Crohn?s disease is an inflammatory bowel disease having multiple gastrointestinal and systemic manifestations by way of its
inflammatory and genetic pathogenic mechanism. The entire gastrointestinal tract may be affected by Crohn?s, affected areas
determining symptomatology and manifestation signs. Prevalence rates are reported as 43 per 100,000 in those under age 20,
and 201 per 100,000 in adults. Diarrhea, abdominal pain often right lower quadrant, cachexia, nutritional deficiencies and extra-
intestinal manifestations ie. arthritis, skin manifestations including erythema nodosum, gallstones, kidney stones have been
observed. Standard diagnostic method includes colonoscopy with biopsy however there is no single gold standard for diagnosis.
Clinical evaluation and a combination of endoscopic findings, histology, radiologic findings and laboratory investigations must
all be considered. Medical and Surgical treatment options exist, both enhanced by dedicated lifestyle modification, an element
commonly underused. Medical treatment objective tends towards infection control with antimicrobial agents and control of
inflammatory processes. Commonly anti-inflammatories are sulfasalazine, mesalamine, olsalazine, balsalazide. Tolerance of such
agents is variable but generally good. Systemic corticosteroids administration also may be used. Probiotics are reported to offer
benefit as well. Other drug types used in may be immunomodulators ie. azathioprine,methotrexate, cyclosporine. Bowel rest
and enteral feeding are used during acute flares. Research demonstrates Tumor Necrosis Factor in a crucial role in Crohn's
inflammation thus treatment with anti-TNF drugs ie. infliximab, adalimumab are seen to benefit. Some clinical trial suggest that
Crohn's patients treated with TNF-alpha inhibitors can reach and maintain remission. Surgery is indicated only in severe forms
of disease and when there are complications like stricture formation, obstruction or fistula formation. Commonly performed
surgeries are strictureplasty resection & anastomosis, Colectomy, Proctocolectomy, and Ileostomy.
Sachin Manthuruthil is a graduate of Sri Ramachandra University of Chennai, Tamil Nadu. He aspires to do his residency training and be a practicing
clinician in the USA.
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