Diagnosing Crohn’s Disease
Crohn's disease is diagnosed using a combination of patient history,
physical examination, endoscopy, radiology, and pathology. Depending on
patient symptoms, the evaluation may include upper endoscopy (EGD), radiographic
studies (CT or MR enterography) colonoscopy, and/or capsule endoscopy
(a small camera is swallowed, which transmits images of the inside of
the intestine to a receiver).
Endoscopy can also be important for surveillance of patients with the disease to
evaluate any development of pre-cancerous or cancerous tumors.
Radiology tests that may be ordered include abdominal X-rays and contrast X-rays.
Contrast X-rays involve drinking a radio-opaque solution while the radiologist
takes images of the intestines using a technique called fluoroscopy. Patients
often may undergo a CT scan of the abdomen and pelvis to look for segments
of involved intestine or the complications of the disease, such as obstruction,
perforation, abscess, or fistula.
When patients have endoscopy or
surgery for diagnosis of Crohn’s disease, tissue is often submitted to the
pathologist for evaluation. Often, the pathologist aids in making the
diagnosis of Crohn's disease.
Undergoing Treatment for Crohn’s Disease
Although there is currently no cure for Crohn’s disease, the goal
of therapy is to induce remission. Treatments ameliorating symptoms, pain,
and chronic complications vary between patients. Based on the location
of the disease, severity of the symptoms, and the presence of complications
such as obstruction, perforation, abscess, or fistula, treatment to slow
the progression of the disease can range greatly. Often, the initial treatment
is non-surgical and is commonly directed by a Gastroenterologist.
Patients suffering with Crohn’s disease can expect the following
methods of non-surgical, medical treatment:
- Antibiotics (such as Cipro and Flagyl)
- Remicade® (infliximab)
- Humira® (adalimumab)
- Cimzia® (certolizumab pegol)
- Entyvio® (vedolizumab)
Indications for surgery include worsening symptoms despite adequate medical
therapy, intolerance of medical therapy, complications of the disease
(obstruction, perforation, abscess, or fistula), and difficulty maintaining
nutrition. Depending on the location of the Crohn's disease, intestinal
resection (removal) may be recommended. This may be performed using laparoscopy
or an open technique. For strictures, stricturoplasty (suturing the intestine
in a manner to increase the diameter of the intestine) may also be used.
In highly selected patients with isolated Crohn's disease of the large
intestine, restorative proctocolectomy (J-pouch procedure) is an option.
For perianal Crohn's disease, drainage of abscesses, placement of
a seton (soft rubber band to facilitate drainage of infected fluid), and
more complex flap or plug procedures may be recommended.
Call Manhattan Surgical Associates to Learn More: (646) 798-4606
We offer cutting-edge therapies and surgical methods to help our patients
achieve remission. Take the first step and regain control over inflammation
or prevent other painful symptoms associated with Crohn’s and other
digestive inflammatory diseases by scheduling a one-on-one consultation
with us today.
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