Crohn disease - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Crohn disease (CD) is a disorder of unknown etiology characterized by transmural inflammation of the gastrointestinal tract.
Common presenting symptoms include chronic diarrhea, weight loss, and right lower quadrant abdominal pain mimicking acute appendicitis.
Diagnosis confirmed by colonoscopy with ileoscopy and tissue biopsy.
Specialist input is required from the time of diagnosis, as treatment regimens require frequent monitoring of clinical response, knowledge of common adverse events, and expertise in managing potentially serious adverse events.
The overall treatment goals are to induce and maintain remission, and to prevent relapse or recurrence.

Significant inflammation in the colonic wall, widening of submucosa, and dense lymphoid aggregates in the submucosa

Provided by Drs Wissam Bleibel, Bishal Mainali, Chandrashekhar Thukral, and Mark A. Peppercorn, the previous authors of this topic

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History & Exam
- Key Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Endoscopic view of Crohn ileitis
Endoscopic view of normal terminal ileum
A patient's arms and hands show the presence of erythema nodosum
CT scan demonstrating thickening of the terminal ileum in a patient with Crohn disease exacerbation
CT scan demonstrating thickening of the terminal ileum in a patient with Crohn disease exacerbation
Significant inflammation in the colonic wall, widening of submucosa, and dense lymphoid aggregates in the submucosa
Granulomas in a patient with Crohn disease; note the aggregate of epithelioid histiocytes
Cryptitis and crypt abscess with morphologic distortion of the crypts accompanied by inflammation and abundant lymphatic and plasma cells
Cryptitis and crypt abscess with morphologic distortion of the crypts accompanied by inflammation and abundant lymphatic and plasma cells

Citations

Key Articles

Ooi CJ, Makharia GK, Hilmi I, et al. Asia Pacific consensus statements on Crohn's disease. Part 1: definition, diagnosis, and epidemiology. J Gastroenterol Hepatol. 2016 Jan;31(1):45-55.[Abstract][Full Text]
Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr;113(4):481-517.[Abstract][Full Text]
Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis. 2017 Jan;11(1):3-25.[Abstract][Full Text]
Torres J, Bonovas S, Doherty G, et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohns Colitis. 2020 Jan 1;14(1):4-22.[Abstract][Full Text]
Adamina M, Bonovas S, Raine T, et al. ECCO guidelines on therapeutics in Crohn's disease: surgical treatment. J Crohns Colitis. 2020 Feb 10;14(2):155-68.[Abstract][Full Text]
Feuerstein JD, Ho EY, Shmidt E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021 Jun;160(7):2496-508.[Abstract][Full Text]
Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 2: surgical management and special situations. J Crohns Colitis. 2017 Feb;11(2):135-49.[Abstract][Full Text]
Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017 Feb;112(2):241-58.[Abstract][Full Text]

Referenced Articles

1. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002 Aug 8;347(6):417-29.[Abstract]
2. Ekbom A, Helmick C, Zack M, et al. The epidemiology of inflammatory bowel disease: a large, population-based study in Sweden. Gastroenterology. 1991 Feb;100(2):350-8.[Abstract]
3. Gasche C, Scholmerich J, Brynskov J, et al. A simple classification of Crohn's disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis. 2000 Feb;6(1):8-15.[Abstract]
4. Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006 Jun;55(6):749-53.[Abstract][Full Text]
5. Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007 May 12;369(9573):1641-57.[Abstract]
6. Barreiro-de Acosta M, Domínguez-Muñoz JE, Nuñez-Pardo de Vera MC, et al. Relationship between clinical features of Crohn's disease and the risk of developing extraintestinal manifestations. Eur J Gastroenterol Hepatol. 2007 Jan;19(1):73-8.[Abstract]
7. Irving PM, Pasi KJ, Rampton DS. Thrombosis and inflammatory bowel disease. Clin Gastroenterol Hepatol. 2005 Jul;3(7):617-28.[Abstract]
8. Fraquelli M, Losco A, Visentin S, et al. Gallstone disease and related risk factors in patients with Crohn disease: analysis of 330 consecutive cases. Arch Intern Med. 2001 Oct 8;161(18):2201-4.[Abstract][Full Text]
9. Centers for Disease Control and Prevention. Inflammatory bowel disease (IBD). Apr 2022 [internet publication].[Full Text]
10. Feuerstein JD, Cheifetz AS. Crohn disease: epidemiology, diagnosis, and management. Mayo Clin Proc. 2017 Jul;92(7):1088-103.[Abstract][Full Text]
11. Torres J, Mehandru S, Colombel JF, et al. Crohn's disease. Lancet. 2017 Apr 29;389(10080):1741-55.[Abstract]
12. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012 Jan;142(1):46-54;e42;quiz e30.[Abstract][Full Text]
13. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018 Dec 23;390(10114):2769-78.[Abstract]
14. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology. 2013 Jul;145(1):158-65;e2.[Abstract][Full Text]
15. Selvaratnam S, Gullino S, Shim L, et al. Epidemiology of inflammatory bowel disease in South America: a systematic review. World J Gastroenterol. 2019 Dec 21;25(47):6866-75.[Abstract][Full Text]
16. Aniwan S, Harmsen WS, Tremaine WJ, et al. Incidence of inflammatory bowel disease by race and ethnicity in a population-based inception cohort from 1970 through 2010. Therap Adv Gastroenterol. 2019 Feb 6;12:1756284819827692.[Abstract][Full Text]
17. Betteridge JD, Armbruster SP, Maydonovitch C, et al. Inflammatory bowel disease prevalence by age, gender, race, and geographic location in the US military health care population. Inflamm Bowel Dis. 2013 Jun;19(7):1421-7.[Abstract]
18. Peeters M, Nevens H, Baert F, et al. Familial aggregation in Crohn's disease: increased age-adjusted risk and concordance in clinical characteristics. Gastroenterology. 1996 Sep;111(3):597-603.[Abstract]
19. Joossens M, Simoens M, Vermeire S, et al. Contribution of genetic and environmental factors in the pathogenesis of Crohn's disease in a large family with multiple cases. Inflamm Bowel Dis. 2007 May;13(5):580-4.[Abstract]
20. Cosnes J, Beaugerie L, Carbonnel F, et al. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology. 2001 Apr;120(5):1093-9.[Abstract]
21. Silverstein MD, Lashner BA, Hanauer SB, et al. Cigarette smoking in Crohn's disease. Am J Gastroenterol. 1989 Jan;84(1):31-3.[Abstract]
22. Franke A, McGovern D, Barrett JC, et al. Genome-wide meta-analysis increases to 71 the number of confirmed Crohn's disease susceptibility loci. Nat Genet. 2010 Dec;42(12):1118-25.[Abstract]
23. Barrett JC, Hansoul S, Nicolae DL, et al. Genome-wide association defines more than 30 distinct susceptibility loci for Crohn's disease. Nat Genet. 2008 Aug;40(8):955-62.[Abstract][Full Text]
24. Xu WD, Xie QB, Zhao Y, et al. Association of interleukin-23 receptor gene polymorphisms with susceptibility to Crohn's disease: a meta-analysis. Sci Rep. 2015 Dec 18;5:18584.[Abstract][Full Text]
25. Dai YE, Guan R, Song YT. The association of DLG5 polymorphisms with inflammatory bowel disease: a meta-analysis of 25 studies. Eur Rev Med Pharmacol Sci. 2016 Jun;20(11):2324-37.[Abstract][Full Text]
26. Uhlig HH. Monogenic diseases associated with intestinal inflammation: implications for the understanding of inflammatory bowel disease. Gut. 2013 Dec;62(12):1795-805.[Abstract]
27. Huang C, Haritunians T, Okou DT, et al. Characterization of genetic loci that affect susceptibility to inflammatory bowel diseases in African Americans. Gastroenterology. 2015 Nov;149(6):1575-86.[Abstract][Full Text]
