Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- dor abdominal
- diarreia prolongada
- lesões perianais
Outros fatores diagnósticos
- 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)
Fatores de risco
- 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)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- 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)
- calprotectina fecal
- exame de fezes
- sorologia para Yersinia enterocolitica
- ileocolonoscopia
- radiografia abdominal simples
- Enterografia por RM
- enterografia por tomografia computadorizada (TC)
Investigações a serem consideradas
- ultrassonografia
- biópsia tecidual
- endoscopia digestiva alta
- endoscopia por cápsula sem fio
Novos exames
- marcadores sorológicos:
Algoritmo de tratamento
doença ileocecal não fistulizante com <100 cm do intestino afetado
doença colônica não fistulizante
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
em remissão
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
Disclosures
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
UK
Disclosures
GW has received a payment from Takeda for delivering a presentation for an IBD leadership course (Activate8).
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, and Best Practice Gastroenterology expert panel member, Dr Brooks Cash, for his contribution to this topic.
Disclosures
GR, PHP, PJS, CF, WB, BM, CT, MAP, and BC 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.
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.
References
Key articles
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.Full text Abstract
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
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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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