of the mouth in the form of aphthous stomatitis (canker sores). These are shallow ulcerations inside the mouth, most commonly between the gums and lower lip or along the sides or base of the tongue. These also usually subside as the bowel disease comes under control.

What are the complications involving the eye?
A small percentage of patients suffer from uveitis, a painful inflammation of the eye. This complication usually improves when the IBD is brought under control. Inflammation of the eye should always be evaluated by a physician.

What are the manifestations of liver disease?
There are several problems pertaining to the liver and bile ducts in IBD. The liver may develop active inflammation, which usually subsides with appropriate treatment of IBD. The bile ducts may develop a particular form of inflammation called sclerosing cholangitis, which may not improve with medical treatment for IBD. On very rare occasion, cancer of the bile ducts may develop.

What are the symptoms of intestinal obstruction and does it always lead to surgery?
Patients with intestinal obstruction develop severe crampy pain, frequently associated with vomiting, in the mid-abdomen. The abdomen may become distended and bloated. Medical treatment frequently relieves the obstruction by reducing local inflammation. If the obstruction is severe and refractory to medical therapy or obstruction recurs at frequent intervals, surgery is required.

What are fistulas and how are they treated?
A fistula is an abnormal passage from one loop of intestine to another structure, such as to another loop of intestine, urinary bladder, vagina, or open to the skin. Fistulas are relitively common in Crohn's Disease because the inflammatory process frequently involves the full thickness of intestine, thereby facilitating adherence of that loop to a neighboring structure. A small passage may then develop through the entire thickness of the intestine to this adjacent structure. If a fistula is small, medical treatment alone may be sufficient to bring about healing and closure. Large or multiple fistulas may require surgery if they are associated with intractable symptoms such as fever or abdominal pain. If a fistula does not re-enter a neighboring structure, it may form an abcess (collection of pus) near the intestine. An abcess is an infection that requires evacuation, either with a catheter introduced by a radiologist through the skin or a drain inserted during a surgical procedure.

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