Crohn’s disease

Crohn’s disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting (can be continuous), or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.

Poorly understood interactions between environmental, immunological and bacterial factors play a role in causing Crohn’s disease. This results in a chronic inflammatory disorder, in which the body’s immune system attacks the gastrointestinal tract possibly directed at a microbial antigens. There is evidence of a genetic link to Crohn’s disease, putting individuals with siblings afflicted with the disease at higher risk. Males and females are equally affected. Smokers are two times more likely to develop Crohn’s disease than nonsmokers. Crohn’s disease affects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age. There is no known pharmaceutical or surgical cure for Crohn’s disease. Treatment options are restricted to controlling symptoms, maintaining remission, and preventing relapse.

The disease was named after American gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness. For this reason, the disease has also been called regional ileitis or regional enteritis. The condition, however, had previously been independently described in medical literature by others. The most notable case was in 1904 by Polish surgeon Antoni Leśniowski for whom the condition is alternatively named Leśniowski-Crohn’s disease in Polish literature.

Radiologic tests

A small bowel follow-through may suggest the diagnosis of Crohn’s disease and is useful when the disease involves only the small intestine. Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine. As a result, a barium follow-through X-ray, wherein barium sulfate suspension is ingested and fluoroscopic images of the bowel are taken over time, is useful for looking for inflammation and narrowing of the small bowel. Barium enemas, in which barium is inserted into the rectum and fluoroscopy is used to image the bowel, are rarely used in the work-up of Crohn’s disease due to the advent of colonoscopy. They remain useful for identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through, or in the detection of colonic fistulae (in this case contrast should be performed with iodate substances).

CT and MRI scans are useful for evaluating the small bowel with enteroclysis protocols. They are also useful for looking for intra-abdominal complications of Crohn’s disease, such as abscesses, small bowel obstructions, or fistulae.[88] Magnetic resonance imaging (MRI) is another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available.

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