Radiographic examination of small bowel after ingestion of contrast medium (barium)ĭetects increase in vascular flow, abscess, sinus tracts, and lymphadenopathyĥ0 mg by mouth per day (maximum: 1.5 mg per kg per day) Uses radiolabeled leukocytes to diagnose bowel inflammation and to estimate disease extent and activity role in clinical practice is limited Reveals intraintestinal inflammation and extraintestinal manifestations without radiation Permits visualization of the bowel and lumen expensive no ionizing radiation Reveals intraintestinal inflammation and extraintestinal manifestations exposes patient to ionizing radiation Permits visualization of the bowel wall and lumen exposes patient to ionizing radiation May distinguish between flare-up of Crohn's disease and symptoms of irritable bowel syndromeĪntibodies to Escherichia coli outer membrane porin and Saccharomyces cerevisiae perinuclear antineutrophil cytoplasmic antibodyĭistinguish between Crohn's disease and ulcerative colitisīetter yield for nonstricturing small bowel Crohn's disease than small bowel follow-through and colonoscopy with ileoscopy capsule retention possible with small bowel strictureĭirect visualization of inflammation, fistula, or stricture of terminal ileum and colon ability to obtain biopsies from the ileum and colon Performed to rule out sclerosing cholangitis, screen for adverse effects of therapiesīlood urea nitrogen and creatinine levelsįecal lactoferrin and calprotectin levels Measure when initiating corticosteroid therapy Iron, ferritin, vitamin B 12, and folate levels total iron-binding capacityĭecreased absorption or increased iron loss leading to anemiaĭecreased with poor nutritional status and with protein-losing enteropathyĭecreased secondary to malabsorption, small bowel resection, or corticosteroid impairment of vitamin D metabolism To rule out major infectious cause of diarrhea Stool for culture, ova and parasites, and Clostridium difficile toxin If elevated, may correlate with disease activity Increased with inflammation or decreased with treatment (e.g., azathioprine)Ĭ-reactive protein level and erythrocyte sedimentation rate Methotrexate is effective in inducing and maintaining remission in patients with Crohn's disease.Įlevated with inflammation or infection, or secondary to glucocorticoid useĭecreased with 6-mercaptopurine and azathioprine (Imuran) use There is no difference between elemental and nonelemental diets in inducing remission in patients with Crohn's disease.īudesonide (Entocort EC) is effective in inducing, but not maintaining, remission in patients with Crohn's disease.Ĭorticosteroids are more effective than placebo and 5-aminosalicylic acid products in inducing remission in patients with Crohn's disease.Īzathioprine (Imuran) and 6-mercaptopurine are effective in inducing remission in patients with active Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging are helpful for excluding extramural complications in persons with Crohn's disease.Ĭolonoscopy with ileoscopy and biopsy is a valuable initial test in the diagnosis of ileocolonic Crohn's disease.Įsophagogastroduodenoscopy is recommended in patients with Crohn's disease who have upper gastrointestinal symptoms.

Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti–tumor necrosis factor agents (e.g., infliximab, adalimumab). Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Levels of vitamin B 12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia.

Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum.

Celiac disease colonoscopy findings