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    Why Is It So Hard to Diagnose Crohn’s Disease?

    By Susan Bernstein
    WebMD Feature
    Reviewed by William Blahd, MD

    At 9, Natalie Rosenthal started having terrible stomach pains, fatigue, and diarrhea. She had dark circles under her eyes. She stopped growing taller or gaining weight.

    “I had spasms whenever I ate anything,” says Rosenthal, now 40. “The pediatrician at first told my mom that I had a nervous stomach.” Meds to calm muscle spasms didn’t help, so her mother pressed for another diagnosis.

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    “She was a real tiger mom,” says Rosenthal, who lives in Atlanta. “She kept taking me back to the doctor. She said that I wasn’t a nervous child, and had no fear or anxiety about school or socializing. She said, ‘This is not psychological.’”

    After a year, a gastroenterologist gave Rosenthal a colonoscopy that showed she had Crohn’s disease, not nerves. Symptoms of Crohn’s include stomach pain, fatigue, diarrhea, nausea, or vomiting, so doctors may mistake it for other conditions. Tests that show inflammation or its damage, like lesions, can reveal the right diagnosis.

    Different People, Different Symptoms

    Crohn’s is caused by an out-of-whack immune system that causes inflammation in your gastrointestinal (GI) tract.

    The disease is hard for doctors to pin down, because it can affect different parts of the tract. That means not everyone has the same symptoms, says Edward V. Loftus, Jr., MD, a gastroenterologist at the Mayo Clinic in Rochester, MN.

    “It’s important to rule out other conditions, because the symptoms are not specific,” he says.

    Stomach pain, diarrhea, and fatigue could also mean you have irritable bowel syndrome (IBS) or celiac disease, Loftus says.

    Mild inflammation may not show up on blood tests. Your doctor might mistakenly think you have anemia from low iron, not from low iron and the bleeding that can come with Crohn’s. Infections like salmonella, E. coli, and tuberculosis could also have Crohn’s-like symptoms.

    Treatments for these conditions are quite different, Loftus says, so it’s important to do definitive testing before you start, Loftus says.

    You Can Help the Process

    Speak up about all of your current or past symptoms so your doctor can pinpoint Crohn’s clues, says Shamita Shah, MD, medical director of the inflammatory bowel disease program at Ochsner Health System in New Orleans.

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