What is the life expectancy of patients with Crohn disease?

Answer

Several earlier studies estimated a slight decrease in life expectancy associated with certain prognostic indicators, such as female sex, long disease duration, and disease location. The increased mortality was related to pulmonary malignancies, genitourinary tract diseases, and GI, liver, and biliary diseases.

In contrast, other studies have reported normal survival in patients with Crohn disease. With the advent of new medical therapies, population-based studies have shown that overall survival for North American patients with IBD is similar to that expected in the US white population.^[40]Individuals with Crohn disease were at increased risk of death from complications of GI disease, GI malignancy, and chronic obstructive pulmonary disease (COPD).^[40]

In a Danish study that evaluated trends in mortality from 1982 to 2010, investigators observed a 50% higher mortality in patients with Crohn disease relative to the general population; this percentage did not change over time.^[41]

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

Kornbluth A, Sachar DB, Salomon P. Crohn's disease. Feldman M, Scharschmidt BF, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, Pa: WB Saunders Co; 1998. Vol 2: 1708-34.
Panes J, Gomollon F, Taxonera C, et al. Crohn's disease: a review of current treatment with a focus on biologics. Drugs. 2007. 67(17):2511-37.
Tierney LM. Crohn's disease. Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. 40th ed. New York, NY: McGraw-Hill Professional Publishing; 2001. 638-42.
Mackner LM, Bickmeier RM, Crandall WV. Academic achievement, attendance, and school-related quality of life in pediatric inflammatory bowel disease. J Dev Behav Pediatr. 2012 Feb. 33(2):106-11. [Medline].
Rabbett H, Elbadri A, Thwaites R, et al. Quality of life in children with Crohn's disease. J Pediatr Gastroenterol Nutr. 1996 Dec. 23(5):528-33. [Medline].
Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology. Nov 2007. 133(5):1670-89. [Full Text].
Strong SA, Koltun WA, Hyman NH, Buie WD. Practice parameters for the surgical management of Crohn's disease. Dis Colon Rectum. 2007 Nov. 50(11):1735-46. [Medline].
Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975 Apr. 68(4 Pt 1):627-35. [Medline].
D'Haens G, Baert F, van Assche G, et al, for the Belgian Inflammatory Bowel Disease Research Group., North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. 2008 Feb 23. 371(9613):660-7. [Medline].
Tsianos EV, Katsanos KH, Tsianos VE. Role of genetics in the diagnosis and prognosis of Crohn's disease. World J Gastroenterol. 2012 Jan 14. 18(2):105-18. [Medline]. [Full Text].
Thoreson R, Cullen JJ. Pathophysiology of inflammatory bowel disease: an overview. Surg Clin North Am. 2007 Jun. 87(3):575-85. [Medline].
[Guideline] Matsuoka K, Kobayashi T, Ueno F, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol. 2018 Mar. 53 (3):305-53. [Medline]. [Full Text].
Hampe J, Grebe J, Nikolaus S, et al. Association of NOD2 (CARD 15) genotype with clinical course of Crohn's disease: a cohort study. Lancet. 2002 May 11. 359(9318):1661-5. [Medline].
Hugot JP, Chamaillard M, Zouali H, et al. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease. Nature. 2001 May 31. 411(6837):599-603. [Medline].
Duerr RH, Taylor KD, Brant SR, et al. A genome-wide association study identifies IL23R as an inflammatory bowel disease gene. Science. 2006 Dec 1. 314(5804):1461-3. [Medline].
Glas J, Seiderer J, Wetzke M, et al. rs1004819 is the main disease-associated IL23R variant in German Crohn's disease patients: combined analysis of IL23R, CARD15, and OCTN1/2 variants. PLoS One. 2007 Sep 5. 2(9):e819. [Medline]. [Full Text].
Van Limbergen J, Russell RK, Nimmo ER, et al. IL23R Arg381Gln is associated with childhood onset inflammatory bowel disease in Scotland. Gut. 2007 Aug. 56(8):1173-4. [Medline]. [Full Text].
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. [Medline]. [Full Text].
Hampe J, Franke A, Rosenstiel P, et al. A genome-wide association scan of nonsynonymous SNPs identifies a susceptibility variant for Crohn disease in ATG16L1. Nat Genet. 2007 Feb. 39(2):207-11. [Medline].
Rioux JD, Xavier RJ, Taylor KD, et al. Genome-wide association study identifies new susceptibility loci for Crohn disease and implicates autophagy in disease pathogenesis. Nat Genet. 2007 May. 39(5):596-604. [Medline]. [Full Text].
Parkes M, Barrett JC, Prescott NJ, et al. Sequence variants in the autophagy gene IRGM and multiple other replicating loci contribute to Crohn's disease susceptibility. Nat Genet. 2007 Jul. 39(7):830-2. [Medline]. [Full Text].
