Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- abdominal pain
- prolonged diarrhea
- perianal lesions
Outros fatores diagnósticos
- bowel obstruction
- blood in stools
- fatigue
- abdominal tenderness
- weight loss
- fever
- oral lesions
- abdominal mass
- extraintestinal manifestations (e.g., erythema nodosum or pyoderma gangrenosum)
Risk factors
- white ethnicity
- Ashkenazi Jewish ancestry
- age 15-40 or 50-60 years
- family history of CD
- use of antibiotics
- cigarette smoking
- diet high in refined sugar
- diet low in fiber
- diet high in ultra-processed foods
- use of oral contraceptives
- not breastfed
- use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Diagnostic tests
1st tests to order
- CBC
- iron studies (serum iron, serum ferritin, total iron binding capacity [TIBC], transferrin saturation)
- serum vitamin B12
- serum folate
- comprehensive metabolic panel (CMP)
- CRP and erythrocyte sedimentation rate (ESR)
- stool testing
- Yersinia enterocolitica serology
- plain abdominal x-ray
- MRI abdomen/pelvis
- CT abdomen
Tests to consider
- abdominal and pelvic ultrasonography
- ileocolonoscopy
- tissue biopsy
- esophagogastroduodenoscopy
- wireless capsule endoscopy
- fecal calprotectin
Emerging tests
- serologic markers
Treatment algorithm
ileocecal disease not fistulizing with <100 cm of bowel affected: initial presentation or relapse
colonic disease not fistulizing: initial presentation or relapse
extensive small bowel disease (>100 cm of bowel affected) not fistulizing: initial presentation or relapse
upper gastrointestinal disease (esophageal and/or gastroduodenal disease) not fistulizing: initial presentation or relapse
perianal or fistulizing disease: initial presentation or relapse
in remission
Contributors
Authors
Lucy Charlotte Hicks, MBBS, PhD, FHEA, MRCP
Consultant Gastroenterologist
Department of Gastroenterology
St Mary's Hospital
Imperial College Healthcare NHS Trust
Honorary Senior Clinical Lecturer
Imperial College
London
UK
Disclosures
LCH declares that she has no competing interests.
Georgia Woodfield, MBChB, MSc, PhD
Specialist Registrar 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.
Acknowledgements
Dr Georgia Woodfield and Dr Lucy Charlotte Hicks would like to gratefully acknowledge Mr George Reese, Dr Pranav H. Patel, 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 topic.
გაფრთხილება:
GR is an author of a number of references cited in this topic. PHP, PJS, CF, WB, BM, CT, and MAP declare that they have no competing interests.
რეცენზენტები
Kiron M. Das, MD, PhD, FACP, FRCP
Chief of Gastroenterology & Hepatology
Professor of Medicine
Director of Crohn's & Colitis Center of New Jersey
New Brunswick
NJ
გაფრთხილება:
KMD declares that he has no competing interests.
John Mansfield, MA, MD, FRCP
Consultant Gastroenterologist and Senior Lecturer
Royal Victoria Infirmary
Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University
Newcastle upon Tyne
UK
გაფრთხილება:
JM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
წყაროები
ძირითადი სტატიები
Ooi CJ, Makharia GK, Hilmi I, et al. Asia Pacific consensus statements on Crohn's disease. Part 1: definition, diagnosis, and epidemiology. J Gastroenterol Hepatol. 2016 Jan;31(1):45-55.სრული ტექსტი აბსტრაქტი
Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr;113(4):481-517.სრული ტექსტი აბსტრაქტი
Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis. 2017 Jan;11(1):3-25.სრული ტექსტი აბსტრაქტი
Torres J, Bonovas S, Doherty G, et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohns Colitis. 2020 Jan 1;14(1):4-22.სრული ტექსტი აბსტრაქტი
Adamina M, Bonovas S, Raine T, et al. ECCO guidelines on therapeutics in Crohn's disease: surgical treatment. J Crohns Colitis. 2020 Feb 10;14(2):155-68.სრული ტექსტი აბსტრაქტი
Feuerstein JD, Ho EY, Shmidt E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021 Jun;160(7):2496-508.სრული ტექსტი აბსტრაქტი
Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: surgical management and special situations. J Crohns Colitis. 2017 Feb;11(2):135-49.სრული ტექსტი აბსტრაქტი
გამოყენებული სტატიები
ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
დიფერენციული დიაგნოზები
- Ulcerative colitis (UC)
- Infectious colitis
- Pseudomembranous colitis
მეტი დიფერენციული დიაგნოზებიგაიდლაინები
- BSG consensus guidelines on the management of inflammatory bowel disease in adults
- Management of Crohn's disease in adults
მეტი გაიდლაინებიპაციენტის ბროშურები
Crohn disease: what is it?
Crohn disease: what are the treatment options?
მეტი პაციენტის ბროშურები
შედით სისტემაში ან გამოიწერეთ BMJ Best Practice
ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას