Local Guidelines Regarding the Therapeutic and Diagnostic Management of Silent Crohn's Patients

Abstract

Crohn's disease is a chronic and progressive inflammatory disease of the gastrointestinal tract; whose symptoms recur and subside. This disease mainly affects the ileum and terminal colon and usually causes segmental, asymmetric, and transmural inflammation. Its clinical symptoms are variable, including diarrhea, abdominal pain, rectal bleeding, weight loss, and skin lesions. Due to the unknown causes of this disease, it is difficult to diagnose and manage it, especially in cases of silent Crohn's disease that does not have clear symptoms, and this has made the diagnosis of silent Crohn's a serious challenge for specialists. Unfortunately, today there is no specific guideline for the diagnosis and management of silent Crohn's disease, and the purpose of this research is to provide such a guideline. Two separate approaches were adopted: firstly, the evaluation of international articles (researchers' point of view) and the second part, the evaluation of the opinions of Iranian specialists active in the field of diagnosis and treatment of Crohn's patients (experts' point of view). in terms of Therefore, the opinions and discussions raised in international articles regarding diagnostic methods, clinical indicators, alternative methods in diagnosis, treatment methods, methods of monitoring treatment, and follow-up are reviewed, summarized, and compared with the opinions and performance of experts. Internally placed. According to experts' opinions, questions were designed based on scenarios of patients with special conditions. Then, the opinions of the country's most prominent internal medicine and gastroenterology specialists were recorded in person or by phone. Finally, the opinions were summarized and a proposed recommendation was created for the diagnosis of silent Crohn's disease. Mainly for the initial diagnosis of silent Crohn's depending on the condition of the disease, the diagnosis of aphthous lesions similar to Crohn's, in patients with high CRP and other inflammatory indicators or fecal calprotectin, the diagnostic recommendations were based on colonoscopy-based methods. Endoscopy (capsule) and especially ileocolonoscopy, fecal calprotectin assay, but no diagnosis is superior to histopathological findings. For treatment, steroid immunosuppressive drugs, mesalazine, budesonide, azathioprine, and sometimes surgery are useful. In cases where the intensity of the lesions is low, the use of non-steroidal anti-inflammatory drugs and acetylsalicylate recommended. However, there is often no need for therapeutic intervention and the lesions may have resolved spontaneously during follow-up. For the diagnosis of silent Crohn's disease, our proposed guideline can be of great help to physicians, as the most available tools are identified in diagnosis, disease monitoring, treatment, and follow-up. We recommend that the effectiveness of this guideline in the diagnosis and treatment of silent Crohn's disease be investigated by other researchers.

Keywords: Anti-inflammatory drugs; calprotectin; ileocolonoscopy; inflammatory bowel disease; silent Crohn’s disease.