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Doença de Crohn

Last reviewed: 23 Sep 2025
Last updated: 11 Apr 2025

Summary

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • dor abdominal
  • diarreia prolongada
  • lesões perianais
完整详情

其他诊断因素

  • obstrução intestinal
  • sangue nas fezes
  • fadiga
  • desconforto abdominal
  • perda de peso
  • febre
  • lesões orais
  • massa abdominal
  • manifestações extraintestinais (por exemplo, eritema nodoso ou pioderma gangrenoso)
完整详情

危险因素

  • etnia branca
  • Ascendência judaica asquenaze
  • idade de 15-40 ou 50-60 anos
  • história familiar de DC
  • uso de antibióticos
  • tabagismo
  • dieta com alto teor de açúcar refinado
  • dieta com baixo teor de fibras
  • dieta com alto teor de alimentos ultraprocessados
  • uso de pílula contraceptiva oral
  • não amamentados
  • uso de anti-inflamatórios não esteroidais (AINEs)
完整详情

诊断性检查

首要检查

  • Hemograma completo
  • perfil de ferro (ferro sérico, ferritina sérica, capacidade total de ligação do ferro [TIBC], saturação da transferrina)
  • vitamina B12 sérica
  • folato sérico
  • perfil metabólico completo (CMP)
  • Proteína C-reativa e velocidade de hemossedimentação (VHS)
  • exame de fezes
  • sorologia para Yersinia enterocolitica
  • radiografia abdominal simples
  • RNM de abdome/pelve
  • tomografia computadorizada (TC) abdominal
完整详情

需考虑的检查

  • ultrassonografia abdominal e pélvica
  • ileocolonoscopia
  • biópsia tecidual
  • endoscopia digestiva alta
  • endoscopia por cápsula sem fio
  • calprotectina fecal
完整详情

新兴检查

  • marcadores sorológicos:

治疗流程

急症处理

doença ileocecal não fistulizante com <100 cm do intestino afetado: apresentação inicial ou recidiva

doença colônica não fistulizante: apresentação inicial ou recidiva

doença do intestino delgado extensa (>100 cm do intestino afetado) não fistulizante: apresentação inicial ou recidiva

doença do trato gastrointestinal superior (doença esofágica e/ou gastroduodenal) não fistulizante: apresentação inicial ou recidiva

doença perianal ou fistulizante: apresentação inicial ou recidiva

持续性治疗

em remissão

撰稿人

作者

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

利益声明

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

利益声明

GW declares that she has no competing interests.

鸣谢

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.

利益声明

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.

同行评议者

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

利益声明

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

Раскрытие информации

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.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

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.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Doença de Crohn images
  • Отличия

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    • Colite infecciosa
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  • Рекомендации

    • BSG consensus guidelines on the management of inflammatory bowel disease in adults
    • Management of Crohn's disease in adults
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