Crohn's Disease Vignette

Question 1

What is Crohn’s disease? Prevalence?

Answer 1

Form of idiopathic Inflammatory Bowel Disease
includes Crohn’s and Ulcerative colitis

Inappropriate inflammatory response to intestinal microbes

1.4 million Americans, onset 15 to 30 years

Question 2

Tobacco Risk

Answer 2

Tobacco users at greater risk for Crohn’s

Non-smokers and former smokers at risk for UC

Question 3

Crohn’s Symptom/Presentation

Answer 3

Hematochezia: Rarely
Location: Ileum
Pattern: Discontinuous
Upper GI: Yes
Extra GI Manifestations: Common
Fistulas: Common
Inflammation: Transmural

AbP, N, V, Dia, weight loss
Entire GI
Perianal disease common

Question 4

Ulcerative Colitis Symptoms/Presentation

Answer 4

Hematochezia: Common
Location: Rectum
Pattern: Continuous
Upper GI: No
Extra GI Manifestations: Common
Fistulas: Rare
Inflammation: Mucosal

AbP, rectal bleeding
Limited to colon
Perianal disease uncommon

Question 5

Extraintestinal Manifestations, prevalence?

Answer 5

25% of IBD patients

Pleuritis, myocarditis, Nephrolithiasis, Pancreatitis, Ankylosing spondylitis, Arthritis, Erythema Nodosum, Pyoderma Gangrenosum, Tendinitis

Question 6

Rising Prevalence?

Answer 6

Changes in diet, ABX use, Altered intestinal colonization, tobacco use

Question 7

Genetic Factors

Answer 7

NOD2, IL23-type 17 Helper T cell pathway, Autophagy genes