28. Ng SC, Bernstein CN, Vatn MH, et al. Geographical variability and environmental risk factors in inflammatory bowel disease. Gut. 2013 Apr;62(4):630-49.[Abstract]
29. Underner M, Perriot J, Cosnes J, et al. Smoking, smoking cessation and Crohn's disease [in French]. Presse Med. 2016 Apr;45(4 Pt 1):390-402.[Abstract]
30. Ortizo R, Lee SY, Nguyen ET, et al. Exposure to oral contraceptives increases the risk for development of inflammatory bowel disease: a meta-analysis of case-controlled and cohort studies. Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1064-70.[Abstract]
31. Chen Y, Wang Y, Shen J. Role of environmental factors in the pathogenesis of Crohn's disease: a critical review. Int J Colorectal Dis. 2019 Dec;34(12):2023-34.[Abstract]
32. Piovani D, Danese S, Peyrin-Biroulet L, et al. Environmental risk factors for inflammatory bowel diseases: an umbrella review of meta-analyses. Gastroenterology. 2019 Sep;157(3):647-59.e4.[Abstract][Full Text]
33. Narula N, Wong ECL, Dehghan M, et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ. 2021 Jul 14;374:n1554.[Abstract][Full Text]
34. Lo CH, Khandpur N, Rossato SL, et al. Ultra-processed foods and risk of Crohn's disease and ulcerative colitis: a prospective cohort study. Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1323-37.[Abstract][Full Text]
35. Castaño-Rodríguez N, Kaakoush NO, Lee WS, et al. Dual role of Helicobacter and Campylobacter species in IBD: a systematic review and meta-analysis. Gut. 2017 Feb;66(2):235-49.[Abstract]
36. Axelrad JE, Cadwell KH, Colombel JF, et al. Systematic review: gastrointestinal infection and incident inflammatory bowel disease. Aliment Pharmacol Ther. 2020 Jun;51(12):1222-32.[Abstract][Full Text]
37. Feller M, Huwiler K, Stephan R, et al. Mycobacterium avium subspecies paratuberculosis and Crohn's disease: a systematic review and meta-analysis. Lancet Infect Dis. 2007 Sep;7(9):607-13.[Abstract]
38. Agrawal G, Aitken J, Hamblin H, et al. Putting Crohn's on the MAP: five common questions on the contribution of Mycobacterium avium subspecies paratuberculosis to the pathophysiology of Crohn's disease. Dig Dis Sci. 2021 Feb;66(2):348-58.[Abstract][Full Text]
39. Lerebours E, Gower-Rousseau C, Merle V, et al. Stressful life events as a risk factor for inflammatory bowel disease onset: a population-based case-control study. Am J Gastroenterol. 2007 Jan;102(1):122-31.[Abstract]
40. Halfvarson J, Jess T, Magnuson A, et al. Environmental factors in inflammatory bowel disease: a co-twin control study of a Swedish-Danish twin population. Inflamm Bowel Dis. 2006 Oct;12(10):925-33.[Abstract]
41. Danese S, Fiocchi C. Etiopathogenesis of inflammatory bowel diseases. World J Gastroenterol. 2006 Aug 14;12(30):4807-12.[Abstract]
42. Sartor RB. Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol. 2006 Jul;3(7):390-407.[Abstract]
43. Heresbach D, Alexandre JL, Branger B, et al. Frequency and significance of granulomas in a cohort of incident cases of Crohn's disease. Gut. 2005 Feb;54(2):215-22.[Abstract][Full Text]
44. Pierik M, De Hertogh G, Vermeire S, et al. Epithelioid granulomas, pattern recognition receptors, and phenotypes of Crohn's disease. Gut. 2005 Feb;54(2):223-7.[Abstract][Full Text]
45. Fabisiak N, Fabisiak A, Watala C, et al. Fat-soluble vitamin deficiencies and inflammatory bowel disease: systematic review and meta-analysis. J Clin Gastroenterol. 2017 Nov/Dec;51(10):878-89.[Abstract]
46. Lapidus A, Akerlund JE, Einarsson C. Gallbladder bile composition in patients with Crohn's disease. World J Gastroenterol. 2006 Jan 7;12(1):70-4.[Abstract]
47. Lapidus A, Einarsson C. Bile composition in patients with ileal resection due to Crohn's disease. Inflamm Bowel Dis. 1998 May;4(2):89-94.[Abstract]
48. Obialo CI, Clayman RV, Matts JP, et al. Pathogenesis of nephrolithiasis post-partial ileal bypass surgery: case-control study. The POSCH Group. Kidney Int. 1991 Jun;39(6):1249-54.[Abstract]
49. Boyko EJ, Koepsell TD, Perera DR, et al. Risk of ulcerative colitis among former and current cigarette smokers. N Engl J Med. 1987 Mar 19;316(12):707-10.[Abstract]
50. Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci. 1989 Dec;34(12):1841-54.[Abstract]
51. Koletzko S, Sherman P, Corey M, et al. Role of infant feeding practices in development of Crohn's disease in childhood. BMJ. 1989 Jun 17;298(6688):1617-8.[Abstract][Full Text]
52. Bonner GF, Fakhri A, Vennamaneni SR. A long-term cohort study of nonsteroidal anti-inflammatory drug use and disease activity in outpatients with inflammatory bowel disease. Inflamm Bowel Dis. 2004 Nov;10(6):751-7.[Abstract]
53. Felder JB, Korelitz BI, Rajapakse R, et al. Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2000 Aug;95(8):1949-54.[Abstract]
54. Ananthakrishnan AN, Adler J, Chachu KA, et al. AGA clinical practice guideline on the role of biomarkers for the management of crohn's disease. Gastroenterology. 2023 Dec;165(6):1367-99.[Abstract][Full Text]
55. Kedia S, Das P, Madhusudhan KS, et al. Differentiating Crohn's disease from intestinal tuberculosis. World J Gastroenterol. 2019 Jan 28;25(4):418-32.[Abstract][Full Text]
56. Gurzu S, Molnar C, Contac AO, et al. Tuberculosis terminal ileitis: a forgotten entity mimicking Crohn's disease. World J Clin Cases. 2016 Sep 16;4(9):273-80.[Abstract][Full Text]
57. Ooi CJ, Makharia GK, Hilmi I, et al. Asia Pacific consensus statements on Crohn's disease. Part 1: definition, diagnosis, and epidemiology. J Gastroenterol Hepatol. 2016 Jan;31(1):45-55.[Abstract][Full Text]
58. Limsrivilai J, Shreiner AB, Pongpaibul A, et al. Meta-analytic Bayesian model for differentiating intestinal tuberculosis from Crohn's disease. Am J Gastroenterol. 2017 Mar;112(3):415-27.[Abstract][Full Text]
59. Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(suppl 3):s1-106.[Abstract][Full Text]
60. Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr;113(4):481-517.[Abstract][Full Text]
61. Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015 Mar;9(3):211-22.[Abstract][Full Text]
62. Balram B, Battat R, Al-Khoury A, et al. Risk factors associated with Clostridium difficile infection in inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2019 Jan 1;13(1):27-38.[Abstract][Full Text]
63. Matsumoto T, Iida M, Matsui T, et al. Endoscopic findings in Yersinia enterocolitica enterocolitis. Gastrointest Endosc. 1990 Nov-Dec;36(6):583-7.[Abstract]
64. American College of Radiology. ACR appropriateness criteria: Crohn disease. 2019 [internet publication].[Full Text]
65. Bruining DH, Zimmermann EM, Loftus EV Jr, et al; Society of Abdominal Radiology Crohn's Disease-Focused Panel. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn's disease. Radiology. 2018 Mar;286(3):776-99.[Abstract][Full Text]
66. Yung DE, Har-Noy O, Tham YS, et al. Capsule endoscopy, magnetic resonance enterography, and small bowel ultrasound for evaluation of postoperative recurrence in Crohn's disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2017 Dec 19;24(1):93-100.[Abstract][Full Text]
67. Bots S, De Voogd F, De Jong M, et al. Point-of-care intestinal ultrasound in IBD patients: disease management and diagnostic yield in a real-world cohort and proposal of a point-of-care algorithm. J Crohns Colitis. 2022 May 10;16(4):606-15.[Abstract][Full Text]
68. Feakins RM; British Society of Gastroenterology. Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines. J Clin Pathol. 2013 Dec;66(12):1005-26.[Abstract][Full Text]
69. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010 Jul 15;341:c3369.[Abstract][Full Text]
70. Kopylov U, Yung DE, Engel T, et al. Fecal calprotectin for the prediction of small-bowel Crohn's disease by capsule endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016 Oct;28(10):1137-44.[Abstract]
71. Kalla R, Ventham NT, Satsangi J, et al. Crohn's disease. BMJ. 2014 Nov 19;349:g6670.
72. Deputy M, Devanaboina R, Al Bakir I, et al. The role of faecal calprotectin in the diagnosis of inflammatory bowel disease. BMJ. 2023 Feb 13;380:e068947.
73. Mao R, Xiao YL, Gao x, et al. Fecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis. 2012 Oct;18(10):1894-9.[Abstract]
74. Mosli MH, Zou G, Garg SK, et al. C-reactive protein, fecal calprotectin, and stool lactoferrin for detection of endoscopic activity in symptomatic inflammatory bowel disease patients: a systematic review and meta-analysis. Am J Gastroenterol. 2015 Jun;110(6):802-19.[Abstract]
75. Rokkas T, Portincasa P, Koutroubakis IE. Fecal calprotectin in assessing inflammatory bowel disease endoscopic activity: a diagnostic accuracy meta-analysis. J Gastrointestin Liver Dis. 2018 Sep;27(3):299-306.[Abstract][Full Text]
76. Yamamoto T, Shimoyama T. Monitoring and detection of disease recurrence after resection for Crohn's disease: the role of non-invasive fecal biomarkers. Expert Rev Gastroenterol Hepatol. 2017 Oct;11(10):899-909.[Abstract]
77. Lakatos PL, Lakatos L, Kiss LS, et al. Treatment of extraintestinal manifestations in inflammatory bowel disease. Digestion. 2012;86(suppl 1):28-35.[Abstract]
78. Chamouard P, Richert Z, Meyer N, et al. Diagnostic value of C-reactive protein for predicting activity level of Crohn's disease. Clin Gastroenterol Hepatol. 2006 Jul;4(7):882-7.[Abstract]
79. Le Berre C, Trang-Poisson C, Bourreille A. Small bowel capsule endoscopy and treat-to-target in Crohn's disease: a systematic review. World J Gastroenterol. 2019 Aug 21;25(31):4534-54.[Abstract][Full Text]
80. Varela Lema L, Ruano-Ravina A. Effectiveness and safety of capsule endoscopy in the diagnosis of small bowel diseases. J Clin Gastroenterol. 2008 May-Jun;42(5):466-71.[Abstract]
81. Chandrakumar A, Georgy M, Agarwal P, et al. Anti-Saccharomyces cerevisiae antibodies as a prognostic biomarker in children with Crohn disease. J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):82-7.[Abstract][Full Text]
82. Kim MJ, Kim E, Kang B, et al. Anti-Saccharomyces cerevisiae antibody in pediatric Crohn's disease patients without mucosal healing is a useful marker of mucosal damage. Gut Liver. 2021 Sep 15;15(5):763-70.[Abstract][Full Text]
83. Sturm A, Maaser C, Calabrese E, et al; European Crohn's and Colitis Organisation (ECCO) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). ECCO-ESGAR guideline for diagnostic assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis. 2019 Mar 26;13(3):273-84.[Abstract][Full Text]
84. Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989 Jul;30(7):983-9.[Abstract]
85. Daperno M, D'Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004 Oct;60(4):505-12.[Abstract]
86. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976 Mar;70(3):439-44.[Abstract]
87. Harvey RF, Bradshaw JM. A simple index of Crohn's-disease activity. Lancet. 1980 Mar 8;1(8167):514.[Abstract]
88. Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis. 2017 Jan;11(1):3-25.[Abstract][Full Text]
89. ASGE Standards of Practice Committee., Storm AC, Fishman DS, et al. American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures. Gastrointest Endosc. 2022 Feb;95(2):207-15;e2.[Abstract][Full Text]
90. ASGE Standards od Practice Committee, Coelho-Prabhu N, Forbes N, et al. Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc. 2022 Sep;96(3):389-401.[Abstract][Full Text]
91. American College of Radiology. ACR appropriateness criteria: Crohn disease - child. 2021 [internet publication].[Full Text]
92. Shergill AK, Lightdale JR, Bruining DH, et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc. 2015 May;81(5):1101-21;e13.[Abstract][Full Text]
93. Maaser C, Sturm A, Vavricka SR, et al; European Crohn's and Colitis Organisation (ECCO) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). ECCO-ESGAR guideline for diagnostic assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019 Feb 1;13(2):144-64.[Abstract][Full Text]
94. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015 Apr;47(4):352-76.[Abstract][Full Text]
95. National Institute for Health and Care Excellence (UK). Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. Oct 2013 [internet publication].[Full Text]
96. Torres J, Bonovas S, Doherty G, et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohns Colitis. 2020 Jan 1;14(1):4-22.[Abstract][Full Text]
97. Adamina M, Bonovas S, Raine T, et al. ECCO guidelines on therapeutics in Crohn's disease: surgical treatment. J Crohns Colitis. 2020 Feb 10;14(2):155-68.[Abstract][Full Text]
98. Sandborn WJ, Feagan BG, Hanauer SB, et al. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn's disease. Gastroenterology. 2002 Feb;122(2):512-30.[Abstract]
99. European Medicines Agency. Guideline on the development of new medicinal products for the treatment of Crohn's disease. Jun 2018 [internet publication].[Full Text]
100. Schulberg JD, Wright EK, Holt BA, et al. Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn's disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2022 Apr;7(4):318-31.[Abstract]
101. Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn's disease. Relationship between the clinical pattern and prognosis. Gastroenterology. 1985 Jun;88(6):1818-25.[Abstract]
102. Bermejo F, Aguas M, Chaparro M, et al; en representación de GETECCU. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of thiopurines in inflammatory bowel disease. Gastroenterol Hepatol. 2018 Mar;41(3):205-21.[Abstract][Full Text]
103. Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001 Oct 11;345(15):1098-104.[Abstract][Full Text]
104. McConachie SM, Wilhelm SM, Bhargava A, et al. Biologic-induced infections in inflammatory bowel disease: the TNF-a antagonists. Ann Pharmacother. 2018 Jun;52(6):571-9.[Abstract]
105. Shivaji UN, Sharratt CL, Thomas T, et al. Review article: managing the adverse events caused by anti-TNF therapy in inflammatory bowel disease. Aliment Pharmacol Ther. 2019 Mar;49(6):664-80.[Abstract]
106. Esteve M, Saro C, González-Huix F, et al. Chronic hepatitis B reactivation following infliximab therapy in Crohn's disease patients: need for primary prophylaxis. Gut. 2004 Sep;53(9):1363-5.[Abstract][Full Text]
107. Huang M, Huang L. Reactivation of hepatitis C viral infection after treatment with infliximab. J Clin Gastroenterol. 2014 Feb;48(2):189-90.[Abstract]
108. Lemaitre M, Kirchgesner J, Rudnichi A et al. Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease. JAMA. 2017 Nov 7;318(17):1679-86.[Abstract][Full Text]
109. Shah ED, Coburn ES, Nayyar A, et al. Systematic review: hepatosplenic T-cell lymphoma on biologic therapy for inflammatory bowel disease, including data from the Food and Drug Administration Adverse Event Reporting System. Aliment Pharmacol Ther. 2020 Mar;51(5):527-33.[Abstract][Full Text]
110. MacDonald JK, Nguyen TM, Khanna R, et al. Anti-IL-12/23p40 antibodies for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2016 Nov 25;(11):CD007572.[Abstract][Full Text]
111. Engel T, Ungar B, Yung DE, et al. Vedolizumab in IBD - lessons from real-world experience; a systematic review and pooled analysis. J Crohns Colitis. 2018 Jan 24;12(2):245-57.[Abstract][Full Text]
112. Ebada MA, Elmatboly AM, Ali AS, et al. An updated systematic review and meta-analysis about the safety and efficacy of infliximab biosimilar, CT-P13, for patients with inflammatory bowel disease. Int J Colorectal Dis. 2019 Oct;34(10):1633-52.[Abstract]
113. Martelli L, Peyrin-Biroulet L. Efficacy, safety and immunogenicity of biosimilars in inflammatory bowel diseases: a systematic review. Curr Med Chem. 2019;26(2):270-9.[Abstract]
114. Hanauer S, Liedert B, Balser S, et al. Safety and efficacy of BI 695501 versus adalimumab reference product in patients with advanced Crohn's disease (VOLTAIRE-CD): a multicentre, randomised, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol. 2021 Oct;6(10):816-25.[Abstract]
115. Xu Y, Yang L, An P, et al. Meta-analysis: the influence of preoperative infliximab use on postoperative complications of Crohn's disease. Inflamm Bowel Dis. 2019 Jan 10;25(2):261-9.[Abstract][Full Text]
116. Yung DE, Horesh N, Lightner AL, et al. Systematic review and meta-analysis: vedolizumab and postoperative complications in inflammatory bowel disease. Inflamm Bowel Dis. 2018 Oct 12;24(11):2327-38.[Abstract][Full Text]
117. Qiu Y, Zheng Z, Liu G, et al. Effects of preoperative anti-tumour necrosis factor alpha infusion timing on postoperative surgical site infection in inflammatory bowel disease: a systematic review and meta-analysis. United European Gastroenterol J. 2019 Nov;7(9):1198-214.[Abstract][Full Text]
118. Kuenzig ME, Rezaie A, Seow CH, et al. Budesonide for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2014 Aug 21;(8):CD002913.[Abstract][Full Text]
119. Bonovas S, Nikolopoulos GK, Lytras T, et al. Comparative safety of systemic and low-bioavailability steroids in inflammatory bowel disease: systematic review and network meta-analysis. Br J Clin Pharmacol. 2018 Feb;84(2):239-51.[Abstract]
120. Rezaie A, Kuenzig ME, Benchimol EI, et al. Budesonide for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2015 Jun 3;(6):CD000296.[Abstract][Full Text]
121. Narula N, Dhillon A, Zhang D, et al. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2018 Apr 1;(4):CD000542.[Abstract][Full Text]
122. Sandborn WJ, Feagan BG, Lichtenstein GR. Medical management of mild to moderate Crohn's disease: evidence-based treatment algorithms for induction and maintenance of remission. Aliment Pharmacol Ther. 2007 Oct 1;26(7):987-1003.[Abstract][Full Text]
123. Kane SV, Schoenfeld P, Sandborn WJ, et al. The effectiveness of budesonide therapy for Crohn's disease. Aliment Pharmacol Ther. 2002 Aug;16(8):1509-17.[Abstract]
124. Feuerstein JD, Ho EY, Shmidt E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021 Jun;160(7):2496-508.[Abstract][Full Text]
125. Summers RW, Switz DM, Sessions JT Jr, et al. National Cooperative Crohn's Disease Study: results of drug treatment. Gastroenterology. 1979 Oct;77(4 Pt 2):847-69.[Abstract]
126. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology. 1984 Feb;86(2):249-66.[Abstract]
127. Brassard P, Bitton A, Suissa A, et al. Oral corticosteroids and the risk of serious infections in patients with elderly-onset inflammatory bowel diseases. Am J Gastroenterol. 2014 Nov;109(11):1795-802.[Abstract]
128. McDonald JW, Wang Y, Tsoulis DJ, et al. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev. 2014 Aug 6;(8):CD003459.[Abstract][Full Text]
129. Chande N, Townsend CM, Parker CE, et al. Azathioprine or 6-mercaptopurine for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2016 Oct 26;(10):CD000545.[Abstract][Full Text]
130. Bebb JR, Scott BB. How effective are the usual treatments for Crohn's disease? Aliment Pharmacol Ther. 2004 Jul 15;20(2):151-9.[Abstract]
131. Sandborn WJ, Faubion WA. Clinical pharmacology of inflammatory bowel disease therapies. Curr Gastroenterol Rep. 2000 Dec;2(6):440-5.[Abstract]
132. Steinhart AH, Ewe K, Griffiths AM, et al. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2003;(4):CD000301.[Abstract][Full Text]
133. Peyrin-Biroulet L, Deltenre P, de Suray N, et al. Efficacy and safety of tumor necrosis factor antagonists in Crohn's disease: meta-analysis of placebo-controlled trials. Clin Gastroenterol Hepatol. 2008 Jun;6(6):644-53.[Abstract]
134. Cholapranee A, Hazlewood GS, Kaplan GG, et al. Systematic review with meta-analysis: comparative efficacy of biologics for induction and maintenance of mucosal healing in Crohn's disease and ulcerative colitis controlled trials. Aliment Pharmacol Ther. 2017 May;45(10):1291-302.[Abstract][Full Text]
135. Abbass M, Cepek J, Parker CE, et al. Adalimumab for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Nov 14;(11):CD012878.[Abstract][Full Text]
136. Hazlewood GS, Rezaie A, Borman M, et al. Comparative effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn's disease: a network meta-analysis. Gastroenterology. 2015 Feb;148(2):344-54;e5.[Abstract]
137. Singh S, Murad MH, Fumery M, et al. Comparative efficacy and safety of biologic therapies for moderate-to-severe Crohn's disease: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol. 2021 Dec;6(12):1002-14.[Abstract]
138. Yamazaki H, So R, Matsuoka K, et al. Certolizumab pegol for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Aug 29;(8):CD012893.[Abstract][Full Text]
139. Ford AC, Peyrin-Biroulet L. Opportunistic infections with anti-tumor necrosis factor-alpha therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol. 2013 Aug;108(8):1268-76.[Abstract]
