Sartini A, Castellani L, Buonfiglioli F, Roda G, Belluzzi A, Roda E
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Minerva Gastroenterol Dietol. 2011 Mar;57(1):89-96.
Crohn's disease is a chronic transmural inflammatory disease that most commonly affects the intestinal wall, but may also occur in any part of the gastrointestinal tract; its incidence is higher in industrialized countries, urban areas and upper socioeconomic classes. Various environmental risk factors have been associated with the pathogenesis of Crohn's disease and possible infectious agents (viruses, bacteria, yeasts) have also been considered. However, none of these factors alone leads to the development of the disease, which may occur only when there is a genetic predisposition and/or an abnormal function of the intestinal immune system. Histopathology demonstrates mucosal hyperemia, with small superficial ulcers in mild forms of the disease; in moderate-to-severe forms, serpiginous ulcerations demarcating areas of edematous mucosa produce the characteristic "cobblestone" appearance. The earliest microscopic lesions appear as neutrophil-mediated cryptic damage, with the formation of focal cryptic abscesses and granulomas throughout the layers of the intestinal wall. In addition to weight loss, patients mainly refer chronic diarrhea and recurrent right iliac fossa abdominal pain. Extraintestinal manifestations include ocular or articular complications. There are several drugs classes available for treating Crohn's disease, but the therapeutic approach depends on the clinical picture and differs from patient to patient. The broad clinical and the histopathological features of Crohn's disease make it a highly polymorphic entity. Diagnostic tests and a thorough knowledge of its various aspects are essential for guiding diagnosis and treatment.
克罗恩病是一种慢性透壁性炎症性疾病，最常累及肠壁，但也可能发生在胃肠道的任何部位；在工业化国家、城市地区和社会经济阶层较高的人群中发病率更高。多种环境风险因素与克罗恩病的发病机制有关，也有人认为可能的感染因子（病毒、细菌、酵母）与之相关。然而，这些因素单独都不会导致疾病的发生，只有在存在遗传易感性和/或肠道免疫系统功能异常时才可能发病。组织病理学表现为黏膜充血，疾病轻度时可见小的浅表溃疡；中重度时，蜿蜒的溃疡将水肿黏膜区域分隔开，形成特征性的“鹅卵石”外观。最早的微观病变表现为中性粒细胞介导的隐窝损伤，在肠壁各层形成局灶性隐窝脓肿和肉芽肿。除体重减轻外，患者主要表现为慢性腹泻和反复的右下腹腹痛。肠外表现包括眼部或关节并发症。有几类药物可用于治疗克罗恩病，但治疗方法取决于临床表现，因人而异。克罗恩病广泛的临床和组织病理学特征使其成为一种高度多态性的疾病。诊断测试以及对其各个方面的全面了解对于指导诊断和治疗至关重要。
