Crohns Disease

By: Sara Gralitzer

Overview

S Inflammatory Bowel Diseases (IBD) are Crohns Disease

(CD) and Ulcerative Colitis (UC).1,2

S Inflammatory Bowel Diseases are autoimmune disorders of

the gastrointenstinal tract.

S Crohns Disease is an inflammatory disease affecting the

gastrointestinal tract anywhere from the mouth to the anus.

24

Overview cont.

S In North America 1-1.5 million people suffer from Crohns

Disease and in Europe the range is 2.5-3 million people.5

S Typical age onset of the disease is between 15-30 years of

age.7

Risk Factors
S Genetics- Ashkenazi Jewish Descent
S Ashkenazi Jews have a 2-4 fold increase in having Crohns Disease

when compared to other ethnic groups1,2,6

S An increased risk of Crohns Disease is present when three
polymorphisms of the gene NOD2 are present.
S Those with a first degree relative with Crohns Disease have a
5-20% chance of having the disease as well.4,6
S Environmental

S Gastroenteritis frequently precedes a Crohns Disease diagnosis

and is thought to occur due to the mucosal flora and intramucosal

bacteria present1.

S Smokers

Signs and Symptoms

S Abdominal Pain or

Cramping

S Bowel Obstruction or

Constipation

S Weight Loss

S Mucous or bloody stools

S Fever

S Rectal Bleeding

S Diarrhea

S Rash 2,8

Signs and Symptoms Cont.

S Children with Crohns Disease may have stunted growth

and are more likely to have fever first.3

S The symptoms may be slightly different in children

presenting with Crohns Disease with children less likely to

have diarrhea or bowel obstructions.

Extraintestinal Manifestations

S Rheumatic

S Hematologic

S Metabolic

S Thromboembolic

S Dermatologic

S Urinary tract

S Ophthalmologic

S Pulmonary

S Hepatobiliary

S Pancreatic diseases.

Complications

S fistulas
S Bowel perforations
S perioninitis
S Strictures
S abcesses10

Differential Diagnosis

S infectious and non-infectious diseases.

S Bechets Disease, Yeirisina, enterovirus, Tuberculosis, and

appendicitis
S Irritable Bowel Syndrome (IBS)
S Ulcerative Colitis1,2

Diagnostic Tests

S Gold Standard:

ileocolonoscopy with
biopsies
S Endoscopy
S Colonoscopy
S Computed Tomography

(CT) enteropgraphy

S Magnetic Resonance

(MRI) enteropgraphy
S Capsule endoscopy.2,3,12
S Blood Tests
S Stool Cultures

Classification

S Montreal Classification which classify the disease by

the phenotype
S Crohns Disease Activity Index which classifies the

disease by its activity

S response to treatment with steroids.2

Classification Cont.

S Montreal Classification:
S include both the location of the disease and if it is penetrating

or stricturing.
S The location: terminal ileum, colon, ileocolon, upper
gastrointestinal tract, upper gastrointestinal tract and distal
disease.
S Most common location is terminal ileum

Treatment

S Medications
S Surgery
S Diet Modifications
S Lifestyle Modifications

Treatment Cont.

S Diet Modifications
S correcting any nutritional deficiencies

S Lifestyle Modifications
S Quitting smoking of a smoker.

Treatment- Medications

S Antibiotics:
S metronidazole or ciprofloxin
S

aminosalicylates: 5-ASA
S

mesalamine, olsalazine, and balsalazide

S Corticosteroids:
S Prednisone
S Glucocorticoids such as budesonide
S

biologics:
S

Adalimumab

immunosuppressive therapy13:
S

6-Mercaptopurine and azathioprine

Treatment- Surgery

S Surgical rates for Crohns Disease after diagnosis is around

60% within the first ten years of diagnosis.6

S Surgery for Crohns Disease is used to resect the diseased

portion of the bowel

S Surgery is indicated:
S abscesses, perineal or internal fistula, fibrostenotic strictures,
cancer and high grade dysplasia.1
S Other medical treatments have failed

Prognosis and Prevention

S prognosis for Crohns Disease depends on the severity of the

disease and the number of flare-ups a person has

S annual vaccinations
S Increased risk for colorectal cancer and small bowel cancer.
S The patient should have a colonoscopy every 1-2 years when in

remission and then every 1-3 when as they stay in remission.1

Prognosis and Prevention Cont.

S 50% of adults with Crohns Disease will go on to develop

intestinal complications within the first 20 years of

diagnosis
S Prolonged remission is rare and occurs in about 10% of the

population with Crohns Disease.9

References

References:

1.

2.
Assche GV, Dignass A, Panes J, et al. The second European evidence-based Consensus on the diagnosis and management
of Crohns disease: Definitions and diagnosis. J. Crohns Colitis 2010;4(1):7-27.

3.
Burbige EJ, Shi-Shung Huang, Bayless TM. Clinical Manifestations of Crohns Disease in Children and Adolescents.
Pediatrics 1975;55(6):866.

4.
CCFA: What is Crohns Disease | Causes of Crohns. Available at: http://www.ccfa.org/what-are-crohns-and-colitis/
what-is-crohns-disease/. Accessed November 25, 2014.

5.

6.
Sugimura K, Taylor KD, Lin Y, et al. A Novel NOD2/CARD15 Haplotype Conferring Risk for Crohn Disease in
Ashkenazi Jews. Am. J. Hum. Genet. 2003;72(3):509-518.

Baumgart DC, Sandborn WJ. Crohns disease. The Lancet 2012;380(9853):1590-1605.

Burisch J, Munkholm P. Inflammatory bowel disease epidemiology: Curr. Opin. Gastroenterol. 2013;29(4):357-362.

References Cont.

7.

Abraham C, Cho JH. Inflammatory Bowel Disease. N. Engl. J. Med. 2009;361(21):2066-2078.

8.
Crohns Disease. Clevel. Clin. Available at: https://my.clevelandclinic.org/health/diseases_conditions/
hic_Inflammatory_Bowel_Disease_IBD_QandA/hic_Crohns_Disease. Accessed November 25, 2014.

9.
Larsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: Epidemiology, diagnosis, and
management. Ann. Med. 2010;42(2):97-114.

10.

11.
CDC - Home Page - Inflammatory Bowel Disease (IBD) - Division of Population Health. Available at: http://www.cdc.gov/ibd/.
Accessed November 25, 2014.

12.
Jensen MD, Nathan T, Rafaelsen SR, Kjeldsen J. Diagnostic Accuracy of Capsule Endoscopy for Small Bowel Crohns Disease Is
Superior to That of MR Enterography or CT Enterography. Clin. Gastroenterol. Hepatol. 2011;9(2):124-129.e1.

13.

14.
Prefontaine E, Sutherland LR, MacDonald JK, Cepoiu M. Azathioprine or 6-mercaptopurine for maintenance of remission in Crohns
disease. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 1996. Available at: http://onlinelibrary.wiley.com/doi/
10.1002/14651858.CD000067.pub2/abstract. Accessed November 24, 2014.

15.

Symptoms That Help Distinguish IBS From Crohns Disease. Dig. Disord. 2006:57-57.

Scribano ML, Prantera C. Medical treatment of active Crohns disease. Aliment. Pharmacol. Ther. 2002;16:35-39.

Lfberg R. Medical treatment of mild to moderately active Crohns disease. Aliment. Pharmacol. Ther. 2003;17:18-22.