eMedicine Specialties > Gastroenterology > Systemic Disease

Crohn Disease: Follow-up

Author: George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
Coauthor(s): Marcy L Coash, DO, Staff Physician, Department of Internal Medicine, University of Connecticut; Senthil Nachimuthu, MD, FACP, Fellow, Department of Internal Medicine, Heart and Vascular Institute, Tulane University School of Medicine
Contributor Information and Disclosures

Updated: Jan 20, 2009

Follow-up

Complications

  • In the initial stages of Crohn disease, obstruction is caused by bowel edema and spasm, which is intermittent and reversible. Treatment involves conservative measures, such as nasogastric decompression, intravenous fluids, anti-inflammatory agents, and steroids (if required). If medical therapy fails, then surgical resection is necessary.1
  • Fistulae occur because of the penetration of a sinus tract through the bowel wall to the adjacent viscera.
    • Most fistulae are enteroenteric and enteromesenteric. They usually cause no symptoms and require no treatment.
    • Coloenteric fistulae and cologastric fistulae may result in bacterial overgrowth, diarrhea, and weight loss.
    • Enterovesical fistulae and enterovaginal fistulae are often complicated by infection.
    • Enterocutaneous fistulae usually occur at a previous surgical site, tracking the path of least resistance.
    • Many fistulae close with the use of TPN, but they recur when oral feeding resumes.
  • A tender abdominal mass, fever, and leukocytosis indicate a possible underlying abscess. As many as 25% of patients with Crohn disease will present at some time in their lives with an abscess. Unfortunately, many patients at risk for perforation or abscess will be on glucocorticoids, which are known to suppress peritoneal signs and fever and mask the presenting signs of infection. A CT scan helps confirm the diagnosis. Abscesses are treated with surgical drainage and broad-spectrum antibiotics.1
  • Severe hemorrhage is unusual in patients with Crohn disease.1
  • Malabsorption may occur for multiple reasons, such as bacterial overgrowth in an enterocolic fistula, strictures and stasis, extensive disease of the small bowel, and resection of large portions of the small intestine. Bile acid malabsorption may occur with extensive ileal disease, further exacerbating the malabsorption process.The steatorrhea that develops may lead to further complications, such as malnutrition, clotting abnormalities, calcium deficiency, and osteomalacia, which may progress to osteoporosis. Vitamin B-12 deficiency may also occur with ileal resection or long-standing disease.1
  • Patients with colonic disease have an increased risk of colon cancer, which has been shown to be correlated with the extent and duration of the disease and the patient's age at onset. The role of colonoscopy as a screening tool in such cases is unclear. The risk of lymphoma secondary to medical therapy is still being investigated.1

Prognosis

  • Although Crohn disease is a chronic condition with recurrent relapses, appropriate medical and surgical therapy helps patients to have a reasonable quality of life.1
  • Medical therapy becomes less effective with time, and surgery for underlying complications is required in nearly two thirds of patients at some point in their disease.1
  • The mortality rate increases with the duration of the disease, and GI tract cancer is the leading cause of disease-related death, including colorectal, small bowel adenocarcinoma, lymphomas, and squamous cell carcinomas arising in association with a chronic fistula to the skin. Some studies have also shown an association between Crohn disease and respiratory cancers.1
  • Acute regional enteritis, which is often discovered during laparotomy for suspected appendicitis, has an excellent prognosis. The acute episode is treated conservatively, and two thirds of patients may not have subsequent evidence of regional enteritis.1

Miscellaneous

Medicolegal Pitfalls

  • Avoid long-term steroid use in patients with Crohn disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, Kathleen M Raynor, MD, and Priyankha Balasundaram, MD, to the development and writing of this article.



More on Crohn Disease

Overview: Crohn Disease
Differential Diagnoses & Workup: Crohn Disease
Treatment & Medication: Crohn Disease
Follow-up: Crohn Disease
References
Further Reading
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References

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  2. Panes J, Gomollon F, Taxonera C, et al. Crohn's disease: a review of current treatment with a focus on biologics. Drugs. 2007;67(17):2511-37. [Medline].

  3. Tierney LM. Crohn's disease. In: Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. 40th ed. New York, NY: McGraw-Hill Professional Publishing; 2001:638-42.

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  8. Friedman S, Blumberg RS. Inflammatory bowel disease. In: Braunwald E, Fauci AS, Kasper DS, et al, eds. Harrison's Principles of Internal Medicine. Vol 2. 15th ed. New York, NY: McGraw-Hill Professional Publishing; 2001:1679-91.

  9. Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn's disease: results of the CLASSIC II trial. Gut. Sep 2007;56(9):1232-9. [Medline]. [Full Text].

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  14. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. May 6 1999;340(18):1398-405. [Medline]. [Full Text].

  15. Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group. N Engl J Med. Oct 9 1997;337(15):1029-35. [Medline]. [Full Text].

  16. Peyrin-Biroulet L, Laclotte C, Bigard MA. Adalimumab maintenance therapy for Crohn's disease with intolerance or lost response to infliximab: an open-label study. Aliment Pharmacol Ther. Mar 15 2007;25(6):675-80. [Medline]. [Full Text].

  17. Sandborn WJ, Rutgeerts P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med. Jun 19 2007;146(12):829-38. [Medline]. [Full Text].

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Further Reading

Related eMedicine topics

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Keywords

Crohn disease, Crohn's disease, regional enteritis, granulomatous enteritis, regional ileitis, terminal ileitis, inflammatory bowel disease, IBD, ulcerative colitis, UC, ileitis, colitis, ileocolitis

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Contributor Information and Disclosures

Author

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Coauthor(s)

Marcy L Coash, DO, Staff Physician, Department of Internal Medicine, University of Connecticut
Marcy L Coash, DO is a member of the following medical societies: American Medical Student Association/Foundation and American Osteopathic Association
Disclosure: Nothing to disclose.

Senthil Nachimuthu, MD, FACP, Fellow, Department of Internal Medicine, Heart and Vascular Institute, Tulane University School of Medicine
Senthil Nachimuthu, MD, FACP is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Waqar A Qureshi, MD, Associate Professor of Medicine, Chief of Endoscopy, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine and Veterans Affairs Medical Center
Waqar A Qureshi, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

BS Anand, MD, Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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