University of Wyoming Family Medicine Residency Program, Casper, WY, USA.
Am Fam Physician. 2018 Dec 1;98(11):661-669.
Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract. It can cause lesions from mouth to anus and may result in extraintestinal complications. The prevalence of Crohn's disease is increasing in adults and children. Genetic predispositions to Crohn's disease have been identified, and specific environmental factors have been associated with its development. Common presenting symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue. Physical examination should identify unstable patients requiring immediate care, include an anorectal examination, and look for extraintestinal complications. Initial laboratory evaluation identifies inflammation and screens for alternative diagnoses. Measurement of fecal calprotectin has value to rule out disease in adults and children. Endoscopy and cross-sectional imaging are used to confirm the diagnosis and determine the extent of disease. Treatment decisions are guided by disease severity and risk of poor outcomes. Patients commonly receive corticosteroids to treat symptom flare-ups. Patients with higher-risk disease are given biologics, with or without immunomodulators, to induce and maintain remission. For children, enteral nutrition is an option for induction therapy. All patients with Crohn's disease should be counseled on smoking avoidance or cessation. Patients with Crohn's disease are at increased risk of cancer, osteoporosis, anemia, nutritional deficiencies, depression, infection, and thrombotic events. Maximizing prevention measures is essential in caring for these patients.
克罗恩病是一种慢性炎症性疾病，影响胃肠道。它可以引起从口腔到肛门的病变，并可能导致肠道外并发症。成人和儿童克罗恩病的患病率正在增加。已经确定了克罗恩病的遗传易感性，并且已经确定了与疾病发展相关的特定环境因素。常见的表现症状包括腹泻、腹痛、直肠出血、发热、体重减轻和疲劳。体格检查应识别需要立即治疗的不稳定患者，包括直肠检查，并寻找肠道外并发症。初步实验室评估可识别炎症并筛查其他诊断。粪便钙卫蛋白的测量有助于排除成人和儿童的疾病。内镜和影像学检查用于确诊和确定疾病的严重程度。治疗决策取决于疾病的严重程度和不良结局的风险。患者通常接受皮质类固醇治疗症状发作。高风险疾病的患者给予生物制剂，联合或不联合免疫调节剂，以诱导和维持缓解。对于儿童，肠内营养是诱导治疗的一种选择。所有克罗恩病患者都应接受避免或戒烟的咨询。克罗恩病患者患癌症、骨质疏松症、贫血、营养缺乏、抑郁、感染和血栓事件的风险增加。在照顾这些患者时，最大限度地采取预防措施至关重要。
