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Teens and Crohn's Disease
A Medical Reason for Unexplained Weight Loss
By Teri Brown
One of the common medical problems thought to be an eating disorder is Crohn's Disease. The symptoms of Crohn's include severe diarrhea, which can lead to weight loss. If a teen is not comfortable talking about diarrhea, parents and physicians may only see the weight loss and make assumptions.
Dr. Jeffery Hyams, head of Digestive Diseases, Hepatology and Nutrition for the Connecticut Children's Medical Center in Hartford, Conn., says that misdiagnosis of eating disorders can be avoided through careful evaluations. "Weight loss can be a sign of an eating disorder, but one needs to evaluate the clinical context," he says. "Is there also abdominal pain, vomiting, fever, diarrhea, rectal bleeding, fatigue, arthritis, rash? Is there a family history of gastrointestinal disease? Are there factors that may be causing psychological distress? Are there factors that suggest an adolescent may have a disturbed body image? In summary, weight loss needs to be evaluated in the context of a careful complete history, physical examination, and if necessary, laboratory studies."
According to Dr. Hyams, when a teen presents with abdominal pain as the only initial manifestation, the diagnosis of Crohn's disease may be delayed as it is often thought no serious disease is present and that stress may be causing the problem. When diarrhea begins, and particularly if there is blood in the stool, more prompt medical attention is often sought. "However, teenagers are notorious for not telling their parents about stool characteristics, so parents may not know about this more serious development," he says. "Poor appetite is common in children with Crohn's disease, and weight loss ensues. Some children with Crohn's disease have minimal gastrointestinal symptoms and present primarily with poor weight gain and slow growth. It is not uncommon for symptoms to be present for months to years before a diagnosis is made."