Abstract
Crohn’s disease is an idiopathic chronic intestinal illness that requires specialized medical care for prompt disease diagnosis and appropriate management. Clinicians must accurately interpret and integrate findings from multitude of sources in order to achieve diagnostic certainty. Ileocolonoscopy remains the most relied modality, allowing for a direct mucosal visualization and biopsies for histologic assessments. Serologic markers currently serve an adjunctive role, often utilized in attempts to further subtype patients with indeterminate colitis. Radiologic imaging, such as computed tomography enterography can evaluate the far reaches of the small intestine, while also providing information about penetrating complications and extraintestinal disease manifestations. Treatment options and strategies continue to evolve with new biologic agents and ongoing testing of aggressive “top–down” approaches. In addition, identification of increased colorectal cancer risks in individuals with Crohn’s colitis has led to formal surveillance guidelines. The clinical diagnosis and management of Crohn’s disease continues to be an area of rapid change and exciting developments.
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References
Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517
Rothfuss KS, Stange EF, Herrlinger KR (2006) Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol 12:4819–4831
Benson L, Song X, Campos J, Singh N (2007) Changing epidemiology of Clostridium difficile-associated disease in children. Infect Control Hosp Epidemiol 28(11):1233–1235
Koutroubakis IE, Petinaki E, Mouzas IA, et al. (2001) Anti-Saccharomyces cerevisiae mannan antibodies and antineutrophil cytoplasmic autoantibodies in Greek patients with inflammatory bowel disease. Am J Gastroenterol 96:449–454
Quinton JF, Sendid B, Reumaux D, et al. (1998) Anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut 42:788–791
Sandborn WJ, Loftus EV Jr, Colombel JF, et al. (2001) Evaluation of serologic disease markers in a population-based cohort of patients with ulcerative colitis and Crohn’s disease. Inflamm Bowel Dis 7:192–201
Peeters M, Joossens S, Vermeire S, et al. (2001) Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol 96:730–734
Linskens RK, Mallant-Hent RC, Groothuismink ZM, et al. (2002) Evaluation of serological markers to differentiate between ulcerative colitis and Crohn’s disease: pANCA, ASCA and agglutinating antibodies to anaerobic coccoid rods. Eur J Gastroenterol Hepatol 14:1013–1018
Austin GL, Shaheen NJ, Sandler RS (2006) Positive and negative predictive values: use of inflammatory bowel disease serologic markers. Am J Gastroenterol 101:413–416
Dubinsky MC, Lin YC, Dutridge D, et al. (2006) Serum immune responses predict rapid disease progression among children with Crohn’s disease: immune responses predict disease progression. Am J Gastroenterol 101:360–367
Bruining DH, Siddiki H, Fletcher JG, et al. (2007) Prevalence of penetrating disease and extraintestinal manifestations of Crohn’s disease detected with CT enterography {abstract}. Gastroenterology 132:A-650
Solem C, Loftus EV, Fletcher JG, et al. (2008) Small bowel imaging in Crohn’s disease (CD): a prospective, blinded, 4-way comparison trial. Gastrointest Endosc in press
Bodily KD, Fletcher JG, Solem CA, et al. (2006) Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography—correlation with endoscopic and histologic findings of inflammation. Radiology 238:505–516
Booya F, Fletcher JG, Huprich JE, et al. (2006) Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology 241:787–795
Colombel JF, Solem CA, Sandborn WJ, et al. (2006) Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut 55:1561–1567
Higgins PD, Caoili E, Zimmermann M, et al. (2006) Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis 13:262–268
Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22): 2277–2284
