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CLINICAL PROGRESS IN CROHN'S DISEASE
Author(s) -
Brown Pamela
Publication year - 1974
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1974.tb93146.x
Subject(s) - medicine , azathioprine , ulcerative colitis , disease , gastroenterology , crohn's disease , inflammatory bowel disease , ileitis , ankylosing spondylitis , colitis
Patients with Crohn's disease have a stronger family history of colitis than have colitis patients of Crohn's disease. This suggests that Crohn's disease and ulcerative colitis may be the same disease, with Crohn's disease developing in people with a more complete genotype. Further evidence in favour of a polygenic influence is that ankylosing spondylitis may be found in both conditions. Anatomical and histological differences on the other hand are in favour of the two conditions being different entities. Crohn's disease may present in a variety of unusual ways, varying from pyrexia of unknown origin, renal, liver, skin and anal lesions, through to miliary tubercles found on the serosal surface of the bowel wall at laparotomy. Persistent diarrhoea, the frequent passage of small amounts of blood per rectum, perianal lesions and systemic complications in diverticular disease suggest that Crohn's disease may also be present. Crohn's disease of both the small and large bowel may be complicated by carcinomatous changes. Nutritional deficiencies, anaemia, diarrhoea, small bowel colic and other clinical symptoms should be appropriately treated as they arise. Corticosteroids are useful in reducing active bowel inflammation. They also contribute to the healing of systemic complications. They may be used in patients in whom further bowel resection is impracticable and are useful in Crohn's colitis. Azathioprine may benefit a proportion of patients who have failed to respond to other treatment. Azathioprine is more effective when used in combination with steroids, or when used alone following steroid‐induced remissions: Complications are reduced to a minimum when a dose regime of 2 mg/kg of body weight is used. Surgery is indicated for emergencies such as perforation, obstruction, severe haemorrhage and abscess formation. Excision surgery is preferred to bypass surgery. After excision surgery the recurrence rate in small bowel Crohn's disease is higher than in Crohn's colitis. All patients with a diagnosis of ulcerative colitis should have a barium meal examination and follow through to exclude Crohn's disease.