The symptoms of Crohn's disease vary according to its site, (i.e. small
or large intestine) and severity. However, the following features occur
in most cases.
1. Diarrhoea - sometimes, but not always, with blood.
2. Abdominal pain and tenderness over the intestine, often more severe
in the right iliac fossa.
3. Weight loss, and in children failure to grow.
4. Fever.
5. Tiredness.
6. Sores and abscesses around the anus, which discharge. These
may be the first signs of the disease in some patients.
7. Other symptoms not involving the intestine may occur:
I. Sore mouth due to ulcers on the tongue or inside the cheek.
II. Painful, inflamed eyes (uveitis).
III. Painful, stiff or swollen joints, e.g. arthritis, ankylosing spondylitis.
IV. Sore, red lumps on the skin (erythema nodosum).
Doctors have devised scoring systems based on patients’ symptoms which enables them to assess progress in a fairly simple and straightforward way. The Crohn’s disease activity index (CDAI) is complex and usually reserved for important research studies. The Harvey and Bradshaw index is simpler and may be used in everyday practice.
This takes into account a number of symptom markers over the previous 24 hour period, i.e.
A score of 3 or less is taken as remission.
A score of 6 or more signifies a relapse.
The symptoms involved are:-
a) General well-being.
b) Number of liquid stools.
c) Presence of abdominal masses.
d) Abdominal pain.
e) Any associated complications.
A symptom score of this type is not used in diagnosis - merely to assess progress.
