Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- dolor abdominal
- diarrea prolongada
- lesiones perianales
Other diagnostic factors
- 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)
Risk factors
- 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)
Diagnostic investigations
1st investigations to order
- 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
Investigations to consider
- ultrasonografía abdominal y pélvica
- ileocolonoscopia
- biopsia de tejido
- esofagogastroduodenoscopia
- cápsula endoscópica inalámbrica
- calprotectina fecal
Emerging tests
- marcadores serológicos
Treatment algorithm
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
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Colitis ulcerosa (CU)
- Colitis infecciosa
- Colitis seudomembranosa
More DifferentialsGuidelines
- BSG consensus guidelines on the management of inflammatory bowel disease in adults
- Management of Crohn's disease in adults
More GuidelinesPatient information
Enfermedad de Crohn: ¿qué es?
Enfermedad de Crohn: preguntas para formularle al médico
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