Do You Know the Different Types of Crohn’s?
Find out how an understanding of the types, variations, and symptoms of Crohn’s can make a difference in treatment and lifetime disease management.
By Michelle Seitzer
Medically Reviewed by Kareem Sassi, MD
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Symptoms and presentations of Crohn’s can vary widely from person to person. Indeed, according to James F. Marion, MD, a professor of medicine at New York’s Icahn School of Medicine at Mount Sinai Hospital and the director of education and outreach at the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai, there are "almost as many versions of Crohn’s disease as there are people presenting.”
For Dr. Marion, knowledge of your “geography,” that is, where your body is most affected by Crohn’s, can be quite valuable to understanding your symptoms — and leads to more informed long-term disease management.
Knowing Your Crohn’s Geography
The Crohn’s and Colitis Foundation of America (CCFA) outlines five main types of Crohn’s and their accompanying symptoms.
- Ileocolitis The most common type of Crohn’s, ileocolitis represents about 75 percent of all cases, according to Marion. Its name is derived from the part of the gastrointestinal (GI) tract it affects: the small intestine (the ileum) and the large intestine (the colon). Symptoms associated with this form of Crohn’s include diarrhea, cramping or pain in the right lower part or middle of the abdomen, and significant weight loss.
- Ileitis Only the ileum is affected by this type of Crohn’s, but it shares many of ileocolitis’s symptoms. Watch for fistulas and inflammatory abscesses in the right lower quadrant of the abdomen, as these complications could indicate a more severe case of ileitis. Isolated ileitis, as it’s also called, is the second most common version of Crohn’s, Marion says.
- Crohn's colitis (formerly called granulomatous colitis) This type of Crohn’s is less prevalent than ileitis, says Marion. Symptoms are not limited to your GI tract; it can also cause skin lesions and joint pain. Within the GI tract, only the colon is affected if you have Crohn’s colitis, which is characterized by rectal bleeding, diarrhea, and ulcers, fistulas, or abscesses around the anus.
- Gastroduodenal Crohn's disease Your stomach and the duodenum, the area where your small intestine starts, are involved in cases of gastroduodenal Crohn's disease, so weight loss, nausea, loss of appetite, and vomiting are common symptoms for individuals diagnosed with this type.
- Jejunoileitis The jejunum — your small intestine’s upper half — is affected by this type of Crohn’s, and that’s where patchy areas of inflammation will present if you have it. Jejunoileitis is relatively rare, says Marion. In severe cases of this type, fistulas can develop, but the more common symptoms include diarrhea, and abdominal pain and cramping — ranging from mild to intense — after meals.
How Crohn’s Progresses and What It Means for Treatment
Apart from these five types, Crohn’s progresses in three distinct ways, or "phenotypes": inflammatory, stricturing (narrowing), and penetrating (also called “fistulizing”). Many people with Crohn's experience a combination of the three, making it difficult to pinpoint just one type of Crohn’s.
Researchers have found that the location of Crohn’s symptoms is not the only driver of how the disease will develop over time. According to a study published in October 2015 inThe Lancet, your age at diagnosis, the extent of the disease, and how Crohn’s shows up in your body may have a greater impact on what complications you have or whether you’ll need surgery. For example, the study showed a younger age at diagnosis is “generally associated with more extensive and aggressive disease in both Crohn's disease and ulcerative colitis.”
But whether you have ileitis or ileocolitis, Marion says that effective treatment boils down to one thing: managing the inflammation process, which in turn may prevent stricturing and potentially reduce the need for — or risks of — surgery, steroid use, or other courses of treatment, he says.
“Crohn’s is not an illness that goes away in a day or overnight; it spans decades,” says Marion. By taking care of inflammation in the near term, you’re also working to minimize the progressive damage that can accumulate over a lifetime.
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