Libioulle C, Louis E, Hansoul S, et al. Novel Crohn disease locus identified by genome-wide association maps to a gene desert on 5p13.1 and modulates expression of PTGER4. PLoS Genet. 2007 Apr 20. 3(4):e58. [Medline]. [Full Text].
Wellcome Trust Case Control Consortium. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature. 2007 Jun 7. 447(7145):661-78. [Medline]. [Full Text].
Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc. 2007 Aug. 66(3):307-15. [Medline].
Baumgart DC. Endoscopic surveillance in Crohn's disease and ulcerative colitis: who needs what and when?. Dig Dis. 2011. 29 Suppl 1:32-5. [Medline].
Sandborn WJ, Hanauer SB, Rutgeerts P, et al. Adalimumab for maintenance treatment of Crohn's disease: results of the CLASSIC II trial. Gut. Sep 2007. 56(9):1232-9. [Full Text].
Lindberg E, Jarnerot G, Huitfeldt B. Smoking in Crohn's disease: effect on localisation and clinical course. Gut. 1992 Jun. 33(6):779-82. [Medline].
D'Souza S, Levy E, Mack D, et al. Dietary patterns and risk for Crohn's disease in children. Inflamm Bowel Dis. 2008 Mar. 14(3):367-73. [Medline].
Davis RL, Kramarz P, Bohlke K, et al, for the Vaccine Safety Datalink Team. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case-control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med. 2001 Mar. 155(3):354-9. [Medline].
Reif S, Lavy A, Keter D, et al. Appendectomy is more frequent but not a risk factor in Crohn's disease while being protective in ulcerative colitis: a comparison of surgical procedures in inflammatory bowel disease. Am J Gastroenterol. 2001 Mar. 96(3):829-32. [Medline].
Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn's disease in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gastroenterology. 1998 Jun. 114(6):1161-8. [Medline].
Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007 Dec. 5(12):1424-9. [Medline].
Shivananda S, Lennard-Jones J, Logan R, et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut. 1996 Nov. 39(5):690-7. [Medline]. [Full Text].
Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004 May. 126(6):1504-17. [Medline].
Lovasz BD, Golovics PA, Vegh Z, Lakatos PL. New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig Liver Dis. 2013 Apr. 45(4):269-76. [Medline].
Economou M, Zambeli E, Michopoulos S. Incidence and prevalence of Crohn’s disease and its etiological influences. Annals of Gastroenterology. Available at http://www.annalsgastro.gr/index.php/annalsgastro/article/view/743. 2009. 22(3):158-67; Accessed: December 11, 2012.
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. [Medline].
Calkins BM, Lilienfeld AM, Garland CF, Mendeloff AI. Trends in incidence rates of ulcerative colitis and Crohn's disease. Dig Dis Sci. 1984 Oct. 29(10):913-20. [Medline].
Duerr RH. Update on the genetics of inflammatory bowel disease. J Clin Gastroenterol. 2003 Nov-Dec. 37(5):358-67. [Medline].
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. [Medline]. [Full Text].
Jess T, Frisch M, Simonsen J. Trends in overall and cause-specific mortality among patients with inflammatory bowel disease from 1982 to 2010. Clin Gastroenterol Hepatol. 2013 Jan. 11(1):43-8. [Medline].
Munkholm P, Langholz E, Davidsen M, Binder V. Intestinal cancer risk and mortality in patients with Crohn's disease. Gastroenterology. 1993 Dec. 105(6):1716-23. [Medline].
Fiocchi C. Inflammatory bowel disease: etiology and pathogenesis. Gastroenterology. 1998 Jul. 115(1):182-205. [Medline].
Friedman S, Blumberg RS. Inflammatory bowel disease. Braunwald E, Fauci AS, Kasper DS, et al, eds. Harrison's Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill Professional Publishing; 2001. Vol 2: 1679-91.
Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician. 2011 Dec 15. 84(12):1365-75. [Medline].
Danese S, Semeraro S, Papa A, et al. Extraintestinal manifestations in inflammatory bowel disease. World J Gastroenterol. 2005 Dec 14. 11(46):7227-36. [Medline]. [Full Text].
Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease. Aliment Pharmacol Ther. 2006 Apr 15. 23(8):1097-104. [Medline].
Jess T, Simonsen J, Jorgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology. 2012 Aug. 143(2):375-81.e1; quiz e13-4. [Medline].
Herrinton LJ, Liu L, Levin TR, Allison JE, Lewis JD, Velayos F. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology. 2012 Aug. 143(2):382-9. [Medline].
Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001 Apr. 96(4):1116-22. [Medline].
