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Crohn's disease

Definition
Risk Factors
  • FHx
  • Smoking
Differential diagnosis

Epidemiology
  • Tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies
  • Prevalence ( Northern Europe): 27–48 per 100,000
  • Higher incidence in western industrialized nations compared to other parts of the world
  • Males and females are equally affected
  • Smokers are two times more likely to develop Crohn's disease than nonsmokers.[5]
  • Genetic link
Aetiology
  • autoimmune disease of the gastrointestinal tract
  • Inflammation stimulated by an overactive Th1 cytokine response
  • Th17 is of greater importance in the disease?[54]
  • ATG16L1 may induce autophagy and hinder the body's ability to attack invasive bacteria
  • Increasing body of evidence in favor of the hypothesis that Crohn's disease results from an impaired innate immunity
Clinical features
Pathophysiology
  • Transmural pattern of inflammation
  • Ulceration is an outcome seen in highly active disease
  • Usually an abrupt transition between unaffected tissue and the ulcer.
  • Mucosal inflammation, characterized by focal infiltration of neutrophils into the epithelium
  • Neutrophils, along with mononuclear cells, may infiltrate the crypts, leading to inflammation (crypititis) or abscess (crypt abscess)
  • Granulomas are found in 50% of cases and are most specific for Crohn's disease
    • Do not show "caseation"
  • Biopsies may also show chronic mucosal damage, as evidenced by blunting of the intestinal villi, atypical branching of the crypts, and a change in the tissue type (metaplasia)
Investigations

Management

a) conservative

b) medical
c) surgical
  • used when partial or a full blockage of the intestine occurs
Prognosis

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