140. Nanda KS, Cheifetz AS, Moss AC. Impact of antibodies to infliximab on clinical outcomes and serum infliximab levels in patients with inflammatory bowel disease (IBD): a meta-analysis. Am J Gastroenterol. 2013 Jan;108(1):40-7.[Abstract][Full Text]
141. Nielsen OH, Bjerrum JT, Seidelin JB, et al. Biological treatment of Crohn's disease. Dig Dis. 2012;30(suppl 3):121-33.[Abstract]
142. Regueiro MD. Update in medical treatment of Crohn's disease. J Clin Gastroenterol. 2000 Dec;31(4):282-91.[Abstract]
143. Colombel JF, Rutgeerts P, Reinisch W, et al. P087: SONIC: a randomized, double-blind, controlled trial comparing infliximab and infliximab plus azathrioprine to azathioprine in patients with Crohn's disease naive to immunomodulators and biologic therapy. Abstracts of the 4th Congress of ECCO - the European Crohn's and Colitis Organisation; Hamburg, Germany, 5-7 February 2009. J Crohns Colitis. 2009 Feb 1;3(1):S45-6.[Full Text]
144. Colombel JF, Sandborn WJ, Reinisch W, et al; SONIC Study Group. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med. 2010 Apr 15;362(15):1383-95.[Abstract]
145. Sandborn WJ, Feagan BG, Rutgeerts P, et al; GEMINI 2 Study Group. Vedolizumab as induction and maintenance therapy for Crohn's disease. N Engl J Med. 2013 Aug 22;369(8):711-21.[Abstract][Full Text]
146. National Institute for Health and Care Excellence (UK). Vedolizumab for treating moderately to severely active Crohn's disease after prior therapy. Aug 2015 [internet publication].[Full Text]
147. Sandborn WJ, Gasink C, Gao LL, et al; CERTIFI Study Group. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N Engl J Med. 2012 Oct 18;367(16):1519-28.[Abstract][Full Text]
148. Singh S, Fumery M, Sandborn WJ, et al. Systematic review and network meta-analysis: first- and second-line biologic therapies for moderate-severe Crohn's disease. Aliment Pharmacol Ther. 2018 Aug;48(4):394-409.[Abstract]
149. Kawalec P, Moćko P. An indirect comparison of ustekinumab and vedolizumab in the therapy of TNF-failure Crohn's disease patients. J Comp Eff Res. 2018 Feb;7(2):101-11.[Abstract]
150. Battat R, Ma C, Jairath V, et al. Benefit-risk assessment of vedolizumab in the treatment of Crohn's disease and ulcerative colitis. Drug Saf. 2019 May;42(5):617-32.[Abstract]
151. Colombel JF, Sands BE, Rutgeerts P, et al. The safety of vedolizumab for ulcerative colitis and Crohn's disease. Gut. 2017 May;66(5):839-51.[Abstract][Full Text]
152. National Institute for Health and Care Excellence (UK). Ustekinumab for moderately to severely active Crohn's disease after previous treatment. Jul 2017 [internet publication].[Full Text]
153. Kawalec P, Moćko P, Malinowska-Lipien I, et al. Efficacy and safety of ustekinumab in the induction therapy of TNF-alpha-refractory Crohn's disease patients: a systematic review and meta-analysis. J Comp Eff Res. 2017 Oct;6(7):601-12.[Abstract]
154. Townsend CM, Parker CE, MacDonald JK, et al. Antibiotics for induction and maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Feb 7;(2):CD012730.[Abstract][Full Text]
155. Weston LA, Roberts PL, Schoetz DJ Jr, et al. Ileocolic resection for acute presentation of Crohn's disease of the ileum. Dis Colon Rectum. 1996 Aug;39(8):841-6.[Abstract]
156. Nordgren SR, Fasth SB, Oresland TO, et al. Long-term follow-up in Crohn's disease: mortality, morbidity, and functional status. Scand J Gastroenterol. 1994 Dec;29(12):1122-8.[Abstract]
157. Kim NK, Senagore AJ, Luchtefeld MA, et al. Long-term outcome after ileocecal resection for Crohn's disease. Am Surg. 1997 Jul;63(7):627-33.[Abstract]
158. Graadal O, Nygaard K. Crohn disease: long-term effects of surgical treatment [in Norwegian]. Tidsskr Nor Laegeforen. 1994 May 30;114(14):1603-5.[Abstract]
159. Mills S, Stamos MJ. Colonic Crohn's disease. Clin Colon Rectal Surg. 2007 Nov;20(4):309-13.[Abstract][Full Text]
160. Sandborn WJ, Feagan BG, Stoinov S, et al. Certolizumab pegol for the treatment of Crohn's disease. N Engl J Med. 2007 Jul 19;357(3):228-38.[Abstract][Full Text]
161. Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the CHARM trial. Gastroenterology. 2007 Jan;132(1):52-65.[Abstract]
162. Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn's disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007 Nov;50(11):1968-86.[Abstract]
163. Reese GE, Purkayastha S, Tilney HS, et al. Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short-term outcomes and recurrence. Colorectal Dis. 2007 Oct;9(8):686-94.[Abstract]
164. Campbell L, Ambe R, Weaver J, et al. Comparison of conventional and nonconventional strictureplasties in Crohn's disease: a systematic review and meta-analysis. Dis Colon Rectum. 2012 Jun;55(6):714-26.[Abstract]
165. Menon AM, Mirza AH, Moolla S, et al. Adenocarcinoma of the small bowel arising from a previous strictureplasty for Crohn's disease: report of a case. Dis Colon Rectum. 2007 Feb;50(2):257-9.[Abstract]
166. Tremaine WJ. Gastroduodenal Crohn's disease: medical management. Inflamm Bowel Dis. 2003 Mar;9(2):127-8.[Abstract]
167. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology. 2002 Apr;122(4):875-80.[Abstract]
168. Gaertner WB, Burgess PL, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2022 Aug 1;65(8):964-85.[Abstract][Full Text]
169. Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 2: surgical management and special situations. J Crohns Colitis. 2017 Feb;11(2):135-49.[Abstract][Full Text]
170. Steinhart AH, Panaccione R, Targownik L, et al. Clinical practice guideline for the medical management of perianal fistulizing Crohn's disease: the Toronto Consensus. Inflamm Bowel Dis. 2019 Jan 1;25(1):1-13.[Abstract][Full Text]
171. Lee MJ, Parker CE, Taylor SR, et al. Efficacy of medical therapies for fistulizing Crohn's disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018 Dec;16(12):1879-92.[Abstract][Full Text]
172. Colombel JF, Schwartz DA, Sandborn WJ, et al. Adalimumab for the treatment of fistulas in patients with Crohn's disease. Gut. 2009 Jul;58(7):940-8.[Abstract][Full Text]
173. Dewint P, Hansen BE, Verhey E, et al. Adalimumab combined with ciprofloxacin is superior to adalimumab monotherapy in perianal fistula closure in Crohn's disease: a randomised, double-blind, placebo controlled trial (ADAFI). Gut. 2014 Feb;63(2):292-9.[Abstract]
