Crohn's Disease

Overview

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the GI tract from mouth to anus (most commonly terminal ileum and colon). Unlike UC, it causes transmural (full-thickness) inflammation, leading to strictures, fistulas, and abscesses. Surgery is needed in 70-80% of patients during their lifetime.

Causes

• Genetic predisposition (NOD2/CARD15 mutations)
• Immune dysregulation
• Environmental triggers
• Gut microbiome imbalance
• Smoking (worsens Crohn's significantly)
• NOT caused by diet or stress alone

Risk Factors

• Age 15-35 (peak onset)
• Smoking (strongest modifiable risk)
• Family history of IBD
• Jewish ancestry
• Urban living
• Appendectomy may increase risk
• Previous antibiotic use

Symptoms

Diagnosis

• Colonoscopy with terminal ileal intubation and biopsies
• CT/MR enterography (small bowel involvement)
• Capsule endoscopy (if small bowel suspected)
• Fecal calprotectin
• Blood tests (CRP, albumin, iron)
• Perianal MRI for fistulizing disease

Treatment Options

Surgical Treatment

Recovery

Ileocecal resection: 4-6 days hospital stay, early feeding, return to work in 2-3 weeks. Maintenance therapy (biologics) usually continued post-surgery. Recurrence at anastomosis: 50% at 5 years without prophylaxis, reduced to 10-20% with biologics.

Prevention

• Stop smoking (most important)
• Regular follow-up with gastroenterologist
• Medication adherence
• Nutritional optimization
• Colonoscopic surveillance for dysplasia
• Vitamin B12 and iron supplementation as needed

Frequently Asked Questions