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Crohn disease

Last reviewed: 21 Oct 2024
Last updated: 05 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • prolonged diarrhea
  • perianal lesions
Full details

Other diagnostic factors

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

Risk factors

  • white ethnicity and Ashkenazi Jewish ancestry
  • age 15-40 or 50-60 years
  • family history of CD
  • cigarette smoking
  • diet high in refined sugar
  • diet low in fiber
  • diet high in ultra-processed foods
  • oral contraceptives
  • not breastfed
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
Full details

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
Full details

Tests to consider

  • abdominal and pelvic ultrasonography
  • ileocolonoscopy
  • tissue biopsy
  • esophagogastroduodenoscopy
  • wireless capsule endoscopy
  • fecal calprotectin
Full details

Emerging tests

  • serologic markers

Treatment algorithm

ACUTE

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

ONGOING

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.

Disclosures

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.

Peer reviewers

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

Disclosures

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

Disclosures

JM declares that he has no competing interests.

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