Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- dolor abdominal
- diarrea prolongada
- lesiones perianales
Otros factores de diagnóstico
- obstrucción intestinal
- sangre en las heces
- fatiga
- abdomen doloroso a la palpación
- pérdida de peso
- fiebre
- lesiones orales
- masa abdominal
- manifestaciones extraintestinales (p. ej., eritema nodoso o pioderma gangrenoso)
Factores de riesgo
- raza blanca
- Ascendencia judía asquenazí
- edad 15-40 o 50-60 años
- antecedentes familiares de enfermedad de Crohn (EC)
- Uso de antibióticos
- tabaquismo
- dieta con niveles elevados de azúcar refinada
- dieta baja en fibra
- dieta alta en alimentos ultraprocesados
- uso de la píldora anticonceptiva oral
- sin lactancia
- uso de fármacos antiinflamatorios no esteroideos (AINE)
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- hemograma completo (HC)
- análisis de hierro (hierro sérico, ferritina sérica, capacidad total de fijación del hierro [CTFH], saturación de la transferrina)
- vitamina B12 sérica
- folato sérico
- perfil metabólico completo (PMC)
- Proteína C-reactiva y velocidad de sedimentación globular (VSG)
- pruebas en heces
- serología para Yersinia enterocolitica
- radiografía simple de abdomen
- resonancia magnética (IRM) de abdomen o pelvis
- tomografía computarizada (TC) de abdomen
Pruebas diagnósticas que deben considerarse
- ultrasonografía abdominal y pélvica
- ileocolonoscopia
- biopsia de tejido
- esofagogastroduodenoscopia
- cápsula endoscópica inalámbrica
- calprotectina fecal
Pruebas emergentes
- marcadores serológicos
Algoritmo de tratamiento
enfermedad ileocecal sin fístulas con <100 cm del intestino afectado: presentación inicial o recidiva
enfermedad colónica sin fístulas: presentación inicial o recidiva
enfermedad extensa del intestino delgado (>100 cm del intestino afectado) sin fístulas: presentación inicial o recidiva
enfermedad del tracto gastrointestinal superior (enfermedad esofágica y/o gastroduodenal) no fistulante: presentación inicial o recaída
enfermedad perianal o con fístulas: presentación inicial o recidiva
en remisión
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 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
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.
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.
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.
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