Crohn’s disease: a clinical update

Crohn’s disease is increasing in prevalence worldwide. It arises from a complex interplay between both genetic predisposition and environmental influence. A search of databases and clinical practice guidelines was performed to provide the most up-to-date evidence-based approach for diagnosing and managing patients with Crohn’s disease. No single gold standard investigation exists. Whilst full ileocolonoscopy with biopsies remains the mainstay for diagnosis, other less invasive imaging modalities are being actively considered in the workup, as well as the use of serological markers. Management should incorporate dietary and lifestyle modifications where necessary, the use of medications in induction and remission of disease, and consideration of surgical intervention where medical therapy has failed.

[1]  Philippe Seksik,et al.  Epidemiology and natural history of inflammatory bowel diseases. , 2011, Gastroenterology.

[2]  D. Rex Methotrexate for Maintenance of Remission in Crohn's Disease , 2000 .

[3]  M. V. van Oijen,et al.  Declining Risk of Colorectal Cancer in Inflammatory Bowel Disease: An Updated Meta-analysis of Population-based Cohort Studies , 2013, Inflammatory bowel diseases.

[4]  P. Siersema,et al.  Determinants of health-related quality of life in Crohn's disease: a systematic review and meta-analysis. , 2014, Journal of Crohn's & colitis.

[5]  A. Zinsmeister,et al.  Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort. , 2010, Gastroenterology.

[6]  P. Moayyedi,et al.  Efficacy of 5-Aminosalicylates in Crohn's Disease: Systematic Review and Meta-Analysis , 2011, The American Journal of Gastroenterology.

[7]  J. Lennard-jones,et al.  Clinical uniformity of inflammatory bowel disease a presentation and during the first year of disease in the north and south of Europe. EC-IBD Study Group. , 1997, European journal of gastroenterology & hepatology.

[8]  B. Calkins A meta-analysis of the role of smoking in inflammatory bowel disease , 1989, Digestive diseases and sciences.

[9]  Sanjay V. Patel,et al.  Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery , 2013, BMC Surgery.

[10]  Stefan Schreiber,et al.  Diagnostics of inflammatory bowel disease. , 2007, Gastroenterology.

[11]  T. Matsui,et al.  Crohn's disease in Japan , 2000, Diseases of the colon and rectum.

[12]  A. Zinsmeister,et al.  The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. , 2002, Gastroenterology.

[13]  K. Abrams,et al.  Meta‐analysis: mortality in Crohn’s disease , 2007, Alimentary pharmacology & therapeutics.

[14]  M. Vatn,et al.  Clustering in time of familial IBD separates ulcerative colitis from Crohn's disease , 2009, Inflammatory bowel diseases.

[15]  S. Lourenço,et al.  Oral manifestations of inflammatory bowel disease: a review based on the observation of six cases , 2010, Journal of the European Academy of Dermatology and Venereology : JEADV.

[16]  Kristin Stephens,et al.  Vedolizumab as induction and maintenance therapy for Crohn's disease. , 2013, The New England journal of medicine.

[17]  Alan Barkun,et al.  SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. , 2015, Gastrointestinal endoscopy.

[18]  M. Picco Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease , 2011 .

[19]  R. Gearry,et al.  High incidence of Crohn's disease in Canterbury, New Zealand: Results of an epidemiologic study , 2006, Inflammatory bowel diseases.

[20]  A. Clegg,et al.  A case–control study of childhood environmental risk factors for the development of inflammatory bowel disease , 2002, European journal of gastroenterology & hepatology.

[21]  M. Muñoz-Navas,et al.  Capsule endoscopy. , 2009, World journal of gastroenterology.

[22]  Conor P. Delaney,et al.  Advantages of Laparoscopic Resection for Ileocecal Crohn’s Disease , 2002, Diseases of the colon and rectum.

[23]  P. Tekkis,et al.  The Risk of Oral Contraceptives in the Etiology of Inflammatory Bowel Disease: A Meta-Analysis , 2008, The American Journal of Gastroenterology.

[24]  R. McLeod,et al.  Position Statement on the Diagnosis and Management of olorectal Neoplasia in Inflammatory Bowel Disease , 2022 .

[25]  P. Siersema,et al.  Sa1167 Determinants of Health-Related Quality of Life in Crohn's Disease: A Systematic Review and Meta-Analysis , 2013 .

[26]  Tetsuya Nakamura,et al.  Capsule endoscopy: past, present, and future , 2008, Journal of Gastroenterology.

[27]  M. Spehlmann,et al.  Epidemiology of inflammatory bowel disease in a German twin cohort: Results of a nationwide study , 2008, Inflammatory bowel diseases.

[28]  K. Beusterien,et al.  The Burden of Inflammatory Bowel Disease: A Patient-reported Qualitative Analysis and Development of a Conceptual Model , 2014, Inflammatory bowel diseases.

[29]  J. McDonnell,et al.  Important cutaneous manifestations of inflammatory bowel disease , 2005, Postgraduate Medical Journal.

[30]  G. Greenberg,et al.  Ustekinumab induction and maintenance therapy in refractory Crohn's disease. , 2012, The New England journal of medicine.

[31]  S. Ng,et al.  Role of genetic and environmental factors in British twins with inflammatory bowel disease , 2012, Inflammatory bowel diseases.

[32]  S. Ng,et al.  Serological Antibodies in Inflammatory Bowel Disease: A Systematic Review , 2012, Inflammatory bowel diseases.

[33]  J. Church,et al.  Quality of life improves within 30 days of surgery for Crohn's disease. , 2003, Journal of the American College of Surgeons.

[34]  W. Sandborn,et al.  Crohn's disease , 2012, The Lancet.