Martin DR, Semelka RC (2006) Health effects of ionising radiation from diagnostic CT. Lancet 367:1712–1714
Peloquin J, Pardi D, Sandborn W, et al. (2006) Exposure to diagnostic ionizing radiation in a population-based cohort of patients with inflammatory bowel disease {abstract}. Am J Gastroenterol 101:S448–S449
Siddiki H, Fletcher J, Bruining D, et al. (2007) Performance of lower-dose CT enterography for detection of inflammatory bowel disease. RSNA abstract Chicago, Illinois SSA 10–2:254
Triester SL, Leighton JA, Leontiadis GI, et al. (2006) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol 101:954–964
Kettritz U, Isaacs K, Warshauer DM, et al. (1995) Crohn’s disease. Pilot study comparing MRI of the abdomen with clinical evaluation. J Clin Gastroenterol 21:249–253
Florie J, Horsthuis K, Hommes DW, et al. (2005) Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn’s disease. Clin Gastroenterol Hepatol 3:1221–1228
Bernstein CN, Greenberg H, Boult I, et al. (2005) A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn’s disease. Am J Gastroenterol 100:2493–2502
Best WR, Becktel JM, Singleton JW, et al. (1976) Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology 70:439–444
Frenz MB, Dunckley P, Camporota L, et al. (2005) Comparison between prospective and retrospective evaluation of Crohn’s disease activity index. Am J Gastroenterol 100:1117–1120
Shillon S, Loftus E (2005) Medical therapy in Crohn’s disease. Curr Treat Options Gastroenterol 8:19–30
Summers RW, Switz DM, Sessions JT Jr, et al. (1979) National Cooperative Crohn’s Disease Study: results of drug treatment. Gastroenterology 77:847–869
Hanauer SB, Stromberg U (2004) Oral Pentasa in the treatment of active Crohn’s disease: a meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2:379–388
Akobeng AK, Gardener E (2005) Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s Disease. Cochrane Database Syst Rev CD003715
Sutherland L, Singleton J, Sessions J, et al. (1991) Double blind, placebo controlled trial of metronidazole in Crohn’s disease. Gut 32:1071–1075
Brandt LJ, Bernstein LH, Boley SJ, et al. (1982) Metronidazole therapy for perineal Crohn’s disease: a follow-up study. Gastroenterology 83:383–387
Kane SV, Schoenfeld P, Sandborn WJ, et al. (2002) The effectiveness of budesonide therapy for Crohn’s disease. Aliment Pharmacol Ther 16:1509–1517
Thomsen OO, Cortot A, Jewell D, et al. (1998) A comparison of budesonide and mesalamine for active Crohn’s disease. International Budesonide-Mesalamine Study Group. N Engl J Med 339:370–374
Sandborn WJ, Lofberg R, Feagan BG, et al. (2005) Budesonide for maintenance of remission in patients with Crohn’s disease in medically induced remission: a predetermined pooled analysis of four randomized, double-blind, placebo-controlled trials. Am J Gastroenterol 100:1780–1787
Faubion WA Jr, Loftus EV Jr, Harmsen WS, et al. (2001) The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology 121:255–260
Munkholm P, Langholz E, Davidsen M, et al. (1994) Frequency of glucocorticoid resistance and dependency in Crohn’s disease. Gut 35:360–362
Pearson DC, May GR, Fick G, et al. (1998) Azathioprine for maintaining remission of Crohn’s disease. Cochrane Database Syst Rev CD000067
Sandborn W, Sutherland L, Pearson D, et al. (1998) Azathioprine or 6-mercaptopurine for induction of remission in Crohn’s disease. Cochrane Database Syst Rev CD000545
Alfadhli AAF, McDonald JWD, Feagan BG (2004) Methotrexate for induction of remission in refractory Crohn’s disease. Cochrane Database Syst Rev CD003459
Targan SR, Hanauer SB, van Deventer SJ, et al. (1997) A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 337:1029–1035
Hanauer SB, Feagan BG, Lichtenstein GR, et al. (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomized trial. Lancet 359:1541–1549
Hanauer SB, Sandborn WJ, Rutgeerts P, et al. (2006) Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology 130:323–333
Colombel J-F, Sandborn WJ, Rutgeerts P, et al. (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology 132:52–65
