Crohn's disease in Hindi- Introduction, cause, symptoms, investigation, T/t |Learn with Dr. Shipra|

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It is a granulomatous transmural inflammatory condition of the ileum.
Rarely other parts of the GIT (colon, jejunum, stomach, duodenum, esophagus)
It is precancerous condition (not as much as ulcerative colitis)

Involvement
Small bowel alone(ileum)- 30% cases(Terminal ileum is most commonly involved (60%)
both small and large bowels(ileocolic)- 50% cases
Large intestine(colon)-20%

Cause
Infectious—Mycobacterium paratuberculosis and atypical mycobacteria
Immunologic
Genetic
Environmental
Smoking, diet, OCPs (controversial), psychosocial factors

Clinical Features
Common- 15-40yr
Abdominal pain
Diarrhea-blood, pus or mucous present-severe
Mild fever
Weight loss
Lethargy
Obstruction
Fistula formation
Perforation
Bleeding (usually chronic but occasionally massive)

Investigations
CBC
Plain X-ray abdomen
USG abdomen.
Barium meal enema
CT scan and CT fistulogram is useful method.
Colonoscopy
Capsule endoscopy
MRI
Serum markers: 90% of patients

Treatment
Medical therapy-

Cessation of smoking
Bed rest, protein and vitamin supplementations. Often nasogastric tube nutrition or TPN is required.
To induce remission—steroids
For maintenance—immunomodulating drugs like azathioprine Antibiotics, metronidazole (as immunomodulator)
Avoid NSAIDs.

Surgery Indications
Failure of medical treatment
Intestinal obstruction—most common indication
Crohn’s disease children with growth retardation
Fistula formation
Bleeding
malignant change
Perforation
Perianal problems(Fissure-in-ano)

Surgeries
Ileocaecal resection
Total colectomy and ileorectal anastomosis- It is only done in extensive colonic Crohn’s.
Stricturoplasty.
Right hemicolectomy is done occasionally.