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Crohn Disease

Crohn disease (Crohn syndrome, regional enteritis, regional ileitis, terminal ileitis) is an inflammatory bowel disease, that can affect any part of the gastrointestinal tract from the mouth to the anus. The exact etiology is unknown. Symptoms depend on what part of the gastrointestinal tract is affected. It primarily causes abdominal pain, diarrhea, vomiting, low-grade fever and weight loss, but may also cause extraintestinal manifestations, usually involving the skin, joints, mouth, eyes, liver or bile ducts. Unpredictable flares and remissions characterize the long-term course of Crohn disease.


Presentation

  • Crypt abscesses may be present Granulomas are present in about 15-36% of biopsied cases Present in over half of colectomy specimens Compact aggregates of epithelioid histiocytes Non-necrotic Multinucleated giant cells may be present May be seen at all[surgpathcriteria.stanford.edu]
  • Patients typically present with chronic diarrhea and recurrent abdominal pain, although occasionally the presentation is with a complication or an extraintestinal manifestation. Anemia may be present and C-reactive protein may be elevated 29.[radiopaedia.org]
  • Although the disease most commonly presents at a young age, it can affect people of all ages. Patients often present with persistent diarrhoea, abdominal pain, and weight loss.[bmj.com]
  • The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.[fascrs.org]
  • Iron deficiency and vitamin deficiencies may present as skin or oral ulceration, persistent infections or pellagra. Drugs prescribed for Crohn disease may also lead to adverse effects on the skin ( drug eruptions ).[dermnetnz.org]
Fatigue
  • It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.[mayoclinic.org]
  • The main symptoms are: diarrhoea stomach aches and cramps blood in your poo tiredness (fatigue) weight loss The symptoms may be constant or may come and go every few weeks or months. When they come back, it's called a flare-up.[nhs.uk]
  • Fatigue : Individuals often feel extremely tired. Fever is also possible during fatigue. Altered appetite : There may be time when the appetite is very low. Weight loss : This can result from a loss of appetite.[medicalnewstoday.com]
  • Immune cells accumulate in the intestines, attacking bacteria, food, healthy body tissue and other harmless or even beneficial substances, causing symptoms such as abdominal pain, diarrhea, rectal bleeding, weight loss, fever and fatigue.[eatright.org]
  • Symptoms of Crohn’s disease The commonest symptoms of this condition include diarrhea that may occur in episodes or for long durations along with abdominal pain, extreme fatigue or tiredness and abnormal weight loss due to malnutrition.[news-medical.net]
Weight Gain
  • Surgery is used to relieve severe, ongoing symptoms and to help children achieve growth and weight gain when medical management is no longer effective on its own.[chop.edu]
  • It is very important if your child is suffering from malnutrition or poor weight gain. Nutrition therapy can also be used for induction and maintenance of remission.[gikids.org]
  • Growth failure and poor weight gain in children with inflammatory bowel disease. UpToDate, Inc. 2017 Nov 22. Available at: Accessed January 22, 2019. Setty M, Russell GH, Bousvaros A.[rarediseases.org]
  • However, a major problem with using them is their side effects, which include: weight gain; increased risk of infection; acne; mood changes; sleep disturbances; wasting of the muscles; high blood pressure; thinning of the bones (osteoporosis); cataracts[mydr.com.au]
  • Steroids are very effective (about eight out of ten patients have a good response) but some steroids can have side effects such as weight gain, insomnia, infection and acne.[gutscharity.org.uk]
Pallor
  • Anemia is associated with fatigue, pale skin color (pallor), lightheadedness, and other symptoms. About 30% of children and adolescents develop perianal disease, which affects the area around the anus.[rarediseases.org]
  • Clinical Examination of Crohn’s Disease (Inflammatory Bowel Disease) There are few physical signs of Crohn’s disease other than weight loss and general ill health, in particular pallor (pale skin) or cachexia (muscle wasting).[healthengine.com.au]
  • […] skin tags, fistulae, ulcers, abscesses, and scarring in the perianal region; nephrolithiasis, hydronephrosis, and enterovesical fistulae Musculoskeletal: Possible arthritis and arthralgia, particularly of the large joints [6] Dermatologic: May show pallor[emedicine.medscape.com]
Abdominal Pain
  • It primarily causes abdominal pain, diarrhea, vomiting, low-grade fever and weight loss, but may also cause extraintestinal manifestations, usually involving the skin, joints, mouth, eyes, liver or bile ducts.[symptoma.com]
  • The goal of treatment is to control the swelling (inflammation), correct any nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea and rectal bleeding.[genome.gov]
