- Inflammatory diseases of the GI tract, of unknown aetiology. Both Crohn's disease and ulcerative colitis demonstrate uncontrolled inflammation.
Crohn's disease
Epidemiology
- Prevalence = 50-60/100000
- More common in Caucasian races
- Familial association
- Genetic predisposition
Pathology
- Any part of the gut from mouth to anus
- Skip lesions - patchy disease with normal mucosa in between
- Commonly terminal ileum and ascending colon
- -> Inflammation, ulceration, abscesses and fistulae
- Full bowel wall thickness involved
- Inflammatory infiltrates
- Non-caseating granulomata
Clinical features
- Depends on the area of bowel involved
- Mouth ulcers
- Diarrhoea
- Abdominal pain - colicky
- Nausea/vomiting
- Low-grade pyrexia
- Generally unwell, lethargy, weight loss
- Cutaneous fistulae (often perianal)
Disease associations
- Small joint arthritis
- Sacroiliitis
- Ankylosing spondylitis
- Iritis/uveitis/conjunctivitis
- Erythema nodosum - tender low leg lesions
- Pyoderma gangrenosum - skin ulceration
- Sclerosing cholangitis
Investigations
- Barium follow-through may show strictures, ulceration and thickened small bowel wall
- Colonoscopy and terminal ileal biopsy
- Proctoscopy and rectal biopsy
Management
- 5-aminosalicylic acid (5-ASA), e.g. mesalazine
- Steroids, e.g. prednisolone
- Azathioprine, methotrexate
- Anti-TNF-a antibodies (infliximab)
- Antibiotics for perianal disease
- Surgery for resistant disease
Extra-gastrointestinal manifestations of Crohn's disease
- Iritis, uveitis or conjunctivitis
- Oral ulceration
- Ankylosing spondylitis
- Kidney stones
- Sacroiliitis
- Small joint arthritis
- Erythema nodosum
- Primary sclerosing cholangitis
- Gall stones
- Pyoderma gangrenosum
Complications
- Vitamin B12 deficiency after surgery
- Short bowel syndrome after surgery
- Toxic megacolon in colitis
- Kidney stones
- Gallstones
- Malnutrition
- Colonic cancer
- Venous and arterial thromboembolism
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