Crohn's disease is part of a group of conditions known as inflammatory bowel diseases (IBDs). There are five main types of Crohn's disease, each with its own set of symptoms. Doctors define each type by the location of inflammation in your gastrointestinal (GI) tract.
- Ileocolitis: Inflames the end of the small intestine (ileum) and a portion of the large intestine (colon)
- Ileitis: Inflames the last section of the small intestine (ileum)
- Gastroduodenal Crohn’s: Inflames the stomach and the start of the small intestine (duodenum)
- Jejunoileitis: Inflames the middle part of the small intestine (jejunum)
- Crohn's (granulomatous) colitis: Inflames only the colon
Ileocolitis
About half of all people with Crohn’s disease have ileocolitis, the most common type. This type causes inflammation in the final section of your small intestine, known as the ileum, as well as in your colon (large intestine).
The ileum absorbs water, carbohydrates, proteins, fats, vitamins, and minerals from the stomach and the small intestine so those nutrients can be used by the body. The colon is the longest section of the large intestine. It also absorbs water and nutrients and helps remove waste products (stool) from the body.
Symptoms
If you have ileocolitis, you may experience one or more of these symptoms:
- Weight loss
- Diarrhea
- Cramping
- Pain in the middle or lower right part of your abdomen
Treatment
Treating ileocolitis usually involves a mix of medications and dietary changes, such as limiting spicy foods and eating smaller meals.
Commonly used medications include corticosteroids and other anti-inflammatory drugs. Your doctor may also prescribe immunomodulators, which are drugs that change how your body’s immune system works.
Surgery may be necessary if other treatments and lifestyle changes can't get your symptoms under control.
Ileitis
While other types of Crohn’s disease can affect multiple parts of the digestive tract, ileitis affects only one area — the ileum. The condition can also affect the ileocecal valve, which separates the ileum from the colon and allows digested food to move from the small intestine to the large intestine.
Symptoms
The typical symptoms of ileitis include:
- Major weight loss
- Diarrhea
- Cramping
In severe cases, ileitis inflammation may cause sores or ulcers to form. These sores can lead to the formation of fistulas — tunnels or channels between your intestines and other organs. Inflammatory abscesses, which are pockets of pus, may also cause fistulas to develop. Fistulas and abscesses caused by ileitis can lead to pain in the lower right part of your abdomen.
Treatment
Treatment options for ileitis are like those for other types of Crohn’s disease. When fistulas are present, the best standard treatment may be anti-tumor necrosis factor (TNF) therapy. TNF is one of the body’s proteins that can cause inflammation. TNF inhibitors are drugs that can help reduce inflammation in people with serious inflammatory conditions, such as Crohn’s disease and rheumatoid arthritis.
Gastroduodenal Crohn's Disease
This type of Crohn’s disease affects the stomach and duodenum, which is the first part of your small intestine. It’s also referred to as Crohn’s disease with upper gastrointestinal (GI) tract involvement.
Gastroduodenal Crohn’s disease is often undiagnosed or misdiagnosed because many people with the condition have no symptoms. Or if they have only dyspepsia (indigestion), they or their doctors may chalk it up to something other than Crohn’s.
Symptoms
If you have gastroduodenal Crohn’s disease, you may not have obvious symptoms. But if you do, they may include:
- Indigestion
- Nausea
- Weight loss
- Loss of appetite
- Vomiting (if the narrow sections of the bowel are blocked)
Treatment
Standard Crohn’s medications, such as TNF inhibitors, may be used to treat gastroduodenal Crohn’s disease. However, this condition can also cause strictures, which are narrowings within your gastrointestinal tract. They can make digestion more difficult. Doctors may treat strictures by inserting a balloon-tipped catheter into the digestive tract. When the tip reaches the narrowed section, the tiny balloon is inflated to widen that portion of the digestive tract. In cases where this can’t be done, surgery may be needed to treat the strictures.
Jejunoileitis
This type of disease causes areas of inflammation in the jejunum, the upper part of your small intestine.
Symptoms
Common symptoms of jejunoileitis are like those of other types of Crohn’s disease. However, this condition is often accompanied by stricturing in the digestive tract. Symptoms of jejunoileitis include:
- Cramps after meals
- Fistulas
- Diarrhea
- Abdominal pain that can become intense
- Weight loss
Treatment
As jejunoileitis tends to be a more severe type of Crohn’s disease, more aggressive treatment may be needed. In addition to a TNF inhibitor, a drug such as thiopurine — used to treat other autoimmune disorders — may be added to treatment.
In severe cases, in which there are strictures or fistulas, surgery may be necessary.
Crohn's (Granulomatous) Colitis
Crohn’s (granulomatous) colitis affects only the colon. If you have this type, you may be more likely to have bacterial and fungal infections. Because the condition is limited to the colon, regular colonoscopies are a vital part of tracking the disease’s progression. However, MRIs may be safer and just as effective.
Symptoms
The symptoms of Crohn’s (Granulomatous) colitis include typical Crohn’s challenges, as well as other problems unique to this condition. Common symptoms include:
- Skin lesions
- Joint pain
- Diarrhea
- Rectal bleeding
- Ulcers, fistulas, and abscesses around the anus
Treatment
Medications, lifestyle changes, and surgery are the standard treatment options. The immunosuppressant drug ustekinumab may be especially helpful.
