Crohn disease: diagnosis and treatment

Colonoscopy showing Crohn disease, with ulceration of the colonic mucosa.
Colonoscopy showing Crohn disease, with ulceration of the colonic mucosa.

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Inflammatory bowel disease (IBD) is believed to result from the interaction of genetic predisposition, environmental triggers, and dysfunctional immune response. IBD may present as ulcerative colitis or Crohn disease (CD). CD is a chronic condition characterized by inflammation anywhere along the gastrointestinal tract.1

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Patient history and presentation

CD most frequently involves the small intestine alone, the colon alone, or both the small intestine and the colon. Although the mouth, esophagus, stomach, and duodenum may be affected, involvement of these sites is uncommon and rarely occurs without active disease in the small or large intestine. 

Inflammation develops in the absence of infection, with periods of relapse and remission (Figure 1). A primary symptom of IBD is diarrhea. Because the terminal ileum is inflamed in a large number of patients with CD, they also typically present with right lower quadrant pain that is cramping in nature.2 

Additional clinical manifestations of CD vary according to disease location. Esophageal disease may manifest as dysphagia, heartburn, or chest pain, whereas gastrointestinal disease may produce epigastric pain or hematemesis.1 Weight loss is often evident in patients with CD and may be caused by food avoidance or malabsorption that results in malnutrition, especially if inflammation of the small intestine is extensive. Impaired growth and malnutrition are significant complications of CD in children and adolescents and can be especially severe in children with stricturing CD.3 Other extraintestinal manifestations of CD include erythema nodosum, pyoderma gangrenosum, uveitis, iritis, peripheral arthritis, sacroiliitis, ankylosing spondylitis, sclerosing cholangitis, cholelithiasis, and hepatitis.2 

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