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March 2011 IBD Newsletter >>
Crohn’s Disease: Strategies and Indications
The diagnosis of Crohn’s disease remains dependent on a combination of clinical, endoscopic, histologic and radiologic findings. In most cases the gastroenterologist or primary care physician makes this diagnosis; though occasionally, it’s made at the time of abdominal exploration for presumed appendicitis. Regardless of presentation, medical management remains the treatment of choice when feasible. Unlike ulcerative colitis, Crohn’s disease is not curable and therefore surgical therapy is generally reserved for treating the potential complications of this disease.
Indications for Crohn’s disease:
The most common indication relates to obstructive symptoms secondary to stricture. Once this occurs, further medical management is unlikely to be of additional benefit. At this point, several factors are also considered prior to surgical intervention.
Factors to consider prior to surgical intervention:
The extent of symptoms related to the stricture ultimately drives surgery. In most cases, work-up prior to surgery aims to document the location and extent of the stricture(s) and also assesses for additional, less symptomatic disease. This should include a recent colonoscopy to assess/rule-out colon involvement. Other studies include CT enterography, Barium small bowel follow-through or MR enterography. These studies not only assist the surgeon in decision-making, but also allows for appropriate preoperative discussion with the patient.
For more clinical information on Crohn’s disease, please click here.