174. Thia KT, Mahadevan U, Feagan BG, et al. Ciprofloxacin or metronidazole for the treatment of perianal fistulas in patients with Crohn's disease: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2009 Jan;15(1):17-24.[Abstract]
175. Ricart E, Panaccione R, Loftus EV, et al. Infliximab for Crohn's disease in clinical practice at the Mayo Clinic: the first 100 patients. Am J Gastroenterol. 2001 Mar;96(3):722-9.[Abstract]
176. Poritz LS, Rowe WA, Koltun WA. Remicade does not abolish the need for surgery in fistulizing Crohn's disease. Dis Colon Rectum. 2002 Jun;45(6):771-5.[Abstract]
177. Ryan WR, Allan RN, Yamamoto T, et al. Crohn's disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg. 2004 Feb;187(2):219-25.[Abstract]
178. Nunes T, Etchevers MJ, García-Sánchez V, et al. Impact of smoking cessation on the clinical course of Crohn's disease under current therapeutic algorithms: a multicenter prospective study. Am J Gastroenterol. 2016 Mar;111(3):411-9.[Abstract]
179. Iheozor-Ejiofor Z, Gordon M, Clegg A, et al. Interventions for maintenance of surgically induced remission in Crohn's disease: a network meta-analysis. Cochrane Database Syst Rev. 2019 Sep 12;(9):CD013210.[Abstract][Full Text]
180. Rolfe VE, Fortun PJ, Hawkey CJ, et al. Probiotics for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004826.[Abstract][Full Text]
181. Ganji-Arjenaki M, Rafieian-Kopaei M. Probiotics are a good choice in remission of inflammatory bowel diseases: a meta analysis and systematic review. J Cell Physiol. 2018 Mar;233(3):2091-103.[Abstract]
182. Patel V, Wang Y, MacDonald JK, et al. Methotrexate for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2014 Aug 26;(8):CD006884.[Abstract][Full Text]
183. Davies SC, Nguyen TM, Parker CE, et al. Anti-IL-12/23p40 antibodies for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Dec 12;(12):CD012804.[Abstract][Full Text]
184. Huang ML, Ran ZH, Shen J, et al. Efficacy and safety of adalimumab in Crohn's disease: meta-analysis of placebo-controlled trials. J Dig Dis. 2011 Jun;12(3):165-72.[Abstract]
185. Ford AC, Sandborn WJ, Khan KJ, et al. Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):644-59.[Abstract]
186. Townsend CM, Nguyen TM, Cepek J, et al. Adalimumab for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2020 May 16;(5):CD012877.[Abstract][Full Text]
187. Lin Z, Bai Y, Zheng P. Meta-analysis: efficacy and safety of combination therapy of infliximab and immunosuppressives for Crohn's disease. Eur J Gastroenterol Hepatol. 2011 Nov;23(12):1100-10.[Abstract]
188. Akobeng AK, Zhang D, Gordon M, et al. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn's disease. Cochrane Database Syst Rev. 2016 Sep 28;(9):CD003715.[Abstract][Full Text]
189. European Crohn's and Colitis Organisation. Thiopurines [internet publication].[Full Text]
190. Lelay-Taha MN, Reveillaud I, Sri-Widada J, et al. RNA-protein organization of U1, U5 and U4-U6 small nuclear ribonucleoproteins in HeLa cells. J Mol Biol. 1986 Jun 5;189(3):519-32.[Abstract]
191. Wright S, Sanders DS, Lobo AJ, et al. Clinical significance of azathioprine active metabolite concentrations in inflammatory bowel disease. Gut. 2004 Aug;53(8):1123-8.[Abstract][Full Text]
192. González-Lama Y, Bermejo F, López-Sanromán A, et al. Thiopurine methyl-transferase activity and azathioprine metabolite concentrations do not predict clinical outcome in thiopurine-treated inflammatory bowel disease patients. Aliment Pharmacol Ther. 2011 Sep;34(5):544-54.[Abstract][Full Text]
193. Reinshagen M, Schütz E, Armstrong VW, et al. 6-thioguanine nucleotide-adapted azathioprine therapy does not lead to higher remission rates than standard therapy in chronic active crohn disease: results from a randomized, controlled, open trial. Clin Chem. 2007 Jul;53(7):1306-14.[Abstract][Full Text]
194. Dassopoulos T, Dubinsky MC, Bentsen JL, et al. Randomised clinical trial: individualised vs. weight-based dosing of azathioprine in Crohn's disease. Aliment Pharmacol Ther. 2014 Jan;39(2):163-75.[Abstract][Full Text]
195. Van Loo ES, Dijkstra G, Ploeg RJ, et al. Prevention of postoperative recurrence of Crohn's disease. J Crohns Colitis. 2012 Jul;6(6):637-46.[Abstract]
196. De Cruz P, Kamm MA, Prideaux L, et al. Postoperative recurrent luminal Crohn's disease: a systematic review. Inflamm Bowel Dis. 2012 Apr;18(4):758-77.[Abstract]
197. Buisson A, Chevaux JB, Allen PB, et al. Review article: the natural history of postoperative Crohn's disease recurrence. Aliment Pharmacol Ther. 2012 Mar;35(6):625-33.[Abstract][Full Text]
198. Nguyen GC, Loftus EV Jr, Hirano I, et al; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the management of Crohn's disease after surgical resection. Gastroenterology. 2017 Jan;152(1):271-5.[Abstract][Full Text]
199. Doherty G, Bennett G, Patil S, et al. Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006873.[Abstract][Full Text]
200. Gjuladin-Hellon T, Iheozor-Ejiofor Z, Gordon M, et al. Azathioprine and 6-mercaptopurine for maintenance of surgically-induced remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Aug 6;(8):CD010233.[Abstract][Full Text]
201. National Institute for Health and Care Excellence (UK). Crohn's disease: management. May 2019 [internet publication].[Full Text]
202. Savarino E, Bodini G, Dulbecco P, et al. Adalimumab is more effective than azathioprine and mesalamine at preventing postoperative recurrence of Crohn's disease: a randomized controlled trial. Am J Gastroenterol. 2013 Nov;108(11):1731-42.[Abstract]
203. Erős A, Farkas N, Hegyi P, et al. Anti-TNFalpha agents are the best choice in preventing postoperative Crohn's disease: a meta-analysis. Dig Liver Dis. 2019 Aug;51(8):1086-95.[Abstract]
204. Bakouny Z, Yared F, El Rassy E, et al. Comparative efficacy of anti-TNF therapies for the prevention of postoperative Rrecurrence of Crohn's disease: a systematic review and network meta-analysis of prospective trials. J Clin Gastroenterol. 2019 Jul;53(6):409-17.[Abstract]
205. Burr NE, Hall B, Hamlin PJ, et al. Systematic review and network meta-analysis of medical therapies to prevent recurrence of post-operative Crohn's disease. J Crohns Colitis. 2019 May 27;13(6):693-701.[Abstract][Full Text]
206. Gjuladin-Hellon T, Gordon M, Iheozor-Ejiofor Z, et al. Oral 5-aminosalicylic acid for maintenance of surgically-induced remission in Crohn's disease. Cochrane Database Syst Rev. 2019 Jun 20;(6):CD008414.[Abstract][Full Text]
