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Review
. 2023 Aug 27;12(17):5595.
doi: 10.3390/jcm12175595.

Unmet Challenges in Patients with Crohn's Disease

Katharina M Scheurlen  1 , Mary A Parks  1 , Anne Macleod  1 , Susan Galandiuk  1   2
Affiliations
Review

Unmet Challenges in Patients with Crohn's Disease

Katharina M Scheurlen et al. J Clin Med. .

Abstract

Patients with Crohn's disease can present with a variety of clinical manifestations; treatment strategies should focus on long-term remission and improvement of quality of life. There is no standardized process of diagnosing, predicting prognosis, and treating the disease. This narrative review was based on a literature search using PubMed, Embase, and Science Direct. Data on unmet challenges in patients with Crohn's disease were extracted from identified manuscripts. The aim was to discuss present research on standardized processes in the management of patients with Crohn's disease and to identify the unmet needs in clinical evaluation and treatment approaches. There is no consensus on standardized diagnostic, treatment, and surveillance algorithms, particularly in assessing complications of Crohn's, such as stricturing disease, intestinal cancer risk, and cutaneous manifestations. Complications and treatment failure rates of conventional, interventional, and surgical therapy place emphasis on the need for standardized treatment algorithms, particularly in the case of acute complications of the disease. Research on standardized clinical approaches, reliable biomarkers for disease diagnosis and therapy monitoring, and new treatment agents is necessary to improve therapy and reduce complications in patients with Crohn's disease.

Keywords: Crohn’s disease; biomarkers; endoscopy; inflammatory bowel disease; tumor necrosis factor inhibitors.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
A diagnostic algorithm for Crohn’s disease. Imaging and endoscopic modalities algorithm for the diagnosis of Crohn’s disease with indication, risks, and benefits of each modality, created and adapted from most recent American College of Gastroenterology (ACG), European Crohn’s and Colitis Organization (ECCO), and British Society of Gastroenterology (BSG) guidelines [1,10,11]. * Guidelines were similar across most areas other than Small Bowel Ultrasound (SBUS) use—not part of ACG clinical guidelines. MRE: magnetic resonance enterography, CTE: computed topography enterography. CD: Crohn’s disease.
Figure 2
Figure 2
Endoscopic view of a small bowel fistula due to Crohn’s (arrow).
Figure 3
Figure 3
Endoscopic view of small bowel Crohn’s stricture with associated ulceration (arrow).
Figure 4
Figure 4
Patient with stricturing jejunal Crohn’s disease. Note massive dilatation of jejunum proximal to short fibrotic strictures (white arrows). These occurred years after a segmental resection proximally, which shows no evidence of recurrent disease (black arrow).
Figure 5
Figure 5
Cutaneous Crohn’s in an inguinal crease.
See this image and copyright information in PMC

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