Crohn disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 28 Sep 2026

Topic last updated: 11 Jun 2026

Crohn disease (CD) is a disorder of unknown etiology characterized by transmural inflammation of the gastrointestinal tract.

Common presenting symptoms include chronic diarrhea, weight loss, and abdominal pain.

Diagnosis is confirmed by correlating imaging, endoscopic findings, and histology, with clinical symptoms consistent with inflammatory bowel disease.

Specialist input is required from the time of diagnosis, as treatment regimens require frequent monitoring of clinical response, knowledge of common adverse events, and expertise in managing potentially serious adverse events.

The overall treatment goals are to avoid surgery and to prevent long-term complications, including cancer.

Complications include extraintestinal involvement, intestinal obstruction, abscess formation, sinuses, and fistulae.

Definição

Crohn disease (CD) is a disorder of unknown etiology characterized by transmural inflammation of the gastrointestinal (GI) tract. CD may involve any or all parts of the entire GI tract from the mouth to colon, with or without perianal involvement. CD is characterized by skip lesions (where normal bowel mucosa is found between diseased areas). The transmural inflammation often leads to fibrosis, causing intestinal obstruction. The inflammation can also result in sinus tracts that burrow through and penetrate the serosa, thereafter giving rise to perforations and fistulae.[1]

This topic covers the diagnosis and management of CD in adults.

História e exame físico

Principais fatores diagnósticos

abdominal pain
prolonged diarrhea
perianal lesions

Detalhes completos

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)

Detalhes completos

Fatores de risco

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)

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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)
fecal calprotectin
stool testing
Yersinia enterocolitica serology
ileocolonoscopy
plain abdominal x-ray
MR enterography
CT enterography

Detalhes completos

Investigações a serem consideradas

ultrasonography
tissue biopsy
esophagogastroduodenoscopy
wireless capsule endoscopy

Detalhes completos

Novos exames

serologic markers

Algoritmo de tratamento

AGUDA

ileocecal disease not fistulizing with <100 cm of bowel affected

colonic disease not fistulizing

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

CONTÍNUA

in remission

Colaboradores

Autores

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

Declarações

LCH declares that she has no competing interests.

Georgia Woodfield, MBChB, MSc, PhD, MRCP

Consultant Gastroenterologist

Department of Gastroenterology

Royal Free Hospital

Royal Free London NHS Foundation Trust

London

Declarações

GW has received a payment from Takeda for delivering a presentation for an IBD leadership course (Activate8).

Agradecimentos

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, and Best Practice Gastroenterology expert panel member, Dr Brooks Cash, for his contribution to this topic.

Declarações

GR, PHP, PJS, CF, WB, BM, CT, MAP, and BC declare that they have no competing interests.

Revisores

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

Declarações

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

Declarações

JM declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

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Referências

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Principais artigos

Lichtenstein GR, Loftus EV, Afzali A, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2025 Jun 3;120(6):1225-64.Texto completo Resumo

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.Texto completo Resumo

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.Texto completo Resumo

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.Texto completo Resumo

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Ulcerative colitis (UC)
- Infectious colitis
- Pseudomembranous colitis
Mais Diagnósticos diferenciais
Diretrizes
- Management of Crohn's disease in adults
- British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
Mais Diretrizes
Folhetos informativos para os pacientes
Crohn disease: what is it?
Crohn disease: what are the treatment options?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

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Crohn disease

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

ileocecal disease not fistulizing with <100 cm of bowel affected

colonic disease not fistulizing

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

Colaboradores

Autores

Lucy Charlotte Hicks, MBBS, PhD, FHEA, MRCP

Declarações

Georgia Woodfield, MBChB, MSc, PhD, MRCP

Declarações

Agradecimentos

Declarações

Revisores

Kiron M. Das, MD, PhD, FACP, FRCP

Declarações

John Mansfield, MA, MD, FRCP

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice