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Overview
Overview cont.
age.7
Risk Factors
S Genetics- Ashkenazi Jewish Descent
S Ashkenazi Jews have a 2-4 fold increase in having Crohns Disease
S Smokers
S Abdominal Pain or
Cramping
S Bowel Obstruction or
Constipation
S Weight Loss
S Fever
S Rectal Bleeding
S Diarrhea
S Rash 2,8
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
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
the phenotype
S Crohns Disease Activity Index which classifies the
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
S Corticosteroids:
S Prednisone
S Glucocorticoids such as budesonide
S
biologics:
S
Adalimumab
immunosuppressive therapy13:
S
Treatment- Surgery
S Surgery is indicated:
S abscesses, perineal or internal fistula, fibrostenotic strictures,
cancer and high grade dysplasia.1
S Other medical treatments have failed
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.
Burisch J, Munkholm P. Inflammatory bowel disease epidemiology: Curr. Opin. Gastroenterol. 2013;29(4):357-362.
References Cont.
7.
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.