207. Feuerstein JD, Nguyen GC, Kupfer SS, et al. American Gastroenterological Association Institute guideline on therapeutic drug monitoring in inflammatory bowel disease. Gastroenterology. 2017 Sep;153(3):827-34.[Abstract][Full Text]
208. National Institute for Health and Care Excellence (UK). Therapeutic monitoring of TNF-alpha inhibitors in Crohn's disease (LISA-TRACKER ELISA kits, IDKmonitor ELISA kits, and Promonitor ELISA kits). Feb 2016 [internet publication].[Full Text]
209. Syversen SW, Jørgensen KK, Goll GL, et al. Effect of therapeutic drug monitoring vs standard therapy during maintenance infliximab therapy on disease control in patients with immune-mediated inflammatory diseases: a randomized clinical trial. JAMA. 2021 Dec 21;326(23):2375-84.[Abstract][Full Text]
210. National Institute for Health and Care Excellence (UK). RIDASCREEN tests for monitoring infliximab in inflammatory bowel disease. Jun 2017 [internet publication].[Full Text]
211. Lémann M, Mary JY, Colombel JF, et al. A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine. Gastroenterology. 2005 Jun;128(7):1812-8.[Abstract]
212. Te HS, Schiano TD, Kuan SF, et al. Hepatic effects of long-term methotrexate use in the treatment of inflammatory bowel disease. Am J Gastroenterol. 2000 Nov;95(11):3150-6.[Abstract]
213. Boyapati RK, Torres J, Palmela C, et al. Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease. Cochrane Database Syst Rev. 2018 May 12;(5):CD012540.[Abstract][Full Text]
214. Braun J, Brandt J, Listing J, et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet. 2002 Apr 6;359(9313):1187-93.[Abstract]
215. Brooklyn T, Dunnill G, Probert C. Diagnosis and treatment of pyoderma gangrenosum. BMJ. 2006 Jul 22;333(7560):181-4.[Abstract][Full Text]
216. Brooklyn TN, Dunnill MG, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006 Apr;55(4):505-9.[Abstract][Full Text]
217. Afifi L, Sanchez IM, Wallace MM, et al. Diagnosis and management of peristomal pyoderma gangrenosum: a systematic review. J Am Acad Dermatol. 2018 Jun;78(6):1195-204;e1.[Abstract]
218. Sandborn WJ, Feagan BG, Loftus EV Jr, et al. Efficacy and safety of upadacitinib in a randomized trial of patients with Crohn's Disease. Gastroenterology. 2020 Jun;158(8):2123-38;e8.[Abstract][Full Text]
219. Peyrin-Biroulet L, Louis E, Loftus EV Jr, et al. Quality of life and work productivity improvements with upadacitinib: phase 2b eidence from patients with moderate to severe Crohn's disease. Adv Ther. 2021 May;38(5):2339-52.[Abstract][Full Text]
220. Vermeire S, Schreiber S, Petryka R, et al. Clinical remission in patients with moderate-to-severe Crohn's disease treated with filgotinib (the FITZROY study): results from a phase 2, double-blind, randomised, placebo-controlled trial. Lancet. 2017 Jan 21;389(10066):266-75.[Abstract]
221. Feagan BG, Sandborn WJ, Danese S, et al. Ozanimod induction therapy for patients with moderate to severe Crohn's disease: a single-arm, phase 2, prospective observer-blinded endpoint study. Lancet Gastroenterol Hepatol. 2020 Sep;5(9):819-28.[Abstract]
222. ClinicalTrials.gov. A placebo-controlled study of oral ozanimod as maintenance therapy for moderately to severely active Crohn's disease. ClinicalTrials.gov identifier: NCT03464097. Aug 2022 [internet publication].[Full Text]
223. D'Haens G, Panaccione R, Baert F, et al. Risankizumab as induction therapy for Crohn's disease: results from the phase 3 ADVANCE and MOTIVATE induction trials. Lancet. 2022 May 28;399(10340):2015-30.[Abstract]
224. Panés J, García-Olmo D, Van Assche G, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016 Sep 24;388(10051):1281-90.[Abstract]
225. Panés J, García-Olmo D, Van Assche G, et al. Long-term efficacy and safety of stem cell therapy (Cx601) for complex perianal fistulas in patients with Crohn's disease. Gastroenterology. 2018 Apr;154(5):1334-42;e4.[Abstract][Full Text]
226. National Institute for Health and Care Excellence (UK). Darvadstrocel for treating complex perianal fistulas in Crohn's disease. Jan 2019 [internet publication].[Full Text]
227. Hawkey CJ, Allez M, Clark MM, et al. Autologous hematopoetic stem cell transplantation for refractory Crohn disease: a randomized clinical trial. JAMA. 2015 Dec 15;314(23):2524-34.[Abstract][Full Text]
228. Jauregui-Amezaga A, Rovira M, Marín P, et al. Improving safety of autologous haematopoietic stem cell transplantation in patients with Crohn's disease. Gut. 2016 Sep;65(9):1456-62.[Abstract]
229. Snowden JA, Hawkey C, Hind D, et al. Autologous stem cell transplantation in refractory Crohn's disease - low intensity therapy evaluation (ASTIClite): study protocols for a multicentre, randomised controlled trial and observational follow up study. BMC Gastroenterol. 2019 May 31;19(1):82.[Abstract][Full Text]
230. Patton PH, Parker CE, MacDonald JK, et al. Anti-tuberculous therapy for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2016 Jul 22;(7):CD000299.[Abstract][Full Text]
231. Schölmerich J, Fellermann K, Seibold FW, et al. A randomised, double-blind, placebo-controlled trial of Trichuris suis ova in active Crohn's disease. J Crohns Colitis. 2017 Apr 1;11(4):390-9.[Abstract][Full Text]
232. Yanai H, Levine A, Hirsch A, et al. The Crohn's disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn's disease (CDED-AD): an open-label, pilot, randomised trial. Lancet Gastroenterol Hepatol. 2022 Jan;7(1):49-59.[Abstract]
233. Lightner AL, Vogel JD, Carmichael JC, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn's disease. Dis Colon Rectum. 2020 Aug;63(8):1028-52.[Abstract][Full Text]
234. Farraye FA, Melmed GY, Lichtenstein GR, et al. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017 Feb;112(2):241-58.[Abstract][Full Text]
235. Bischoff SC, Escher J, Hébuterne X, et al. ESPEN practical guideline: clinical nutrition in inflammatory bowel disease. Clin Nutr. 2020 Mar;39(3):632-53.[Abstract][Full Text]
236. National Institute for Health and Care Excellence (UK). Colorectal cancer prevention: colonoscopic surveillance in adults with ulcerative colitis, Crohn's disease or adenomas. Mar 2011 [internet publication].[Full Text]
