CROHN’S DISEASE: A REVIEW ON EPIDEMIOLOGY, DIAGNOSIS AND THERAPEUTIC MANAGEMENT

Abstract

Crohn’s disease (CD) is a kind of inflammatory bowel disease (IBD) characterized by the chronic transmural inflammatory state of gastrointestinal tract that typically affects ileum, colon, and perineum. Although the precise etiology is unknown, the major risk aspects concerned with CD consist of several environmental factors, altered microbiota, unhealthy low fiber- high carbohydrate diet, and certain medicines like non-steroidal anti-inflammatory drugs. The disease has wide distribution and inflammation may affect the different areas of the alimentary tract in diverse people. In about 80 % of patients, only small bowel involvement is typically present, affecting distal ileum resulting in ileitis. In about 50 % patients, both ileum and colon are affected resulting in ileocolitis and in approximately 20 % patients, disease is limited to colonic portion. Perianal disease affects almost one-third of patients. As per the various genetic researches in the CD patients, various genetic mutations affect the body’s immunological system that results in severe inflammatory state. The two major gene mutations which result in the pathological state of CD are autophagy-related 16-like 1 (ATG16L1) and nucleotidebinding oligomerization domain-containing protein 2 (NOD2/ Card15). The main techniques used for diagnosis of CD include the combination of pathological findings, endoscopic and radiographic findings demonstrating the disease features. The utmost preferred radiologic study for assessing the small bowel CD is abdominal computerized tomography (CT). The goal of current treatment strategies is to address symptomatic relief. Sequence of treatment includes induction therapy, followed by maintenance of remission. The currently used drugs that effectively can cause induction as well as maintain remission include 5-aminosalicylic acid, Tumor Necrosis Factor (TNF) inhibitors, immunomodulators and steroids. Treatment and management should be integrated with lifestyle and dietary amendments to prevent therapeutic failure and consideration of surgical intervention.