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Crohn Disease

Eric J. Mao, MD and Samir A. Shah, MD, FACG, FASGE, AGAF Reviewed 06/2019
 


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 fibr...

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 patien...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Vaccinations 
  • Check titers; avoid live vaccines (MMR, varicella, Zostavax) in patients on immunosuppressive therapy (steroids, 6MP, azathioprine,...

REFERENCES

1
Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol.  2018;113(4):481–517. [View Abstract on OvidMedline]
...

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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