237. Moum B, Ekbom A, Vatn MH, et al. Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease. Results of a large, prospective population-based study in southeastern Norway, 1990-93. Scand J Gastroenterol. 1997 Oct;32(10):1005-12.[Abstract]
238. Munkholm P, Langholz E, Davidsen M, et al. Disease activity courses in a regional cohort of Crohn's disease patients. Scand J Gastroenterol. 1995 Jul;30(7):699-706.[Abstract]
239. Burisch J, Kiudelis G, Kupcinskas L, et al. Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut. 2019 Mar;68(3):423-33.[Abstract]
240. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease. Br J Surg. 2000 Dec;87(12):1697-701.[Abstract]
241. Murray JJ, Schoetz DJ Jr, Nugent FW, et al. Surgical management of Crohn's disease involving the duodenum. Am J Surg. 1984 Jan;147(1):58-65.[Abstract]
242. Beaugerie L, Seksik P, Nion-Larmurier I, et al. Predictors of Crohn's disease. Gastroenterology. 2006 Mar;130(3):650-6.[Abstract]
243. Weterman IT, Biemond I, Peña AS. Mortality and causes of death in Crohn's disease. Review of 50 years' experience in Leiden University Hospital. Gut. 1990 Dec;31(12):1387-90.[Abstract][Full Text]
244. Card R, Hubbard R, Logan RF. Mortality in inflammatory bowel disease: a population-based cohort study. Gastroenterology. 2003 Dec;125(6):1583-90.[Abstract]
245. Jess T, Loftus EV Jr, Harmsen WS, et al. Survival and cause specific mortality in patients with inflammatory bowel disease: a long term outcome study in Olmsted County, Minnesota, 1940-2004. Gut. 2006 Sep;55(9):1248-54.[Abstract]
246. Bernstein CN, Nugent Z, Targownik LE, et al. Predictors and risks for death in a population-based study of persons with IBD in Manitoba. Gut. 2015 Sep;64(9):1403-11.[Abstract]
247. Bettenworth D, Gustavsson A, Atreja A, et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn's disease. Inflamm Bowel Dis. 2017 Jan;23(1):133-42.[Abstract]
248. Navaneethan U, Lourdusamy V, Njei B, et al. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc. 2016 Dec;30(12):5434-43.[Abstract]
249. Jess T, Gamborg M, Matzen P, et al. Increased risk of intestinal cancer in Crohn's disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol. 2005 Dec;100(12):2724-9.[Abstract]
250. Jess T, Loftus EV Jr, Velayos FS, et al. Incidence and prognosis of colorectal dysplasia in inflammatory bowel disease: a population-based study from Olmsted County, Minnesota. Inflamm Bowel Dis. 2006 Aug;12(8):669-76.[Abstract]
251. Bernstein CN, Blanchard JF, Kliewer E, et al. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001 Feb 15;91(4):854-62.[Abstract][Full Text]
252. Connell WR, Sheffield JP, Kamm MA, et al. Lower gastrointestinal malignancy in Crohn's disease. Gut. 1994 Mar;35(3):347-52.[Abstract][Full Text]
253. Loftus EV Jr, Tremaine WJ, Habermann TM, et al. Risk of lymphoma in inflammatory bowel disease. Am J Gastroenterol. 2000 Sep;95(9):2308-12.[Abstract]
254. Kandiel A, Fraser AG, Korelitz BI, et al. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005 Aug;54(8):1121-5.[Abstract]
255. Jess T, Horváth-Puhó E, Fallingborg J, et al. Cancer risk in inflammatory bowel disease according to patient phenotype and treatment: a Danish population-based cohort study. Am J Gastroenterol. 2013 Dec;108(12):1869-76.[Abstract]
256. Wang LH, Yang YJ, Cheng WC, et al. Higher risk for hematological malignancies in inflammatory bowel disease: a nationwide population-based study in Taiwan. Am J Gastroenterol. 2016 Sep;111(9):1313-9.[Abstract]
257. Compston J. Osteoporosis in inflammatory bowel disease. Gut. 2003 Jan;52(1):63-4.[Abstract][Full Text]
258. Ali T, Yun L, Rubin DT. Risk of post-operative complications associated with anti-TNF therapy in inflammatory bowel disease. World J Gastroenterol. 2012 Jan 21;18(3):197-204.[Abstract][Full Text]
259. Khan N, Abbas AM, Whang N, et al. Incidence of liver toxicity in inflammatory bowel disease patients treated with methotrexate: a meta-analysis of clinical trials. Inflamm Bowel Dis. 2012 Feb;18(2):359-67.[Abstract]
260. de Jong MJ, van der Meulen-de Jong AE, Romberg-Camps MJ, et al. Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial. Lancet. 2017 Sep 2;390(10098):959-68.[Abstract]
261. Cao BL, Qasem A, Sharp RC, et al. Systematic review and meta-analysis on the association of tuberculosis in Crohn's disease patients treated with tumor necrosis factor-alpha inhibitors (Anti-TNFalpha). World J Gastroenterol. 2018 Jul 7;24(25):2764-75.[Abstract][Full Text]
262. Farraye FA, Odze RD, Eaden J, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010 Feb;138(2):738-45.[Abstract][Full Text]
263. von Roon AC, Reese G, Teare J, et al. The risk of cancer in patients with Crohn's disease. Dis Colon Rectum. 2007 Jun;50(6):839-55.[Abstract]
264. Bye WA, Nguyen TM, Parker CE, et al. Strategies for detecting colon cancer in patients with inflammatory bowel disease. Cochrane Database Syst Rev. 2017 Sep 18;(9):CD000279.[Abstract][Full Text]
265. Maykel JA, Hagerman G, Mellgren AF, et al. Crohn's colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum. 2006 Jul;49(7):950-7.[Abstract]
266. Eaden JA, Mayberry JF; British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 2002 Oct;51(suppl 5):V10-2.[Abstract][Full Text]
267. Shah S. Dietary factors in the modulation of inflammatory bowel disease activity. MedGenMed. 2007 Mar 27;9(1):60.[Abstract][Full Text]
268. Brennan GT, Ha I, Hogan C, et al. Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn's disease patients: a meta-analysis. Eur J Gastroenterol Hepatol. 2018 Sep;30(9):997-1002.[Abstract]
269. Grass F, Pache B, Martin D, et al. Preoperative nutritional conditioning of Crohn's patients - systematic review of current evidence and practice. Nutrients. 2017 Jun 1;9(6):E562.[Abstract][Full Text]
270. Khalili H, Granath F, Smedby KE, et al. Association between long-term oral contraceptive use and risk of Crohn's disease complications in a nationwide study. Gastroenterology. 2016 Jun;150(7):1561-7.e1.[Abstract][Full Text]
271. Tu W, Xu G, Du S. Structure and content components of self-management interventions that improve health-related quality of life in people with inflammatory bowel disease: a systematic review, meta-analysis and meta-regression. J Clin Nurs. 2015 Oct;24(19-20):2695-709.[Abstract]
272. Eaden JA, Mayberry JF; British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease. Gut. 2002 Oct;51(5 suppl):V10-2.[Abstract][Full Text]