Present DH, Rutgeerts P, Targan S, et al. (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405
Sands BE, Anderson FH, Bernstein CN, et al. (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–885
Sandborn WJ, Rutgeerts P, Enns R, et al. (2007) Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med 146:829–838
Rutgeerts P, Feagan BG, Lichtenstein GR, et al. (2004) Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology 126:402–413
Lichtenstein GR, Yan S, Bala M, et al. (2005) Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology 128:862–869
Feagan B, Panaccione R, Sandborn W, et al. (2007) An evaluation of adalimumab on the risk of hospitalization in patients with Crohn’s disease, data from CHARM {abstract}. Gastroenterology 132(4 Suppl 2):A513
Schreiber S, Reinsich R, Colombel JF, et al. (2007) Early Crohn’s disease shows high levels of remission to therapy with adalimumab: sub-analysis of CHARM {abstract}. Gastroenterology 132:A-147
Schreiber S, Colombel J, Panes J, et al. (2006) Recent onset Crohn’s disease shows higher remission rates and durability of response to treatment with subcutaneous monthly certolizumab pegol: results from the analysis of the PRECISE III Study {abstract}. Gut 55(suppl II):A131
Hommes D, Baert F, van Assche G, et al. (2006) The ideal management of Crohn’s disease: top down versus step up strategies, a randomized controlled trial {abstract}. Gastroenterology 130:A108–A109
D’Haens G, Hommes D, Baert F, et al. (2006) A combined regimen of infliximab and azathioprine induces better endoscopic healing than classic step-up therapy in newly diagnosed Crohn’s disease (abstract). Gastroenterology 130:A110
Reddy JG, Loftus EV Jr (2006) Safety of infliximab and other biologic agents in the inflammatory bowel diseases. Gastroenterol Clin North Am 35:837–855
Sandborn WJ, Colombel JF, Enns R, et al. (2005) Natalizumab induction and maintenance therapy for Crohn’s disease. N Engl J Med 353:1912–1925
Targan SR, Feagan BG, Fedorak RN, et al. (2007) Natalizumab for the treatment of active Crohn’s disease: results of the ENCORE Trial. Gastroenterology 132:1672–1683
Van Assche G, Van Ranst M, Sciot R, et al. (2005) Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn’s disease. N Engl J Med 353:362–368
Munkholm P, Langholz E, Davidsen M, et al. (1993) Intestinal cancer risk and mortality in patients with Crohn’s disease. Gastroenterology 105:1716–1723
Dhillon S, Loftus EJ, Tremaine W, et al. (2005) The natural history of surgery for Crohn’s disease in a population-based cohort from Olmsted County, Minnesota {abstract}. Gastroenterology 100(9 suppl):S305
Ekbom A, Helmick C, Zack M, et al. (1990) Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet 336:357–359
Rubin DT, Kavitt RT (2006) Surveillance for cancer and dysplasia in inflammatory bowel disease. Gastroenterol Clin North Am 35:581–604
Itzkowitz SH, Harpaz N (2004) Diagnosis and management of dysplasia in patients with inflammatory bowel diseases. Gastroenterology 126:1634–1648
Itzkowitz SH, Present DH, Crohn’s, Colitis Foundation of America Colon Cancer in IBDSG (2005) Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis 11:314–321
Acknowledgements
Dr. Loftus has received research support from Techlab, Inc, Given Imaging, Schering-Plough, Abbott Labs, UCB Pharma, PDL Biopharma, and Procter & Gamble. Dr. Loftus has served as a consultant for Prometheus Laboratories, UCB Pharma, Abbott Labs, PDL Biopharma, Elan, Bristol Myers Squibb, Procter & Gamble, Shire, and Salix.
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Bruining, D.H., Loftus, E.V. Crohn’s disease clinical issues and treatment: what the radiologist needs to know and what the gastroenterologist wants to know. Abdom Imaging 34, 297–302 (2009). https://doi.org/10.1007/s00261-008-9410-x
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DOI: https://doi.org/10.1007/s00261-008-9410-x