Clinical Review

Crohn’s disease

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6670 (Published 19 November 2014) Cite this as: BMJ 2014;349:g6670
  1. Rahul Kalla, clinical research fellow,
  2. Nicholas T Ventham, clinical research fellow,
  3. Jack Satsangi, professor of gastroenterology,
  4. Ian D R Arnott, consultant gastroenterologist
  1. 1Gastrointestinal Unit, Centre for Molecular Medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh EH4 2XU, UK
  1. Correspondence to: I D R Arnott ian.arnott{at}nhslothian.scot.nhs.uk

The bottom line

  • The incidence and prevalence of Crohn’s disease is increasing worldwide

  • Crohn’s disease can have a major impact on patients’ education, work, and social and family life

  • To induce early remission and prevent long term complications, early diagnosis of Crohn’s disease is a priority

  • Adequate clinical and biochemical (for example, faecal calprotectin level) or endoscopic assessment of disease activity is needed to guide further decisions about treatment

  • Drugs such as thiopurines, methotrexate, and anti-tumour necrosis factor are often used to maintain remission in patients with Crohn’s disease

  • Adverse pregnancy outcomes are associated with active Crohn’s disease, and disease flares should be treated aggressively in pregnancy

  • A systematic programme of surveillance to monitor long term sequelae should be in place to ensure the best outcomes for patients with Crohn’s disease

Crohn’s disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract. Although the disease most commonly presents at a young age, it can affect people of all ages. Patients often present with persistent diarrhoea, abdominal pain, and weight loss. Crohn’s disease has a global impact on patients’ education, work, and social and family life. High quality multidisciplinary care, of which primary care is a key aspect, can attenuate relapse, prevent long term complications, and improve quality of life. In this review we provide a practical approach to the diagnosis, management, and long term care of patients with Crohn’s disease.

Sources and selection criteria

We carried out an electronic search of PubMed, the Cochrane Library, and Ovid databases for articles using the term “Crohn’s disease”. We limited studies to those in adults and focused on high quality randomised control trials, meta-analyses, and systematic reviews.

How common is it?

Crohn’s disease is an idiopathic, chronic relapsing immune mediated disease, the pathogenesis of which remains incompletely understood, although the condition is thought to arise from environmental priming and …

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