From the Research
Introduction to Crohn's Disease
Crohn's disease is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation of any part of the gastrointestinal tract, with a progressive and destructive course 1. The disease has a complex pathogenesis, involving a dysregulated immune system, altered microbiota, genetic susceptibility, and environmental factors 2.
Risk Factors
Several factors have been implicated in the cause of Crohn's disease, including:
- Genetic susceptibility
- Environmental factors
- Dysregulated immune system
- Altered microbiota
Signs and Symptoms
Common presenting symptoms of Crohn's disease include:
- Diarrhea
- Abdominal pain
- Rectal bleeding
- Fever
- Weight loss
- Fatigue
Diagnosis
Diagnosis of Crohn's disease relies on:
- Endoscopy
- Histological assessment of biopsy specimens
- Measurement of fecal calprotectin to rule out disease in adults and children
- Cross-sectional imaging to confirm the diagnosis and determine the extent of disease
Treatment
Treatment decisions are guided by disease severity and risk of poor outcomes. Options include:
Medications
- Corticosteroids to treat symptom flare-ups
- Biologics, with or without immunomodulators, to induce and maintain remission
- Immunomodulators
- Monoclonal antibodies to IL-12/23 or integrin α4β7
Other Therapies
- Enteral nutrition for induction therapy in children
- Surgery for complications such as fibrotic strictures, enteric fistulae, and intestinal neoplasia
Prevention
Prevention measures include:
- Smoking avoidance or cessation
- Vaccinations to prevent infections, such as influenza, pneumonia, and herpes zoster
- Monitoring for extraintestinal complications, such as osteoporosis, anemia, nutritional deficiencies, depression, infection, and thrombotic events
Management
Effective management of Crohn's disease requires:
- Patient risk stratification
- Personalized treatment to address the underlying pathogenetic mechanism
- Close monitoring of disease activity to reduce the severity of complications
- Consideration of disease severity, patient preference, and clinical factors in therapeutic decision-making 3