Crohn's disease natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History , Complications and Prognosis
Natural History
Crohn's disease increases the risk of cancer in the area of inflammation. For example, individuals with Crohn's disease involving the small bowel are at higher risk for small intestinal cancer. Similarly, people with Crohn's colitis have a relative risk of 5.6 for developing colon cancer.[1] Screening for colon cancer with colonoscopy is recommended for anyone who has had Crohn's colitis for eight years, or more.[2]
Complications
There are many complications that can come with Crohn's disease like: obstructions, abscesses, free perforation, and hemorrhage.[3]
- Abscess - Abscesses are walled off collections of infection, which can occur in the abdomen or in the perianal area in Crohn's disease sufferers.
- Bowel obstructions - obstruction typically occurs from strictures or adhesions which narrow the lumen, blocking the passage of the intestinal contents.
- Complications of corticosteroid therapy
- Erythema nodosum
- Fistulae can develop between two loops of bowel, between the bowel and bladder, between the bowel and vagina, and between the bowel and skin.
- Impaired growth and sexual development in children
- Arthritis
- Lesions in the eye
- Nutritional deficiencies (particularly vitamin B12 deficiency)
- Pyoderma gangrenosum
- Development of cancer
- Malnutrition[4]
Prognosis
Crohn's disease is a chronic condition for which there is currently no cure. It is characterized by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is low. Crohn's disease is associated with an increased risk of small bowel and colorectal carcinoma.[5]
Crohn's cannot be cured by surgery, though surgery does happen with blockages, whether partial or a full blockage occurs. After the first surgery, the Crohn's usually shows up at the site of the resection though it can appear in other locations. After a resection, scar tissue builds up which causes strictures. A stricture is when the intestines becomes too small to allow excrement to pass through easily which can lead to a blockage. After the first resection, another resection may be necessary within five years of the first surgery. [2]
Many patients will have temporary stoma formations together with possible associated complications. [3]
References
- ↑ Ekbom A, Helmick C, Zack M, Adami H (1990). "Increased risk of large-bowel cancer in Crohn's disease with colonic involvement". Lancet. 336 (8711): 357–9. PMID 1975343.
- ↑ Collins P, Mpofu C, Watson A, Rhodes J. "Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease". Cochrane Database Syst Rev: CD000279. PMID 16625534.
- ↑ "Complications of Crohn's Disease". Retrieved 2008-01-16.
- ↑ Evans J, Steinhart A, Cohen Z, McLeod R (2003). "Home total parenteral nutrition: an alternative to early surgery for complicated inflammatory bowel disease". J Gastrointest Surg. 7 (4): 562–6. PMID 12763417.