What symptom is typically present in patients with ileal disease in Crohn’s?

In patients with ileal disease in Crohn's disease, bile salt diarrhoea is a typical symptom due to the role of the ileum in the absorption of bile salts. When the ileum is inflamed or diseased, its ability to reabsorb bile acids is compromised. Bile salts that are not reabsorbed enter the colon, where they can cause an increase in fluid secretion and lead to diarrhoea. This is a common manifestation in Crohn's disease affecting the ileal segment.

The other symptoms mentioned, while they can occur in various gastrointestinal disorders, are either less specific or not characteristic of ileal Crohn's disease. Weight gain is generally not seen in these patients due to malabsorption and potential calorie restriction. Chronic constipation is not typically associated with ileal disease; rather, diarrhoea is more common. Severe abdominal pain may occur but is not exclusive to ileal disease and does not directly relate to the specific mechanisms involved in bile salt malabsorption. Thus, the presence of bile salt diarrhoea is a distinctive symptom that effectively reflects the specific pathophysiological changes occurring in ileal Crohn's disease.