  • It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.[mayoclinic.org]
  • When you have symptoms, such as diarrhea or abdominal pain, follow the recommended food list provided by your registered dietitian nutritionist.[eatright.org]
  • Symptoms include abdominal pain and diarrhea, sometimes bloody, and weight loss.[webmd.com]
Nausea
  • Common side effects of sulfasalazine include: headache nausea abdominal pain diarrhoea If side effects become particularly troublesome, you should tell your GP as the dose used may need to be adjusted.[hse.ie]
  • Symptoms include loss of appetite, weight loss, nausea, and vomiting. Jejunoileitis This less common type of Crohn's disease affects the upper half of the small intestine, called the jejunum.[medicalnewstoday.com]
  • This can be very painful and can cause diarrhea, abdominal pain, nausea and decreased appetite. The inflammatory process tends to be eccentric and segmental, often with skip areas (normal regions of bowel between inflamed areas).[genome.gov]
  • Side effects of aminosalicylates include: heartburn; headaches; nausea; diarrhoea; and abdominal pain. Corticosteroids Corticosteroids can be given to treat active disease.[mydr.com.au]
Rectal Bleeding
  • Diarrhea Rectal bleeding Weight loss Arthritis Skin problems Fever Rectal bleeding may be serious and continuous enough to cause anemia (low red blood count). Children who have Crohn's disease may have delayed development and stunted growth.[genome.gov]
  • The disease may cause: abdominal pain and cramps diarrhea constipation rectal bleeding bloody stools weight loss fatigue Crohn's disease can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.[medicalnewstoday.com]
  • Other symptoms include rectal bleeding, weight loss, and fever. If you believe you have Crohn’s disease, you should speak with a healthcare provider who can confirm a diagnosis through laboratory tests, examination, imaging, and a colonoscopy.[celiac.org]
  • Unexplained abdominal pain, diarrhea, rectal bleeding, weight loss and fever are all symptoms of Crohn's disease and are very similar to those of ulcerative colitis.[radiologyinfo.org]
  • Treatment for the disorder has 4 goals: Correct nutritional problems Control the swelling and inflammation Ease symptoms such as belly pain, diarrhea, and rectal bleeding Keep complications from occurring.[stanfordchildrens.org]
Abdominal Mass
  • mass : the solid mass is often palpable in the RLQ Enterocutaneous fistula formation, typically seen in the perianal region Clinical features of abscesses ( 50% of cases) and fistulas ( 30% of cases) Typically involve the terminal ileum and/or perianal[amboss.com]
  • Inspection and palpation of the abdomen may reveal abdominal mass secondary to obstruction or granuloma formation. Bowel sounds may be hyperactive or even hypoactive as a result of this obstruction.[cancertherapyadvisor.com]
  • mass Rarely Yes Significant perineal disease No Frequently Fistulas No Yes Small intestinal obstruction No Frequently Colonic obstruction Rarely Frequently Response to antibiotics No Yes Recurrence after surgery No Yes ANCA-positive Frequently Rarely[lecturio.com]
  • mass, hematocrit Patient Population Subjects 18 years with a diagnosis of CD of 6 months duration established by clinical, endoscopic or radiological, and histopathological assessment were enrolled following informed consent.[frontiersin.org]
  • Individuals with abdominal abscesses can develop tender abdominal masses, high fevers, and abdominal pain. When the ulcer tunnels into an adjacent organ, a channel ( fistula ) is formed.[medicinenet.com]
Lower Abdominal Pain
  • Chronic diarrhoea associated with abdominal pain, fever, anorexia, weight loss and a right lower abdominal pain and tenderness are the most common features. Sometimes the inflammation is so great that it blocks movement through the bowel.[crohnsandcolitis.org.nz]
Arthralgia
  • Crohn’s patient 4 and is often chronic or nocturnal); Abdominal pain; Weight lossor anorexia; Blood or mucus in stools (faeces); Rectal bleeding ; Perineal pain (pain in the area between the anus and the genitals); Nausea; Malaise (feeling unwell); Arthralgia[healthengine.com.au]
  • The examiner should ask about any history of arthritis/arthralgia, back pain, rashes, pruritus, dyspnea, jaundice, right upper quadrant pain, mouth ulcerations, and eyesight changes.[cancertherapyadvisor.com]
  • Some affected individuals develop joint pain (arthralgia) or joint inflammation (arthritis). Causes The exact cause of pediatric Crohn’s disease is not fully understood.[rarediseases.org]
  • […] abnormalities, presence of hematochezia Genitourinary: May include presence of skin tags, fistulae, ulcers, abscesses, and scarring in the perianal region; nephrolithiasis, hydronephrosis, and enterovesical fistulae Musculoskeletal: Possible arthritis and arthralgia[emedicine.medscape.com]

