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| __NOTOC__ | | __NOTOC__ |
| {{Infobox_Disease | | | {| class="infobox" style="float:right;" |
| Name = Crohn's disease |
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| Image = Patterns of CD.svg|
| | | [[File:Siren.gif|30px|link=Crohn's disease resident survival guide]]|| <br> || <br> |
| Caption = The three most common sites of intestinal involvement in '''Crohn's disease''' are [[ileum|ileal]], ileocolic and [[colon]]ic.<ref name=Hanauer/>|
| | | [[Crohn's disease resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| DiseasesDB = 3178 |
| | |} |
| ICD10 = {{ICD10|K|50||k|50}} |
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| ICD9 = {{ICD9|555}} |
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| ICDO = |
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| OMIM = 266600 |
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| MedlinePlus = 000249 |
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| MeshID = D003424 |
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| }}
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| {{Crohn's disease}} | | {{Crohn's disease}} |
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| {{CMG}} | | {{CMG}} |
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| {{SK}} Regional enteritis | | {{SK}} Regional enteritis; Crohn disease; regional ileitis |
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| == [[Crohn's disease overview|Overview]] == | | == [[Crohn's disease overview|Overview]] == |
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| == [[Crohn's disease causes|Causes]] == | | == [[Crohn's disease causes|Causes]] == |
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| == [[Crohn's disease differential diagnosis|Differential Diagnosis]] == | | == [[Crohn's disease differential diagnosis|Differentiating Crohn's Disease from other Diseases]] == |
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| | ==[[Crohn's disease epidemiology and demographics|Epidemiology and Demographics]]== |
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| == [[Crohn's disease risk factors|Risk Factors]] == | | == [[Crohn's disease risk factors|Risk Factors]] == |
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| | ==[[Crohn's disease screening|Screening]]== |
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| == [[Crohn's disease natural history, complications and prognosis|Natural History, Complications and Prognosis]] == | | == [[Crohn's disease natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| == Diagnosis == | | == Diagnosis == |
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| [[Crohn's disease history and symptoms|History and Symptoms]] | [[Crohn's disease physical examination|Physical Examination]] | [[Crohn's disease laboratory tests|Laboratory tests]] | [[Crohn's disease electrocardiogram|ECG]] | [[Crohn's disease chest x ray|Chest X Ray]] |[[Crohn's disease CT|CT]] | [[Crohn's disease MRI|MRI]] | [[Crohn's disease echocardiography or ultrasound|Echocardiography or Ultrasound]] |[[Crohn's disease other imaging findings|Other imaging studies]] | [[Crohn's disease other diagnostic studies|Alternative diagnostics]] | | [[Crohn's disease history and symptoms|History and Symptoms]] | [[Crohn's disease physical examination|Physical Examination]] | [[Crohn's disease laboratory findings|Laboratory Findings]] | [[Crohn's disease CT|CT]] | [[Crohn's disease MRI|MRI]] | [[Crohn's disease other imaging findings|Other Imaging Findings]] | [[Crohn's disease other diagnostic studies|Other Diagnostic Studies]] |
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| == Treatment == | | == Treatment == |
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| [[Crohn's disease medical therapy|Medical therapy]] | [[Crohn's disease surgery|Surgical options]] | [[Crohn's disease prevention|Prevention]] | [[Crohn's disease cost-effectiveness of therapy|Financial costs]]| [[Crohn's disease future or investigational therapies|Future therapies]] | | [[Crohn's disease medical therapy|Medical Therapy]] | [[Crohn's disease surgery|Surgery]] | [[Crohn's disease prevention|Prevention]] | [[Crohn's disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Crohn's disease future or investigational therapies|Future or Investigational Therapies]] |
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| [[Image:CD colitis.jpg|150px|thumb|left|[[Colonoscopy|Endoscopic]] image of Crohn's colitis showing deep ulceration.]]
