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)
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)
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)
- stool testing
- Yersinia enterocolitica serology
- plain abdominal x-ray
- MRI abdomen/pelvis
- CT abdomen
Investigações a serem consideradas
- abdominal and pelvic ultrasonography
- ileocolonoscopy
- tissue biopsy
- esophagogastroduodenoscopy
- wireless capsule endoscopy
- fecal calprotectin
Novos exames
- serologic markers
Algoritmo de tratamento
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
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
UK
Declarações
LCH has received costs for travel and accommodation from Takeda.
Georgia Woodfield, MBChB, MSc, PhD, MRCP
Consultant Gastroenterologist
Department of Gastroenterology
Royal Free Hospital
Royal Free London NHS Foundation Trust
London
UK
Declarações
GW declares that she has no competing interests.
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.
Declarações
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.
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
NJ
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
UK
Declarações
JM declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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
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.Texto completo Resumo
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.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
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.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 diferenciaisDiretrizes
- BSG consensus guidelines on the management of inflammatory bowel disease in adults
- Management of Crohn's disease in adults
Mais DiretrizesFolhetos informativos para os pacientes
Crohn disease: what is it?
Crohn disease: what are the treatment options?
Mais Folhetos informativos para os pacientes
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