[35]  R. Balfour Sartor,et al.  Microbial host interactions in IBD: Implications for pathogenesis and therapy , 2007, Current gastroenterology reports.

[36]  B. Cagir,et al.  Malignant Transformation in Perianal Fistulas of Crohn’s Disease: a Systematic Review of Literature , 2009, Journal of Gastrointestinal Surgery.

[37]  D. McKay,et al.  Laparoscopic versus Open surgery for small bowel Crohn's disease. , 2011, The Cochrane database of systematic reviews.

[38]  A. Buda,et al.  Intestinal Surgery for Crohn’s Disease: Predictors of Recovery, Quality of Life, and Costs , 2009, Journal of Gastrointestinal Surgery.

[39]  J. Gisbert,et al.  Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease , 2011, Alimentary pharmacology & therapeutics.

[40]  S. Travis,et al.  Introducing vedolizumab to clinical practice: who, when, and how? , 2015, Journal of Crohn's & colitis.

[41]  W. Sandborn,et al.  An Update on the Epidemiology of Inflammatory Bowel Disease in Asia , 2008, The American Journal of Gastroenterology.

[42]  X. Bossuyt Serologic markers in inflammatory bowel disease. , 2006, Clinical chemistry.

[43]  Mieke Koehoorn,et al.  The Epidemiology of Inflammatory Bowel Disease in Canada: A Population-Based Study , 2006, The American Journal of Gastroenterology.

[44]  J. Barrett,et al.  New IBD genetics: common pathways with other diseases , 2011, Gut.

[45]  J. Halfvarson,et al.  Environmental factors in inflammatory bowel disease: A co‐twin control study of a Swedish‐Danish twin population , 2006, Inflammatory bowel diseases.

[46]  H. Ahn,et al.  Incidence and Natural Course of Inflammatory Bowel Disease in Korea, 2006–2012: A Nationwide Population-based Study , 2015, Inflammatory bowel diseases.

[47]  Z. Fireman,et al.  Epidemiology of Crohn's disease in the Jewish population of central Israel, 1970-1980. , 1989, The American journal of gastroenterology.

[48]  R. Cohen,et al.  The cost of hospitalization in Crohn's disease , 2000, American Journal of Gastroenterology.

[49]  O Bernell,et al.  Risk factors for surgery and postoperative recurrence in Crohn's disease. , 2000, Annals of surgery.

[50]  H. El‐Serag,et al.  Dietary Intake and Risk of Developing Inflammatory Bowel Disease: A Systematic Review of the Literature , 2011, The American Journal of Gastroenterology.

[51]  Nancy Xiaonan Yu,et al.  The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study , 2001, American Journal of Gastroenterology.

[52]  A. Cheifetz,et al.  Capsule endoscopy for small-bowel evaluation in Crohn's disease. , 2011, Gastrointestinal endoscopy.

[53]  C. Bernstein,et al.  The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. , 2005, Gastroenterology.

[54]  M. Silverberg,et al.  Future directions in inflammatory bowel disease management. , 2014, Journal of Crohn's & colitis.

[55]  B. Sands From symptom to diagnosis: clinical distinctions among various forms of intestinal inflammation. , 2004, Gastroenterology.

[56]  A. Otley,et al.  Budesonide for induction of remission in Crohn's disease. , 2005, The Cochrane database of systematic reviews.

[57]  P. Rutgeerts,et al.  Infliximab, azathioprine, or combination therapy for Crohn's disease. , 2010, The New England journal of medicine.

[58]  G. Kaplan,et al.  Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn's disease: a network meta-analysis. , 2015, Gastroenterology.

[59]  A. Tjønneland,et al.  Serological markers predict inflammatory bowel disease years before the diagnosis , 2012, Gut.

[60]  G. Rogler,et al.  Frequency and Risk Factors for Extraintestinal Manifestations in the Swiss Inflammatory Bowel Disease Cohort , 2011, The American Journal of Gastroenterology.

[61]  M. Picco Decreasing Time-Trends of Colorectal Cancer in a Large Cohort of Patients With Inflammatory Bowel Disease , 2009 .

[62]  C. O'Morain,et al.  The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. , 2010, Journal of Crohn's & colitis.

[63]  R. Trivedi,et al.  Evaluation of chronic diarrhea. , 2011, American family physician.

[64]  J. González,et al.  Genetic factors conferring an increased susceptibility to develop Crohn's disease also influence disease phenotype: results from the IBDchip European Project , 2012, Gut.

[65]  R. Steele,et al.  Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) , 2010, Gut.

[66]  P. Seksik,et al.  Predictors of Crohn's disease. , 2006, Gastroenterology.

[67]  I. Leodolter [Crohn's disease]. , 1967, Wiener Zeitschrift fur innere Medizin und ihre Grenzgebiete.

[68]  A. Akobeng,et al.  Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn's Disease. , 2005, The Cochrane database of systematic reviews.

[69]  A. Hara,et al.  Capsule Endoscopy Has a Significantly Higher Diagnostic Yield in Patients With Suspected and Established Small-Bowel Crohn's Disease: A Meta-Analysis , 2010, The American Journal of Gastroenterology.

[70]  K. Motil,et al.  bowel disease , 2022 .

[71]  L. Peyrin-Biroulet,et al.  Review article: the natural history of postoperative Crohn's disease recurrence , 2012, Alimentary pharmacology & therapeutics.

[72]  J. Macdonald,et al.  Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease. , 2013, The Cochrane database of systematic reviews.

[73]  Z. Zeng,et al.  Systematic review with meta‐analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease , 2014, Alimentary pharmacology & therapeutics.