PRIMEVIEW
CROHN’S DISEASE
Crohn’s disease (CD) is a type of
inflammatory bowel disease that can
affect any part of the gastrointestinal
tract and that has a chronic, progressive
and destructive course.
DIAGNOSIS
Diagnosis of CD relies on endoscopy (usually
ileocolonoscopy) and histological analysis of
biopsy specimens. Although no histological
features are diagnostic for CD, typical microscopic
findings include patchy inflammation, skip
lesions (usually with a ‘cobblestone’ appearance),
granulomas and irregular crypts (focally) and
villous architecture. Other imaging modalities,
including CT, ultrasonography and MRI, are useful
for assessing disease extent and for detecting
intestinal complications. Differential diagnosis of
other intestinal diseases, such as ulcerative colitis,
intestinal infectious diseases and lymphoma,
is complicated by the pervasive, non-specific
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MECHANISMS
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The prevalence of CD is highest in western
countries but the incidence of CD is increasing
globally, particularly in newly industrialized
countries in Asia, Africa and South America,
possibly related to the influence of a western
Intestinal lifestyle. Risk factors for CD include genetic
NWOGP predisposition and environmental factors, such
as smoking, diet and the use of some medications
and contraceptives. CD risk variants have
been identified in genes involved in bacterial
recognition (such as NOD2) and clearance (such
+PVGUVKPCNNCOKPCRTQRTKC as ATG16L) and gut immune homeostasis (such as
TNFSF15), amongst others.
Defective tight junctions,
reduced antimicrobial peptide
Chronic inflammation in secretion and impaired bacterial
CD is due to disrupted clearance can result in intestinal
immune homeostasis, barrier dysfunction
including persistent
activation of immune MANAGEMENT
cells, increased pro-
inflammatory cytokine 2TQKPȯCOOCVQT[
production and reduced E[VQMKPGU Traditionally, CD has been treated with
anti-inflammatory immunosuppressants for both induction and
responses maintenance of disease remission, but the
introduction of biological agents has changed
4GETWKVOGPVQHNGWMQE[VGU the treatment paradigm. The treatment
approach differs based on the risk of disease
5[UVGOKE progression, which is dependent on disease
EKTEWNCVKQP activity and duration, age of onset, lifestyle
factors, serum and fecal biomarker levels
and ulcer morphology). Induction therapy
involves treatment with targeted or systemic
#NVJQWIJIWVF[UDKQUKUJCUDGGP corticosteroids in low-risk patients or with
GZVGPUKXGN[UVWFKGFKP%&PQEQPUKUVGPV biological agents (such as anti-TNF drugs)
QUALITY OF LIFE CNVGTCVKQPUURGEKȮEVQ%&JCXGDGGPKFGPVKȮGF OUTLOOK in high-risk patients. Maintenance therapy
involves immunosuppressants and/or biological
Pain, especially abdominal pain, is the most To prevent disease progression and the agents. Treat to target, including mucosal
common patient-reported factor that reduces development of complications, early, targeted healing on endoscopy and symptom remission,
quality of life, although other important treatment is important and will require and close monitoring for disease relapse are
stressors include symptoms such as diarrhoea, improved bowel damage assessment and the major current therapeutic aims. Surgery may
impaired appetite and weight loss, and identification of prognostic biomarkers to be required in patients who do not respond
treatment effects, such as need for long-term enable better stratification of patients based on to pharmacological therapy or for some
immunosuppression, hospitalization or surgery. FKUGCUG|UGXGTKV[ KPVGUVKPCN|EQORNKECVKQPU
Written by Grant Otto; designed by Laura Marshall
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