CROHN’S DISEASE

• Crohn’s disease (CD) is an inflammatory bowel disease (IBD), in which inflammation is transmural and may involve any or all segments of the gastrointestinal tract
• CD mostly affects young adults and adolescents between the ages of 15 and 35. It typically affects the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis

• Immune dysregulation and dysbiosis, which promotes chronic inflammation, and later to abscess and fistula formation

Risk factors

• Active and passive smoking of tobacco
• Familial aggregation
• Genetic predisposition

Predominat symptoms

• Diarrhoea – may be of small volume with urgency and tenesmus , whereas extensive small intestinal involvement produces larger stools with steatorrhoea
• Abdominal Pain – pain abdomen results from intermittent partial obstruction or serosal inflammation
• Weight loss – because of malabsorption and reduced intake

Intestinal symptoms

• Most commonly affects the terminal ileum and colon, but involvement of any part of the GI tract (from mouth to anus, except rectum) is possible
• Chronic diarrhoea, typically non bloody 
• Abdominal pain, typically in the Right lower quadrant
• Palpable abdominal mass in the Right lower quadrant 
• Oral aphthae
• Malabsorption
• Enterocutaneous perianal fistulas, often associated with abscess formation

Other symptoms

• Joints : Enteropathic arthritis (e.g. sacroiliitis, spondylitis)
• Eyes : Uveitis, Iritis, Episcleritis
• Liver/bile ducts: cholelithiasis 
• Urogenital system: urolithiasis
• Skin : Erythema nodosum, Acrodermatitis enteropathica
• Low-grade fever
• Fatigue

Differential diagnosis

• Ulcerative Colitis

Blood

• CBC - signs of pernicious anaemia
• ↑ CRP, ↑ ESR, ↑ thrombocytes, and ↑ leukocytes
• ↑ Anti-Saccharomyces cerevisiae antibodies (ASCA) 
• pANCA most likely negative 

Stool analysis

• Stool culture to rule out bacterial gastroenteritis
• Microscopy to examine presence of ova and parasites
• Faecal occult blood test

Plain x-ray abdomen: may show bowel distention or pneumo peritoneum

Barium swallow :used to detect fistulas or stenosis, characteristic findings are String sign and Creeping fat

Ultrasound : Gastrointestinal wall thickening ,Detection of abscesses/fistulas

Endoscopy : Characteristic macroscopic findings are Segmental/discontinuous pattern of involvement, Snail trails, Pinpoint lesions, Cobblestone sign

• Lifestyle modifications : Cessation of smoking, Minimizing stress, avoiding certain drugs ( NSAIDs)
• Surgery : Balloon dilatation , Strictureplasty

Internal Medications

• Kalashakadi kashaya
• Kaidaryadi kashaya
• Pachanamruta kashaya
• Vilwadi gutika
• Musta ksheera paka (Aja ksheera)
• Dadimashtaka choorna
• Taleesadi vataka

Procedures

• Picha vasti