The Diagnosis and Management of Crohn's Disease

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Laboratorinė medicina. 2016,
t. 18,
Nr. 3,
p. 150 -
154
Authors: 

Crohn’s disease is inflammatory bowel disease which is not easy to differentiate from other bowel diseases. Also it is an incurable and progressive disease which could cause many complications. Fibrocolonoscopy is the preferred diagnostic investigation. During fibrocolonoscopy multiple biopsies from at least five sites in the ascending colon, transverse colon, sigmoid colon, rectum and terminal ileum should be taken. Evaluation for small bowel disease should be considered. Computed tomography or magnetic resonance enterography/enteroclysis is the preferred investigation which can establish disease extent and activity based on wall thickness. Upper gastrointestinal endoscopy is available in pediatric age group and undifferentiated inflamma­tory bowel disease. Serum anti-Saccharomyces cerevisiae antibody and anti-neutrophil cytoplasmic antibody could play the role in the differentiation of Crohn’s disease from ulcerative colitis.

It is important to differentiate Crohn’s disease from intestinal tuberculosis and Behcet’s disease. The goals of treatment include induction and maintenance of remission, prevention of strictures, fistula and other complications and improving quality of life. Treatment of Crohn’s disease depends on the extent, behaviour and activity of the disease. Mild to moderately active Crohn’s disease to induce remission should be treated with budesonide. For severe disease to induce remission conventional corticosteroids should be used. The first line of treatment for maintenance of remission is thiopurines and methotrexate. The indications for biological agents include failure of conventional therapy in luminal disease, as well as fistulizing Crohn’s disease, perianal fistulizing Cronh’s disease and treatment of some extra-intestinal manifestations.

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