There can be an overlap between these types of Crohn's disease. Sometimes, more than one area of your digestive tract is affected.
Types of Crohn’s Disease Based on Severity
In addition to diagnosing types of Crohn’s disease, doctors also classify the condition based on symptom severity. One tool doctors use is called the Crohn’s Disease Activity Index (CDAI). A CDAI score is based on the severity of various symptoms over seven days. Those symptoms include things such as abdominal pain, fevers, and the number of soft or liquid stools you had.
There are four basic categories of Crohn’s severity. They are:
Asymptomatic remission
The CDAI range for asymptomatic is less than 150. In this stage, there are few, if any, noticeable symptoms.
Mild to moderate
The CDAI range for mild to moderate is 150 to 220. Symptoms can include diarrhea and abdominal pain. There should be no signs of dehydration, weight loss, or fever.
Moderate to severe
The CDAI range for moderate to severe is 220 to 450. Symptoms can include diarrhea and abdominal pain and/or tenderness. You may also experience major weight loss, nausea, and vomiting.
Severe fulminant
The CDAI range is greater than 450. Symptoms can include abdominal pain and tenderness, frequent vomiting, high fever, diarrhea, significant weight loss, and loss of muscle mass. This stage usually means there is intestinal lining disease, abscesses, and blockages in the digestive tract.
Crohn’s Phenotypes
The disease can be further divided by phenotypes, or physical traits, as it gets worse. For Crohn’s, these are based on:
Your age when you were diagnosed:
- Child
- Young adult
- Elderly
The affected body part
- Terminal ileum
- Colon
- Ileocolon
- Upper gastrointestinal tract
How the disease behaves
- Stricturing: The disease causes swelling and scarring on the walls of your intestine. This makes the walls thicker and can form strictures, or narrowed areas, that lead to blockages.
- Penetrating: Crohn’s causes fistulas, perianal ulcers, inflammatory masses, or abscesses.
- Uncomplicated
How to Know Which Type of Crohn’s Disease You Have?
Crohn’s disease is usually diagnosed when people see their doctor about symptoms such as diarrhea, unexplained weight loss, and painful abdominal cramps. Your doctor may then review your medical history and family medical history. You may also undergo a physical exam, including a checkup to see if you have any swelling or tenderness in your belly.
If Crohn’s disease is suspected, further testing and imaging may be necessary. Screenings can help make the right diagnosis as well as rule out other causes of your symptoms.
For example, you may have a blood test. A high white blood cell count can indicate inflammation. A low red blood cell count can be a sign of anemia, which is a common complication of Crohn’s disease.
Your doctor may also order a stool (poop) test to check, among other things, if a bacterial infection rather than Crohn’s could be causing your diarrhea.
Other screenings may include a CT scan and/or an MRI of your digestive tract. These tests can help gauge the severity of the inflammation and identify any fistulas.
To get a closer look at the lining of your digestive tract, your doctor may suggest one or more endoscopic procedures. They involve the use of a tiny camera that records pictures or videos of inflamed areas. Three common procedures used to diagnose various types of Crohn’s disease are:
- Colonoscopy
- Upper endoscopy
- Capsule endoscopy
The different types of Crohn’s disease may be similar in many ways. But it’s important to get a proper diagnosis to begin the most effective treatment possible.
Living With Crohn’s Disease
Whichever type of Crohn’s disease you are diagnosed with, the following tips should help:
- Keep a food diary to track what foods may cause flare-ups.
- Eat smaller meals.
- Avoid or limit alcohol and caffeine.
- Eat a low-fiber diet and drink plenty of water.
- Quit smoking.
- Get regular exercise.
- Call your doctor if you have sudden or serious symptoms, such as severe abdominal pain, uncontrollable diarrhea, or blood in your stools.
Takeaways
All types of Crohn’s disease require treatment to manage symptoms, so don’t ignore symptoms such as abdominal pain and diarrhea. Tell your doctor or seek out a gastroenterologist for a thorough checkup. If you receive a Crohn’s diagnosis of any type, follow your doctor’s instructions about medications and diet closely.
Types of Crohn’s Disease FAQs
Is celiac disease a type of Crohn's disease?
No, though both are inflammatory conditions affecting the digestive tract. Celiac disease results from eating foods containing gluten. It’s also limited to the small intestine. Crohn’s disease can affect any part of the digestive tract and appears to be related to genetic and environmental factors, rather than a specific ingredient such as gluten.
What type of doctor treats Crohn's disease?
While your primary care physician may be able to diagnose Crohn’s disease and treat mild cases, you should work with a gastroenterologist experienced in treating Crohn’s disease for ongoing care.
What color is Crohn's mucus?
People with Crohn’s disease may notice a yellowish mucus covering their poop.
Is Crohn's disease a type of cancer?
Crohn’s disease is not a type of cancer, but it may increase your chances of developing colorectal cancer.
Is Crohn's disease serious?
Yes, Crohn’s is a lifelong condition that requires treatment. While symptoms can often be controlled, the potential complications of Crohn’s can be quite serious.
What are the types of fistula in Crohn's disease?
The types of fistula in Crohn’s disease include: perianal, rectovaginal or colovaginal, enteroenteric, enterocutaneous or colocutaneous, enterovesical or colovesical, and eneterocolonic.
