Crohn Disease: Epidemiology, Diagnosis, and Management

• Published in: Mayo Clinic proceedings Vol. 92; no. 7; pp. 1088 - 1103
• Main Authors: Feuerstein, Joseph D., Cheifetz, Adam S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.07.2017; Frontline Medical Communications Inc; Elsevier Limited
• Subjects: 6-Mercaptopurine; Abdominal Pain - etiology; Antibodies, Monoclonal - therapeutic use; Care and treatment; Causes of; Chronic illnesses; Colon; Crohn Disease - diagnosis; Crohn Disease - drug therapy; Crohn Disease - epidemiology; Crohn's disease; Diagnosis; Diarrhea - etiology; Disease Management; Endoscopy - methods; Epidemiology; Humans; Inflammatory bowel disease; Internal Medicine; Medical diagnosis; Primary care; Recurrence; Risk Factors; Tumor necrosis factor-TNF; United States; CD; MRE; FDA; MP; TPMT; Anti-TNF; AZA; EIM; IBD; PML; UC; MTX; CTE; AGA; ADA; magnetic resonance enterography; methotrexate; ulcerative colitis; anti–tumor necrosis factor; extraintestinal manifestation; Food and Drug Administration; antidrug antibody; computed tomography enterography; azathioprine; inflammatory bowel disease; Crohn disease; thiopurine methyltransferase; mercaptopurine; progressive multifocal leukoencephalopathy; American Gastroenterological Association
• ISSN: 0025-6196; 1942-5546; 1942-5546
• DOI: 10.1016/j.mayocp.2017.04.010

Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications.