Distinct management issues with Crohnʼs disease of the small intestine

Abstract

Although small bowel Crohn's disease presents specific management issues not seen in patients with Crohn's disease elsewhere in the gastrointestinal tract, our knowledge of how to manage these is improving.

Enteroscopy in children and adults with inflammatory bowel disease

“…Inflammatory bowel disease (IBD) represents a group of chronic inflammatory disorders that involve the colon, small bowel (SB) and the entire gastrointestinal tract and include Crohn’s disease (CD), ulcerative colitis (UC) and unclassified entities[ 1 , 2 ]. CD is a chronic immuno-mediated inflammation that most commonly involves the terminal ileum and colon, but at the time of diagnosis, it can be confined to the SB, as seen in approximately 30% of CD patients, especially young patients[ 2 - 8 ].…”

“…First, the SB is less easily accessible by endoscopy, making it easy to miss a SB-CD diagnosis with conventional endoscopy contributing to a delay in diagnosis as observed in many patients with CD[ 5 ]. Second, SB ulcerations induced by infection (such as tuberculosis) or drugs can sometimes be difficult to differentiate from CD[ 1 , 8 ]. Third, compared with the other phenotypes, SB-CD is associated with an increased risk of relapse and stricture development[ 1 , 3 , 6 , 7 ].…”

“…Second, SB ulcerations induced by infection (such as tuberculosis) or drugs can sometimes be difficult to differentiate from CD[ 1 , 8 ]. Third, compared with the other phenotypes, SB-CD is associated with an increased risk of relapse and stricture development[ 1 , 3 , 6 , 7 ]. Fourth, SB cancer associated with CD is a rare but difficult problem because only a minority of these cases are diagnosed preoperatively and at an early stage[ 9 ].…”

Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease

“…An array of medical therapies are available including antibiotics, steroids, and immune modulators such as anti‐tumor necrosis factor alpha (TNFα) agents, each attracting their own benefits and side effect profiles. Targeted surgical and endoscopic interventions also play an important role . However, CD phenotyping is complex and requires accurate delineation of disease presence, segmental location, the relative contribution of inflammatory activity versus irreversible fibrosis, and the presence of extraluminal complications.…”

“…Targeted surgical and endoscopic interventions also play an important role. [6][7][8][9] However, CD phenotyping is complex and requires accurate delineation of disease presence, segmental location, the relative contribution of inflammatory activity versus irreversible fibrosis, and the presence of extraluminal complications. Furthermore, CD is also characterized by periods of relapse and remission.…”