Crohn's

Epidemiology

Crohn's Disease

www.ncbi.nlm.nih.gov

www.ccfa.org

digestive.niddk.nih.gov/ddiseases/pubs/crohns/

Extraintestinal

Greater than

60% occurrence

in twins

Thats all folks

USA149:100,000

uveitis, and episcleritis.

Complications

In addition to systemic and

gastrointestinal

involvement, Crohn's disease can affect

many other organ systems

osteoporosis,seizures, stroke, myopathy, peripheral neuropathy, headache and depression.

rheumatologic disease

known as seronegative

spondyloarthropathy.

One type of skin manifestation,

erythema nodosum, presents

as red nodules usually appearing on the shins

Low in Asia , Africa

Higher rates in jews and

smokers

By Matt Borum

History

Research

Giovanni Battista Morgagni and by Scottish physician T. Kennedy Dalziel in 1913

helminthic therapy or hookworms

leitis terminalis was first described by Polish surgeon Antoni Leśniowski in 1904, however, due to the precedence of Crohn's name in the alphabet, it became later to be known in the worldwide literature as Crohn's disease.[citation needed] Only in Poland it continues to be named Leśniowski-Crohn's disease.

Methotrexate is a folate anti-metabolite drug that is also used for chemotherapy. It is useful in maintenance of remission for those no longer taking corticosteroids

Genetics

Allogeneic Transplant ( bone marrow)

Immunology

Burrill Bernard Crohn, an American gastroenterologist at New York City's Mount Sinai Hospital, described fourteen cases in 1932

Crohn's Disease is associated with a frame shift

mutation in NOD 2 ( recognizes bacteria ) which

stimulates an immune reaction.

"old view" T-Cell auto-immune disorder

"New View" Impaired innate immunity causing

malfunctioning cytokine secretion by macrophages

This has been shown with overactive Th1 cytokine

responses as well Th17 which seems to be more

important in recent studies , Th17 produces IL-17

Its argued if the mutations are gain or loss of function

Over 30 point mutations are associated with

Crohn's disease

2007 new gene tied to Crohn's !

ATG16L1 - induced autophagy

and limit the ability to fight bacteria

Ex: XBP1 - unfolded protein

Response

Causes

Microbes ?

Current thinking is that microorganisms are taking advantage of their host's weakened mucosal layer and inability to clear bacteria from the intestinal walls, which are both symptoms of Crohn's

Symptoms

Environmental factor smoking , Age range of

of diagnosis 15-30 , with outliers at 50 and 70

due to IBS classifications, till crohn's manifested

Diagnosis

Different strains found in tissue and different outcomes to antibiotics therapy and resistance suggest Crohn's Disease is not one disease, but an umbrella of diseases related to different pathogens

Increased intake of animal protein

Hormonal contraception - more women

than men have Crohn's disease

Mycobacterium avium subspecies paratuberculosis (MAP), which causes a similar disease, Johne's disease, in cattle

Stress also can lead to crohns

Diarrhea

Abdominal pain and cramping

Blood in stool

Ulcers

Reduced appetite and weight loss

Fever

Fatigue

Arthritis

Eye inflammation

Mouth sores

Skin disorders

Inflammation of the liver or bile ducts

Delayed growth or sexual development, in children

Fistulas

B12 deficiency

Skin Tags ( resemble hemorrhoids)

Endoscopy

Radiological

Blood Tests

Pill Cam

Crohn's Disease

Because there is some immune system involvement, you also may have symptoms outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.

Pathophysiology

Is an inflammatory bowl disease that can

affect any part of the gastrointestinal tract

from mouth to anus

This disease results in a chronic inflammatory

disorder causing the immune system to attack

the gastrointestinal tract

Location of infection

transmural pattern of inflammation

Ulceration is an outcome seen in highly active disease

a characteristic sign known as skip lesions

Granulomas, are found in 50% of cases and are most specific for Crohn's disease. These show similarities

to those found in tuberculosis

ileocolic - 50% of all cases

ileitis - 30% ileum only

Crohn's colitis - 20% hard to

distinguish between UC ( another IBD)

It's possible to fall outside these categories but

its very rare

chronic mucosal damage, as evidenced

by blunting of the intestinal villi

Intestinal metaplasia - Panth cells

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