Crohn Disease

Eric Ji-Yuan Mao, MD and Samir A. Shah, MD, FACG, FASGE, AGAF Reviewed 06/2017
 


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: spontaneously, after medical/surgical intervention, or while on steroids (CDAI ≪150)
    • ▪ Mild to moderate CD: ambulatory pat...

ADDITIONAL THERAPIES

COMPLICATIONS

  • Peritonitis: bowel rest and antibiotic therapy (7 to 10 days parenteral antibiotics, followed by 2- to 4-week course of PO ciprofloxacin and metronidazole ); surgery ...

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 an...

REFERENCES

Baumgart  DC, Sandborn  WJ. Crohn's disease. Lancet.  2012;380(9853):1590–1605. [View Abstract on OvidInsights]
Talley  NJ, Abreu  MT, Achkar  JP, et al. An evidence-based systematic ...

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 developing CD; tobacco cessation may reduce frequency of flares and need for surgery.

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

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