Crohn's disease and clinical management today: How it does?

Abstract

Crohn's Disease (CD) is an Inflammatory Bowel Disease and is characterized by an immune-mediated nature. Its etiology results from the interaction between genetic, enviromental and microbial factors. Regarding pathophysiology, it involves high levels of interleukin (IL)-12, IL-17, and Th1 profile, along with loss of tolerance mechanisms, an increase in pro-inflammatory interleukins, beyond the possibility to affect any part of the gastrointestinal tract. Its symptoms include abdominal pain, chronic diarrhea, weight loss, anorexia, and fatigue, as well as blood in the stool or rectum. Additionally, conditions comprising musculoskeletal, cutaneous, ocular, hepatic, and hematological alterations may be associated with this scenario and extra-intestinal presentation, such as erythema nodosum, anterior uveitis, osteoporosis, and arthritis can also occur. Today, clinical history, exams as fecal calprotectin, ileocolonocopy, and capsule endoscopy can be performed in the diagnosis investigation, along with treatments to induce and maintain remission. In this sense, anti-inflammatory drugs, such as corticosteroids, immunomodulators, and biological agents, as well as surgery and non-pharmacological interventions plays a role in its therapy. The aim of this review is to bring more current evidence to clinical management of CD, as well as to briefly discuss aspects of its pathophysiology, surveillance, and associated disorders.

Keywords: Biological agents; Crohn's disease; Diagnosis; Immunomodulation; Inflammatory bowel diseases; Treatment.

Figure 1

Summary of the articles selection process.

Figure 2

Clinical presentation that can occur in Crohn’s disease patients. The symptoms may be fever, abdominal pain, diarrhea, as well as extra-intestinal symptoms, such as episclerits, anterior uveitis, cholagintis, arthritis, erythema nodosum, and pyoderma gangrenosum.

Figure 3

Montreal classification of Crohn’s disease. A: It involves age at the diagnostic; B: Inflammation locality; C: Behavior of the disease. For A, ages of ≤ 16 years, 17-40 years and > 40 years are classified to A1, A2 or A3, respectively. Depending on location (B), this disorder can be classified in L1 to terminal ileum, L2 for predominant disease in colon, L3 if ileocolonaccometiment, and L4 for illness in upper gastrointestinal tract. Finally, according to behavior, Crohn’s disease can present as inflammatory, stricturing or penetrating, being classified in B1, B2 or B3, respectivelly. GI: Gastrointestinal tract.