2. • It is a granulomatous, noncaseating
(transmural) inflammatory condition of the
ileum commonly and of the colon often.
• It is independent of age, sex, socioeconomic
status and geographic areas.
• Rarely other parts of the GIT like colon,
jejunum, stomach, duodenum, oesophagus
can get involved.
• Terminal ileum is most commonlyinvolved
(60%). In 75% cases perianal is involved
(fissure in ano).
3. Aetiology
• Unknown, but a familial and infective nature is thought
of.
• Increased auto-antibodies.
• Diet and food allergy.
• It is slightly more common in females.
• DNA of Mycobacterium para-tuberculosis was found in
intestines of 60% of patient’s with Crohn‘s disease but
anti-tuberculous drug therapy has not helped them.
• Focal ischaemia as a vasculitis may be the cause.
• Smoking is related to Crohn‘s disease as aetiology, as
for relapse and for exacerbations.
4. Causes for Crohn’s
• ™
Infectious—Mycobacterium paratuberculosis
and atypical mycobacteria. It causes Johne’s
disease in cattle
• ™
Immunologic
• ™
Environmental
• ™
Jews are more prone
• ™
Smoking, diet, OCPs (controversial),
psychosocial factors
6. Main features of Crohn’s disease
• Ileum—most common site of occurrence—
60%
• ™
Rectal sparing is usual and common
• ™
Skip lesion
• ™
Hose-pipe pattern
• ™
Linear ulcers and cobblestone appearance of
mucosa
• ™
Transmural
7. Clinical Features
• It is common in young age group.
• Abdominal pain and diarrhoea is the initial slow
insidious presentation.
• There is also asymptomatic period in between.
• Diarrhoea is usually less severe without blood,
pus or mucous.
• Mild fever, weight loss, lethargy.
• Crohn’s disease may present as tender, firm,
resonant mass in right iliac fossa.
• Obstruction, fistula formation, often perforation.
• Bleeding which is usually chronic but occasionally
massive can occur.
8. Clinical Features
• Perianal disease with fissure, fistula, and
abscess can occur in 25% of patients with
small bowel Crohn’s.
• It can be the only presentation of Crohn’s in
5% of cases.
• 50% of colonic Crohn’s will have perianal
disease.
• Extraintestinal manifestations occur in 30% of
Crohn’s disease.
10. Acute presentations
• It mimics acute appendicitis with severe
diarrhoea.
• Often there will be localised or diffuse
peritonitis.
11. Chronic Crohn’s
First stage
• Mild diarrhoea, colicky pain, fever, anaemia, mass
in right iliac fossa which is tender, firm,
nonmobile along with recurrent perianal abscess.
Second stage
• is either acute or chronic intestinal obstruction
due to cicatrisation with narrowing.
Third stage
• Fistula formation—enterocolic, enteroenteric
enterovesical, enterocutaneous, etc.
12. Investigations
• Plain X-ray abdomen, ultrasound abdomen.
• Barium meal follow through or small bowel
enema.
• CT scan and CT fistulogram is useful method.
• Colonoscopy
• Blood tests for anaemia, protein loss, mineral and
trace element loss like magnesium, zinc, and
selenium.
• Therewill be raised C reactive protein.
13. Complications of Crohn’s
• Intestinal obstruction
• ™
Stricture
• ™
Bleeding
• ™
Fistula formation
• ™
Carcinoma small and large bowel
• ™
Perianal abscess
• ™
Peritonitis
• ™
Pericolic abscess
14. Differential Diagnosis
• Radiation enteritis and Yersinia enteritis.
• Ulcerative colitis, acute appendicitis.
• Intestinal tuberculosis, Salmonella, Shigella,
CMV
• Carcinoma ileum or caecum.
• Differential diagnosis for mass in the right iliac
fossa (carcinoma caecum, actinomycosis,
appendicular mass, ileocaecal TB, ectopic
kidney, mesenteric lymphadenitis).
15. Treatment
• Medical
• Cessation of smoking
• Bed rest, protein and vitamin supplementations.
• Often nasogastric tube nutrition or TPN is
required.
• Steroids are mainly used to induce remission of
the disease in initial phase.
• It is less useful for maintenance.
• Dose is 20–40 mg/
• Antibiotics (Ciprofloxacin) are useful in controlling
sepsis in fistula, colitis.
17. • Mercurius Corrosivus:
• It is the top natural Homeopathic medicine to
treat patients suffering from Crohn’s disease.
This is the best remedy for patients in whom
blood and shreds of mucus membranes are
passed along with the stool. Constant urge to
pass stool but only scanty, hot stool of
offensive odour is passed. After passing the
stool, the urge reappears and the patient gets
no satisfaction.
18. • Colchicum Autumnale:
Patient complains of excessive jelly-like mucus
in stool. The patients experience nausea of
the extreme degree and even faint from the
odour of cooking food, mainly eggs and meat.
19. • Arsenicum Album:
It is a natural Homeopathic medicine of great
help for the treatment of Ulcerative Colitis.
The main symptom guiding its use is stool with
an offensive odour and dark-coloured blood in
it. The complaints get worse at night and the
patient feelsa lot of weakness.
20. • Podophyllum:
This is very beneficial remedy for Crohn’s
Disease with diarrhoea and when the stool is
watery, greenish and very offensive. The
diarrhoea mainly gets worse in the morning
but in the evening, the stool is normal. The
patient can also complain of prolapse of
rectum before or during stool.
21. • Nitric acid
Great straining, but little passes, Rectum feels
torn. Bowels constipated, with fissures in
rectum.Violent cutting pains after stools, lasting
for hours . Hæmorrhages from bowels, profuse,
bright. Prolapsus ani. Hæmorrhoids bleed easily.
Diarrhœa, slimy and offensive. After stools,
irritable and exhausted. Colic relieved from
tightening clothes. Jaundice, aching in liver.
22. • Phosphorus:
cutting pains. A very weak, empty, gone sensation
felt in whole abdominal Large, yellow spots on
abdomen.Very fetid stools and flatus. Long,
narrow, hard, like a dog’s. Difficult to expel.
Desire for stool on lying on, left side. Painless,
copious debilitating diarrhœa. Green mucus with
grains like sago. Involuntary; seems as if anus
remained open. Great weakness after stool.
Discharge of blood from rectum, during stool.