Workup

  • Clinical Testing and Workup Children and adolescents suspected to have pediatric Crohn’s disease will receive a complete blood count. A complete blood count is a test that evaluates the cells in a person’s blood.[rarediseases.org]
  • […] accuracy, but their overall sensitivity and specificity are reported to be 75–85% and 85–98%, respectively. 24,40,79–85 It is not infrequent to find intraoperatively more locations [mainly short skip lesions] than there were identified in the preoperative workup[academic.oup.com]
Nephrolithiasis
  • […] ducts connecting to the liver); and Fatty liver or the excessive build-up of fat in liver cells, which may lead to further liver disorders such as chronic hepatitis (inflammation of the liver) and liver failure ; Urogenital complications, including: Nephrolithiasis[healthengine.com.au]
  • […] from normal to those of an acute abdomen; assess for rectal sphincter tone, gross rectal mucosal abnormalities, presence of hematochezia Genitourinary: May include presence of skin tags, fistulae, ulcers, abscesses, and scarring in the perianal region; nephrolithiasis[emedicine.medscape.com]

Treatment

  • The authors conclude that a further trial is required to confirm that genetic testing prior to treatment will reduce the rate of treatment failure by facilitating the most effective choice of therapy for individual patients.[eurekalert.org]
  • Maintaining remission Your doctor should discuss all the treatment options with you, including treatment, no treatment and treatment side-effects.[patient.info]
  • Treatment is self-administered by subcutaneous injection.[frontiersin.org]
  • Therapeutics There is a pressing need to identify and develop more effective treatments for Crohn’s disease.[helmsleytrust.org]
  • […] and require surgical treatment (1%).[healthengine.com.au]

Prognosis

  • Left untreated, Crohn's spreads throughout the intestinal tract, causing more severe symptoms and a bleaker prognosis.[edition.cnn.com]
  • POST-TREATMENT PROGNOSIS It is important to follow up with your physicians so they can devise an ongoing management plan to control your symptoms. When you have Crohn’s disease, you must stay on medication throughout your entire life.[fascrs.org]
  • What is the prognosis? The outlook (prognosis) is variable. It depends on which part or parts of the gut (gastrointestinal tract) are affected and how often and how severe the flare-ups are.[patient.info]
  • The outlook, or prognosis, for Crohn’s disease is different for different people and depends on which part or parts of the gut are affected and how often and how severe the flare-ups are.[healthnavigator.org.nz]

Etiology

  • The exact etiology is unknown. Symptoms depend on what part of the gastrointestinal tract is affected.[symptoma.com]
  • Etiology Cause : Unknown factors lead to an imbalance between proinflammatory and anti-inflammatory mediators.[amboss.com]
  • The etiology for Crohn’s disease is likely multifactorial as genetic, microbial, environmental, and host factors have been associated with disease.[cancertherapyadvisor.com]
  • Obstruction due to uncomplicated Crohn disease should resolve within a few days and therefore does not require either specific anti-inflammatory therapy or parenteral nutrition; absence of prompt response, however, indicates a complication or another etiology[msdmanuals.com]
  • Etiology The exact cause of Crohn disease remains unknown.[emedicine.medscape.com]

Epidemiology

  • More common in white populations and people of Jewish descent (especially Ashkenazi Jews, middle European Jews) References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2017 Jul;92(7):1088-1103. doi: 10.1016/j.mayocp.2017.04.010. Epub 2017 Jun 7. Review.[ghr.nlm.nih.gov]
  • (See Epidemiology.) The characteristic presentation is abdominal pain and diarrhea, which may be complicated by intestinal fistulization or obstruction.[emedicine.medscape.com]
  • Chapter 2: Epidemiology. In: Tersigni R, Prantera C (eds). Crohn’s Disease: A multidisciplinary approach. Milan: Springer-Verlag; 2010: 9-16. Book Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults.[healthengine.com.au]
  • Epidemiology of Crohn's Disease”. J Clin Gastroenterol. vol. 8. 1986. pp. 160-5. Abraham, C, Cho, J. “Inflammatory bowel disease”. N Engl J Med. vol. 361. 2009. pp. 2066-2078. Nikolaus, S, Schreiber, S. “Diagnostics of inflammatory bowel disease”.[cancertherapyadvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • References: [1] [4] Pathophysiology Clinical features Typically, CD occurs episodically and there is a 30% risk of recurring inflammation over the span of one year. If symptoms persist for six months, the disease is considered chronic.[amboss.com]
  • The pathophysiology of Crohn’s has been extensively studied, yet there still exists much uncertainty about the underlying cause and reason for certain populations being affected more than others.[cancertherapyadvisor.com]
  • Risk Factors of Crohn’s Disease (Ileitis) and Ulcerative Colitis (UC) The exact pathophysiology of inflammatory bowel disease (IBD) is unclear, but a number of risk factors are associated with their development.[lecturio.com]
  • Identification of genetic variants linked to CD that associate with innate immune function lends support to the idea that innate immune insufficiency plays a role in disease pathophysiology, at least for a significant segment of those suffering from CD[frontiersin.org]

Prevention

  • These prevent the onset of acute episodes and prolong remission phases, while allowing gastrointestinal tract lesions time to heal.[inserm.fr]
  • This will enable further efforts to prevent onset, recurrence, or progression, as well as development of complications from the disease.[helmsleytrust.org]
  • The goal of treatment is to relieve symptoms, prevent other problems, and prevent future flare-ups.[kidshealth.org]
  • High quality multidisciplinary care, of which primary care is a key aspect, can attenuate relapse, prevent long term complications, and improve quality of life.[bmj.com]
  • A well-balanced and nutritious diet is essential for anyone with Crohn’s disease to prevent malnutrition and maintain good health.[southerncross.co.nz]

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Last updated: 2019-07-11 22:11