Crohns Disease

i^v Epidemiology (lancef 2007:369:1627)

• Prevalence 1:3000

• Bimodal with peaks in 20s and 50-70; T incidence in Caucasians. Jews, and smokers

• Mutation of the N0D2 CARD 15 gene found in 20% of Pts (Notu* 1996:379821)

homozygotes have 40-fold risk heterozygotes 7-fold risk of developing Crohn's

Pathology

• Extent: can affect any portion of Gl tract from mouth to anus, with skip lesions

30% of Pts have ileitis. 50% ileocolitis, and 20% colitis; isolated upper-tract disease rare

• Appearance: nonfriable mucosa, cobblestoning. aphthous ulcers, deep & long fissures barium enema — sharp lesions, cobblestoning. long ulcers & fissures, "string sign"

• Microscopy transmural inflammation with mononuclear cell infiltrate, noncascaong granulomas (seen in <25% of mucosal biopsies), fibrosis, ulcers, fissures Clinical manifestations

• Smoldering disease with abdominal pain, fevers, malaise, weight loss

• Mucus-containing, nongrossly bloody diarrhea

• 1 albumin, t ESR. i Hct (due to Fe. Bn. folate deficiency, or chronic disease)

• Extracolonic: same as UC. plus gallstones (malabsorption of bile salts, i bile cholesterol ratio, t lithogenicity) and kidney stones (Ca oxalate stones due to binding of intraluminal Ca' * by unabsorbed free fatty acids allowing T'd oxalate absorption)

• Serologies: anu-Saccharomyces cerevisiae antibodies (ASCA) in 60-70%

Complications

• Perianal fissures, perirectal abscesses (up to 33% of Pts)

• Stricture: postprandial abdominal pain and bloating, can lead to complete obstruction

• Fistulas: perianal, enteroenteric. rectovaginal, enterovesicular. enterocutaneous

• Abscess: fever, tender abd mass. T WBC; steroids mask sx. need high-level suspicion

• Cancer: small intestinal colorectal; risk of colorectal cancer in CD -- to that in UC;

recs for colonoscopic surveillance in Pts w Crohn's pancolitis are same as those for UC

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