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Crohn Disease

Eric Ji-Yuan Mao, MD and Samir A. Shah, MD, FACG, FASGE, AGAF Reviewed 06/2018
 


BASICS

DESCRIPTION

A chronic, relapsing inflammatory GI tract disorder, most commonly involving the terminal ileum (80%) 
  • Hallmark features of Crohn disease (CD)

    • Transmural inflammation resulting in fi...

DIAGNOSIS

HISTORY

Hallmarks: fatigue, fever, weight loss, prolonged diarrhea, perianal disease, crampy abdominal pain (+/− bleeding). Children may present with failure to thrive. 
  • Factors exacerbating C...

TREATMENT

  • Disease severity: Crohn Disease Activity Index (CDAI)

    • Asymptomatic: spontaneous, after medical/surgical intervention, or while on steroids (CDAI <150)

    • Mild to moderate CD: ambulatory pati...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

Vaccinations 
  • Check titers; avoid live vaccines (MMR, varicella, zoster) in patients on immunosuppressive therapy (steroids, 6MP, AZA, MTX, or bi...

REFERENCES

1
1 Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet.  2012;380(9853):1590–1605. {L-End} {L-End} [View Abstract on OvidMedline]
2
2 Talley NJ, Abreu MT, Achkar JP, et al. An evidence-...

CODES

ICD10

  • K50.919 Crohn’s disease, unspecified, with unspecified complications

  • K50.00 Crohn’s disease of small intestine without complications

  • K50.10 Crohn’s disease of large intestine without complica...

CLINICAL PEARLS

  • Cigarette smoking doubles the risk of CD; tobacco cessation reduces flares and need for surgery.

  • MRE allows assessment of luminal and extraluminal CD without radiation exposure.

  • Assess f...

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