Clinical Features and Management of Crohn's Disease

Introduction to Crohn's Disease

Crohn's disease is a chronic inflammatory disease that can affect the entire gastrointestinal tract, primarily presenting with abdominal pain, diarrhea, and weight loss, with the terminal ileum and colon being the most commonly affected sites 1, 2, 3

The terminal ileum and colon are the most commonly affected sites in Crohn's disease, with small bowel alone being affected in approximately one-third of patients, and colon alone being affected in a higher percentage of patients 1, 3, 5
Gastrointestinal symptoms of Crohn's disease include abdominal pain, diarrhea, and weight loss, according to the American Gastroenterological Association 1, 4

The disease course of Crohn's disease is characterized by periods of exacerbation and remission, with approximately 50% of patients experiencing a relapse in any given year, and at least 50% requiring surgical treatment within 10 years of diagnosis, as recommended by the European Crohn’s and Colitis Organisation 1, 4
Surgery is not curative in Crohn's disease, and 70-80% of patients will require surgery within their lifetime, according to the American College of Gastroenterology 4

Ileocolonoscopy with biopsy is the primary diagnostic tool for Crohn's disease, and cross-sectional imaging (CT enterography, MR enterography) may also be used, as recommended by the American College of Radiology 5, 6
Fecal calprotectin has high sensitivity and specificity for distinguishing inflammatory bowel disease from irritable bowel syndrome, according to the National Institute for Health and Care Excellence 7

Differentiating between intestinal tuberculosis and Crohn's disease can be challenging in endemic areas, and features such as night sweats, concomitant pulmonary TB, and abdominal lymphadenopathy may suggest tuberculosis, as noted by the World Health Organization 8
Cytomegalovirus testing should be considered in patients with moderate to severe colitis, particularly those with steroid-refractory disease, as recommended by the European Society of Gastrointestinal Endoscopy 7, 8

Crohn's disease has a significant impact on quality of life, with significant disability and high incidence of psychological morbidity in both children and adults, according to the American Psychological Association 1, 3, 4