Crohn's Disease: Diagnosis and Management.

Abstract

Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract and often causes extraintestinal manifestations. Diarrhea, abdominal pain, fatigue, weight loss, and fever are common symptoms. Children may present with changes in growth velocity or delayed puberty. Initial evaluation for suspected Crohn's disease includes endoscopy and cross-sectional imaging. Fecal calprotectin testing is useful for determining whether ileocolonoscopy and imaging are needed in uncertain cases. These tests are critical in monitoring treatment effectiveness because mucosal inflammation may remain after symptoms resolve and inflammatory markers normalize. Patients should be tested for iron, 25-hydroxyvitamin D, folate, and vitamin B12 deficiencies. Frequent screening for colon cancer is indicated due to increased colon cancer risk. Most guidelines recommend colonoscopy 8 years after symptom onset, with monitoring dependent on additional risk factors. Treatment is based on disease severity and whether remission is being induced or maintained. Budesonide, sulfasalazine, and dietary modifications should be used to induce remission in mild to moderate disease. Corticosteroids and biologic therapy, with or without immunomodulators, may be used to induce remission of moderate to severe disease. Severe disease is initially treated with intravenous corticosteroids or anti-tumor necrosis factor agents. Perianal and fistulizing disease require treatment of infection, followed by advanced medical therapy and surgical repair.