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| [[Image:CT scan gastric CD.jpg|150px|thumb|left|[[CT scan]] showing Crohn's disease in the fundus of the [[stomach]]]]
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| [[Image:CD colitis 2.jpg|thumb|left|150px|Crohn's disease can mimic [[ulcerative colitis]] on endoscopy. This [[Colonoscopy|endoscopic]] image is of Crohn's colitis showing diffuse loss of [[mucosa]]l architecture, friability of mucosa in sigmoid colon and exudate on wall, all of which can be found with ulcerative colitis.]]
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| Images shown below are courtesy of RadsWiki and copylefted
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| <div align="center">
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| <gallery heights="175" widths="175">
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| Image:Crohns-pseudosacculations-001.jpg|Abdominal x-ray of a patient with Crohn disease
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| Image:Crohns-pseudosacculations-002.jpg|Pseudosacculations in Crohn's disease
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| Image:Crohns-pseudosacculations-003.jpg|Pseudosacculations in Crohn's disease
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| Image:Crohns-pseudosacculations-004.jpg|Pseudosacculations in Crohn's disease
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| </gallery>
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| </div>
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| <gallery>
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| Image:
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| Active Crohn's disease CT 002.jpg|Active Crohn's disease CT
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| Active Crohn's disease MRI 003.jpg|Active Crohn's disease MRI
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| Active Crohn's disease MRI 004.jpg|Active Crohn's disease MRI
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| Active Crohn's disease small bowel series 001.jpg|Active Crohn's disease small bowel series
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| Image:
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| Comb3.jpg|Comb sign in Crohn's disease
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| </gallery>
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| ==Risk Factors==
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| Although the cause of Crohn's disease is not known, it is believed to be an [[autoimmunity|autoimmune disease]] that is [[genetics|genetically]] linked. The highest relative risk occurs in siblings, affecting males and females equally. Smokers are three times more likely to get Crohn's disease.
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| Unlike the other major type of IBD, [[ulcerative colitis]], there is no known medical or [[surgery|surgical]] cure for Crohn's disease.<ref>{{cite web|first= M Bashar|last= Al-Ataie|coauthors=Vishwanath N Shenoy|publisher=eMedicine|title=Ulcerative colitis|url=http://www.emedicine.com/med/topic2336.htm|accessdate=2006-07-02|
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| date=2005-10-04}}</ref> Instead, a number of medical treatments are utilized with the goal of putting and keeping the disease in [[remission (medicine)|remission]]. These include [[mesalazine|5-aminosalicylic acid]] (5-ASA) formulations (Pentasa capsules, Asacol tablets, Lialda tablets, Rowasa retention enemas), [[prednisone|steroid]] medications, immunomodulators (such as [[azathioprine]], [[mercaptopurine]] (6-MP), and [[methotrexate]]), and newer [[biological therapy for inflammatory bowel disease|biological]] medications, such as [[infliximab]] (Remicade) and [[adalimumab]] (Humira).<ref name=Podolsky>{{Cite journal|last=Podolsky|first= Daniel K.|title=Inflammatory bowel disease|journal=New England Journal of Medicine|month=August|year=2002|volume=346|issue=6|pages=417-29
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| |url=http://content.nejm.org/cgi/content/extract/347/6/417|accessdate=2006-07-02|id=PMID 12167685}}</ref>Also in January 2008 the U.S. Food and Drug Administration approved a new biologic known as [[natalizumab]] (Tysabri) for both induction of remission and maintenance of remission in moderate and severe Crohns Disease.
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| ==Treatment==
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| {{main|Treatment of Crohn's disease|Biological therapy for inflammatory bowel disease}}
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| Treatment is only needed for people exhibiting symptoms. The therapeutic approach to Crohn's disease is sequential: to treat [[acute (medical)|acute]] disease and then to maintain [[remission]]. Treatment initially involves the use of medications to treat any infection and to reduce inflammation. This usually involves the use of aminosalicylate anti-inflammatory drugs and corticosteroids, and may include antibiotics.
