Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal pain
  • prolonged diarrhoea
  • perianal lesions

Other diagnostic factors

  • bowel obstruction
  • blood in stools
  • fever
  • fatigue
  • abdominal tenderness
  • weight loss
  • oral lesions
  • abdominal mass
  • extra-intestinal manifestations (e.g., erythema nodosum or pyoderma gangrenosum)

Risk factors

  • white ancestry
  • age 15-40 or 60-80 years
  • FHx of CD
  • cigarette smoking
  • diet high in refined sugar
  • oral contraceptive pill
  • not breastfed
  • NSAIDS

Diagnostic investigations

1st investigations to order

  • FBC
  • iron studies (serum iron, serum ferritin, total iron binding capacity [TIBC], transferrin saturation)
  • serum vitamin B12
  • serum folate
  • comprehensive metabolic panel (CMP)
  • C-reactive protein (CRP) and ESR
  • stool testing
  • Yersinia enterocolitica serology
  • plain abdominal films
  • CT abdomen
  • MRI abdomen/pelvis
Full details

Investigations to consider

  • upper GI and small bowel series
  • abdominal and pelvic ultrasonography
  • colonoscopy
  • tissue biopsy
  • technetium-99 labelled white blood cell scanning
  • oesophagogastroduodenoscopy
  • wireless capsule endoscopy
  • autoantibodies
  • fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)
Full details

Emerging tests

  • faecal calprotectin or faecal lactoferrin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Colorectal Surgeon

Imperial College Healthcare NHS Trust

London

UK

Disclosures

GR is an author of a number of references cited in this monograph.

SpR in Gastroenterology and General Medicine

Imperial College Healthcare NHS Trust

Research Fellow

Imperial College London

London

UK

Disclosures

GW declares that she has no competing interests.

SpR in General Surgery

Imperial College Healthcare

Research Fellow

Imperial College London

London

UK

Disclosures

PHP declares that he has no competing interests.

Mr George Reese, Dr Georgia Woodfield, and Mr Pranav H. Patel would like to gratefully acknowledge Dr Philip J. Smith, Dr Charlotte Ford, Dr Wissam Bleibel, Dr Bishal Mainali, Dr Chandrashekhar Thukral, and Dr Mark A. Peppercorn, the previous contributors to this monograph. PJS, CF, WB, BM, CT, and MAP declare that they have no competing interests.

Peer reviewers VIEW ALL

Chief of Gastroenterology & Hepatology

Professor of Medicine

Director of Crohn's & Colitis Center of New Jersey

New Brunswick

NJ

Disclosures

KMD declares that he has no competing interests.

Consultant Gastroenterologist and Senior Lecturer

Royal Victoria Infirmary

Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University

Newcastle upon Tyne

UK

Disclosures

JM declares that he has no competing interests.

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