Crohn's disease

Question 1

What is Crohn’s disease?

Answer 1

Chronic inflammatory disease characterised by transmural granulomatous inflammation at any part from mouth to anus
Peaks at 15-35 years, second peak at 60 years

Question 2

What are the risk factors of Crohn’s disease?

Answer 2

Nicotine abuse
Familial predisposition (e.g., mutation of the NOD2 gene, HLA-B27 association)

Question 3

What are the clinical features of Crohn’s disease?

Answer 3

(Intestinal) Non-bloody, chronic diarrhoea, abdominal pain (normally RLQ), malabsorption, anemia, low vitamin B12
(Non-intestinal) Arthritis, Erythema nodosum, Pyoderma gangrenosum, eye problems, clubbing

Question 4

How is Crohn’s disease diagnosed?

Answer 4

(Blood) ↑ Inflammatory markers (↑ CRP, ↑ ESR, ↑ thrombocytes, and ↑ leukocytes)
(Stool) Rule out gastroenteritis caused by bacteria, ↑ fecal calprotectin and/or lactoferrin inflammatory markers
(X-ray) String sign, distended bowel, pneumoperitoneum
(Colonoscopy) Pebblestone sign, transmural inflammation (Non-caseating granulomas), discontinuous involvement

Question 5

What is the treatment for Crohn’s disease?

Answer 5

(General) Smoking cessation, nutritional supplementation
(Medical) (Mild - moderate) Prednisolone
(Severe) IV steroids (e.g. hydrocortisone / methylprednisolone), thromboembolism prophylaxis
(Azathioprine) If steroids ineffective
(Anti-TNFalpha, i.e. infliximab / adalimumab) immunosuppresants
(Surgery, if medical therapy fails) Resection of affected bowel (e.g., ileostomy, ileocolostomy, colectomy, proctocolectomy)

Question 6

What are the differential diagnosis of Crohn’s disease?

Answer 6

Ulcerative colitis 
Acute appendicitis
Infectious gastroenteritis
Non-infectious colitis
IBS 
Diverticulitis

Question 7

What are the complications of Crohn’s disease?

Answer 7

Small bowel obstruction, abscess / fistula, colon cancer