Crohn’s disease is characterized by inflammation extending in all layers of the intestinal wall.
Clinical features:
The main clinical features of CD are fever, abdominal pain, diarrhea and fatigue.
Associated weight loss is often seen.
When colon is involved diarrhea and pain in the abdomen are the most common features.
Rectal bleeding is distinctly less.
Apthous ulcers are the most common oral symptom.
Diagnosis:
Sigmoidoscopy and radiologic studies of the bowel are most important in establishing the diagnosis
Air contrast barium enema examination of the prepared colon may disclose earliest mucosal changes in CD
Endoscopic examination of the colon is valuable in the diagnosis of CD.
Colonoscopic examination is indicated when CD appears only to involve the small bowel.
Rectal biopsy samples help in 5 to 15% of cases.
Systemic manifestations:
Weight loss
Anemia
Folate or Vitamin B12 deficiency
Arthritis and Arthralgia
Aphthous stomatitis
CD of buccal mucosa, gingiva, vagina
Management:
Sulfasalazine is effective in the therapy of active colonic disease.
Glucocorticoids must be used with caution and constant attention. It is difficult to achieve a clinical remission and to withdraw steroids completely.
Metronidazole shows marked improvement in patients with perineal fistulas with CD
Drugs like mercaptopurine or azathioprine decreases disease activity, causes fistulas to close, exerts a steroid sparing effect, decreases relapse rate if used as maintenance therapy.
Diet in CD:
Eat small and frequent meals.
Steamed or baked vegetables rather than raw vegetables.
High protein diets like fish, soy are good.
Fruits like apples, grape fruit, oranges, plums, blue berries, raspberries, strawberries are good.
Potatoes, avocados, brown rice and bananas are helpful.
Low fat pizza, low fat hamburger, turkey sandwiches are allowed
Milkshakes can be taken but if lactose intolerant avoid dairy products.
What food to avoid:
Avoid oily, spicy, refined foods such as white breads and pastas.
Avoid high fibre diet in flare up condition.
Avoid these during flare up and eat very little: nuts, corn, seeds, raw fruits and vegetables, sauces ,high sugar fruits like grapes, pineapple and watermelon
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