Inflammatory Bowel Disease: Introduction FeedbackA general introduction to Inflammatory Bowel Disease.Source: Clinical Knowledge Summaries, 01 Dec 2012
Crohn's disease is a chronic, relapsing–remitting, non-infectious inflammatory disease of the gastrointestinal tract. The inflammation involves discrete parts of the gastrointestinal tract, anywhere from the mouth to the anus; these are called 'skip lesions' because they leave normal areas in between. The full thickness of the intestinal wall is inflamed.
Crohn's disease has several extra-intestinal manifestations, including iritis, arthritis, erythema nodosum, and pyoderma gangrenosum.
Crohn's disease is thought to be caused by the interaction of environmental factors with immunological factors. Risk factors include smoking, family history of inflammatory bowel disease, appendectomy, and oral contraceptives.
Complications of Crohn's disease include:
Psychological effects due to the impact on social life at home and in education or employment.
Abscesses in the wall of the intestine or adjacent structures.
Fistulas between the intestine and adjacent structures, such as peri-anal skin, bladder, and vagina.
Anaemia due to iron deficiency (through blood loss), vitamin B12 deficiency, or folate deficiency (through decreased absorption).
Growth failure (in children).
Colorectal and small bowel cancers.
Crohn's disease should be suspected in children or adults with otherwise unexplained persistent diarrhoea and abdominal pain or discomfort. Suspicion is increased if they also have a history of similar episodes, weight loss (or in children, failure to grow), anorexia, fatigue, fever, malabsorption, mouth ulcers, fistula, or abscess; or they have a relative with inflammatory bowel disease, coeliac disease, or colorectal cancer.
With Crohn's colitis, there may be urgency, tenesmus (feeling the need to pass stool although the rectum is empty), and blood or mucus in the stool.
Where Crohn’s disease is suspected, referral should be made. The urgency of referral depends on the severity of the condition. Admit the person as an emergency if they have bloody diarrhoea and fever or tachycardia.
Management in primary care involves:
Ensuring that primary care is coordinated with secondary care. Drug treatment for the induction and maintenance of remission in Crohn's disease is always initiated by a specialist (such as a gastroenterologist or paediatric gastroenterologist) but may be continued and monitored by the general practitioner under a shared-care protocol.
Assessing the impact of symptoms on mood and activities of daily life, including home, work or school, and social activities.
Offering advice on Crohn's disease and how to access support.
Prescribing and monitoring drug treatment as recommended by the person's gastroenterologist.
Encouraging adherence to drug treatments.
Being alert for complications.
Managing a general flare of their symptoms, or more specific problems, such as pain, diarrhoea, fistulas, strictures, upper gastrointestinal symptoms, and oral symptoms (e.g. ulceration and chelitis).
Ensuring that the person is receiving appropriate specialist follow up. This will ensure that necessary changes are made to drug treatment and that, if appropriate, dietary supplementation can be provided.
Encouraging smokers to quit.
Discussing colorectal cancer screening and arranging this if it has not already been organized in secondary care.
Inflammatory Bowel Disease: Guidance FeedbackThe most relevant search results for Inflammatory Bowel Disease from producers of guidance information.
- Clinical Knowledge Summaries, 19 June 2014
- British Society of Gastroenterology, 18 February 2011
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Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas - guidance (CG118)National Institute for Health and Care Excellence, 01 March 2011
- National Institute for Health and Care Excellence, 01 October 2012
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- NHS Choices, 28 March 2014
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- UK Database of Uncertainties about the Effects of Treatments, 18 May 2012
- UK Database of Uncertainties about the Effects of Treatments, 10 April 2012
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Clinical practice guideline: Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care
...gained) — incremental cost. Inflammatory bowel disease: general term for any disease characterised by inflammation...most common inflammatory bowel diseases are ulcerative colitis and Crohn's disease. Note: not to be confused with...
Royal College of Nursing, 19 November 2008
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