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| Once remission is induced, the goal of treatment becomes maintaining remission and avoiding flares. Because of side-effects, the prolonged use of corticosteroids must be avoided. Although some people are able to maintain remission with aminosalicylates alone, many require immunosuppressive drugs.<ref name="HanauerCrohns"/>
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| On 14 January 2008 the U.S. Food and Drug Administration approved [[natalizumab]] (Tysabri) for both induction of remission and maintenance of remission in Crohns. Natalizumab is humanised monoclonal antibody (MAb), and the first alpha-4 antagonist in a new class of agents called selective adhesion-molecule (SAM) inhibitors. Alpha-4 integrin is required for leukocytes to adhere to the walls of blood vessels and migrate into the gut; natalizumab prevents leukocytes from doing that. Natalizumab was previously approved for multiple sclerosis. However, because it suppresses the immune system, natalizumab has been linked to a very rare adverse effect that is usually fatal if undetected. Leukocytes also protect the body from viruses, and 2 patients on natalizumab, who were also receiving other immuno-suppressive drugs ([[Interferon beta-1a|Avonex]] and Immuran), died of a rare brain infection, [[progressive multifocal leukoencephalopathy]]. Because of this danger, patients must be in a special monitoring program, and natalizumab is given as a mono-therapy.<ref name="FDA-Tysbari">{{cite press release|title=FDA Approves Tysabri to Treat Moderate-to-Severe Crohn's Disease|publisher=U.S. Food and Drug Administration|date=2008-01-14|url=http://www.fda.gov/bbs/topics/NEWS/2008/NEW01775.html|accessdate=2008-01-16
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| }}</ref>.As of late December 2007, more than 21,000 MS patients were receiving natalizumab mono-therapy without a single incidence of PML occurring.<ref>.http://www.elan.com/News/full.asp?ID=1091942</ref>.
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| [[Surgery]] may be required for complications such as obstructions, fistulas and/or abscesses, or if the disease does not respond to drugs within a reasonable time. For patients with an obstruction due to a stricture, two options for treatment are strictureplasty and resection of that portion of bowel. According to a retrospective review at the Cleveland Clinic, there is no [[statistical significance]] between strictureplasty alone versus strictureplasty and resection specifically in cases of duodenal involvement. In these cases, re-operation rates were 31% and 27%, respectively, indicating that strictureplasty is a safe and effective treatment for selected patients with duodenal involvement.<ref name="pmid8918424">{{cite journal | author = Ozuner G, Fazio VW, Lavery IC, Milsom JW, Strong SA | title = Reoperative rates for Crohn's disease following strictureplasty. Long-term analysis | journal = Dis. Colon Rectum | volume = 39 | issue = 11 | pages = 1199-203 | year = 1996 | pmid = 8918424 | doi = }}</ref>
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| Recent studies using [[Helminthic therapy]] or [[Hookworm]]s to treat Crohn's Disease and other (non-viral) auto-immune diseases seem to yield promising results.<ref>British Medical Journal [http://gut.bmj.com/cgi/content/full/55/1/136 A proof of concept study establishing Necator americanus in Crohn’s patients and reservoir donors]</ref><ref name="Daily Mail">Daily Mail. [http://www.dailymail.co.uk/pages/live/articles/technology/technology.html?in_article_id=481875&in_page_id=1965 The bloodsucking worm that fights allergies from inside your tummy] 14-09-2007.</ref><ref>[http://www.kuro5hin.org/story/2006/4/30/91945/8971 How to cure your asthma or hayfever using hookworm - a practical guide]. 01-05-2006.</ref>
| | ==Case Studies== |
| | [[Crohn's disease case study one|Case #1]] |
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| ==See also== | | ==Related Chapters== |
| * [[Small bowel bacterial overgrowth syndrome]] | | * [[Small bowel bacterial overgrowth syndrome]] |
| | | * [[Ulcerative colitis]] |
| == References ==
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| {{reflist|2}}
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| {{Crohn's}} | | {{Crohn's}} |
| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Disease]] | | [[Category:Disease]] |
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| [[Category:Conditions diagnosed by stool test]] | | [[Category:Conditions diagnosed by stool test]] |
| [[Category:Abdominal pain]] | | [[Category:Abdominal pain]] |
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