Isaacs KL. How prevalent are extraintestinal manifestations at the initial diagnosis of IBD?. Inflamm Bowel Dis. 2008 Oct. 14 Suppl 2:S198-9. [Medline].
Aghazadeh R, Zali MR, Bahari A, Amin K, Ghahghaie F, Firouzi F. Inflammatory bowel disease in Iran: a review of 457 cases. J Gastroenterol Hepatol. 2005 Nov. 20(11):1691-5. [Medline].
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. [Medline].
Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005 Sep. 19 Suppl A:5-36. [Medline].
Leach ST, Nahidi L, Tilakaratne S, Day AS, Lemberg DA. Development and assessment of a modified Pediatric Crohn Disease Activity Index. J Pediatr Gastroenterol Nutr. 2010 Aug. 51(2):232-6. [Medline].
Kappelman MD, Crandall WV, Colletti RB, et al. Short pediatric Crohn's disease activity index for quality improvement and observational research. Inflamm Bowel Dis. 2011 Jan. 17(1):112-7. [Medline]. [Full Text].
[Guideline] Bernstein CN, Eliakim A, Fedail S, et al. World Gastroenterology Organisation global guidelines inflammatory bowel disease: update August 2015. J Clin Gastroenterol. 2016 Nov/Dec. 50 (10):803-18. [Medline]. [Full Text].
[Guideline] World Gastroenterology Organisation. World Gastroenterology Organisation global guideline: inflammatory bowel disease: a global perspective. Munich, Germany: World Gastroenterology Organisation; 2009. Available at http://guideline.gov/content.aspx?id=15231. Accessed: December 12, 2012.
McNamara D. New IBD guidelines aim to simplify care. Medscape Medical News. Available at https://www.medscape.com/viewarticle/892853. February 20, 2018; Accessed: June 6, 2018.
Govani SM, Guentner AS, Waljee AK, Higgins PD. Risk stratification of emergency department patients with Crohn's disease could reduce computed tomography use by nearly half. Clin Gastroenterol Hepatol. 2014 Oct. 12(10):1702-1707.e3. [Medline]. [Full Text].
Newnham E, Hawkes E, Surender A, James SL, Gearry R, Gibson PR. Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy?. Aliment Pharmacol Ther. 2007 Oct 1. 26(7):1019-24. [Medline].
Desmond AN, O'Regan K, Curran C, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008 Nov. 57(11):1524-9. [Medline].
Kambadakone AR, Prakash P, Hahn PF, Sahani DV. Low-dose CT examinations in Crohn's disease: Impact on image quality, diagnostic performance, and radiation dose. AJR Am J Roentgenol. 2010 Jul. 195(1):78-88. [Medline].
Craig O, O'Neill S, O'Neill F, et al. Diagnostic accuracy of computed tomography using lower doses of radiation for patients with Crohn's disease. Clin Gastroenterol Hepatol. 2012 Aug. 10(8):886-92. [Medline].
Panes J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther. 2011 Jul. 34(2):125-45. [Medline].
Gisbert JP, McNicholl AG. Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease. Dig Liver Dis. 2009 Jan. 41(1):56-66. [Medline].
D'Inca R, Dal Pont E, Di Leo V, et al. Calprotectin and lactoferrin in the assessment of intestinal inflammation and organic disease. Int J Colorectal Dis. 2007 Apr. 22(4):429-37. [Medline].
Mackalski BA, Bernstein CN. New diagnostic imaging tools for inflammatory bowel disease. Gut. May 2006. 55(5):733-41.
Saibeni S, Rondonotti E, Iozzelli A, et al. Imaging of the small bowel in Crohn's disease: a review of old and new techniques. World J Gastroenterol. 2007 Jun 28. 13(24):3279-87. [Medline].
Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis. 2004 Jan. 10(1):45-54. [Medline].
[Guideline] Kidd R, Mezwa DG, Ralls PW, et al. Imaging recommendations for patients with newly suspected Crohn's disease, and in patients with known Crohn's disease and acute exacerbation or suspected complications. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000 Jun. 215 Suppl:181-92. [Medline].
Fidler JL, Rosen MP, Blake MA, et al, for the Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria: Crohn disease. [online publication]. Reston, Va: American College of Radiology; 2011. Available at http://guideline.gov/content.aspx?id=35137. Accessed: April 5, 2011.
Pilleul F, Godefroy C, Yzebe-Beziat D, Dugougeat-Pilleul F, Lachaux A, Valette PJ. Magnetic resonance imaging in Crohn's disease. Gastroenterol Clin Biol. 2005 Aug-Sep. 29(8-9):803-8. [Medline].
Florie J, Horsthuis K, Hommes DW, et al. Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn's disease. Clin Gastroenterol Hepatol. 2005 Dec. 3(12):1221-8. [Medline].
Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn's disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis. 2011 Aug. 17(8):1759-68. [Medline].
Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009 Jun. 251(3):751-61. [Medline].
Low RN, Francis IR, Politoske D, Bennett M. Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging. 2000 Feb. 11(2):127-35. [Medline].
Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn's disease. Inflamm Bowel Dis. 2011 May. 17(5):1073-80. [Medline].
Hafeez R, Punwani S, Boulos P, et al. Diagnostic and therapeutic impact of MR enterography in Crohn's disease. Clin Radiol. 2011 Dec. 66(12):1148-58. [Medline].
Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol. 2008 Jun. 12(2):111-7. [Medline].
Schwartz DA, White CM, Wise PE, Herline AJ. Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohn's perianal fistulas. Inflamm Bowel Dis. 2005 Aug. 11(8):727-32. [Medline].
Wise PE, Schwartz DA. The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin North Am. 2012 Jun. 41(2):379-91. [Medline].
Leighton JA, Shen B, Baron TH, et al. ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc. 2006 Apr. 63(4):558-65. [Medline].
Rubin DT, Panaccione R, Chao J, Robinson AM. A practical, evidence-based guide to the use of adalimumab in Crohn's disease. Curr Med Res Opin. 2011 Sep. 27(9):1803-13. [Medline].
Robinson M. Optimizing therapy for inflammatory bowel disease. Am J Gastroenterol. 1997 Dec. 92(12 Suppl):12S-17S. [Medline].
Helwick C. Stem cell transplantation halts Crohn's disease. Medscape Medical News from WebMD. Available at http://www.medscape.com/viewarticle/804570. May 22, 2013; Accessed: June 4, 2013.
Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med. 2010 Apr 15. 362(15):1383-95. [Medline].
Lim WC, Hanauer S. Aminosalicylates for induction of remission or response in Crohn's disease. Cochrane Database Syst Rev. 2010 Dec 8. CD008870. [Medline].
Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr. 106(4):590-9. [Medline].
Turner D, Grossman AB, Rosh J, et al. Methotrexate following unsuccessful thiopurine therapy in pediatric Crohn's disease. Am J Gastroenterol. 2007 Dec. 102(12):2804-12; quiz 2803, 2813. [Medline].
Ford AC, Sandborn WJ, Khan KJ, Hanauer SB, Talley NJ, Moayyedi P. Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr. 106(4):644-59. [Medline].
US Food and Drug Administration. Tumor necrosis factor-alpha (TNFα) blockers: label change - boxed warning updated for risk of infection from Legionella and Listeria. Posted September 7, 2011. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm270977.htm. Accessed: April 5, 2012.
Yadav A, Kurada S, Foromera J, Falchuk KR, Feuerstein JD. Meta-analysis comparing the efficacy and adverse events of biologics and thiopurines for Crohn's Disease after surgery for ulcerative colitis. Dig Liver Dis. 2018 May 30. [Medline].
[Guideline] Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006 Mar. 130(3):935-9. [Medline]. [Full Text].
Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999 May 6. 340(18):1398-405. [Medline].
Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group. N Engl J Med. 1997 Oct 9. 337(15):1029-35. [Medline]. [Full Text].
Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999 May 6. 340(18):1398-405. [Medline]. [Full Text].
Louis E, Mary JY, Vernier-Massouille G, et al. Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology. 2012 Jan. 142(1):63-70.e5; quiz e31. [Medline].
Peyrin-Biroulet L, Laclotte C, Bigard MA. Adalimumab maintenance therapy for Crohn's disease with intolerance or lost response to infliximab: an open-label study. Aliment Pharmacol Ther. 2007 Mar 15. 25(6):675-80. [Medline]. [Full Text].
Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial. Gastroenterology. 2006 Feb. 130(2):323-33; quiz 591. [Medline].
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. [Medline].
Mannon PJ, Fuss IJ, Mayer L, et al. Anti-interleukin-12 antibody for active Crohn's disease. N Engl J Med. 2004 Nov 11. 351(20):2069-79. [Medline].
Sandborn WJ, Rutgeerts P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med. 2007 Jun 19. 146(12):829-38. [Medline]. [Full Text].
Peppercorn MA. Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults. UpToDate. September 15, 2008. [Full Text].
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. [Medline].
Schreiber S, Khaliq-Kareemi M, Lawrance IC, et al. Maintenance therapy with certolizumab pegol for Crohn's disease. N Engl J Med. 2007 Jul 19. 357(3):239-50. [Medline].
Lichtenstein GR, Thomsen OO, Schreiber S, et al. Continuous therapy with certolizumab pegol maintains remission of patients with Crohn's disease for up to 18 months. Clin Gastroenterol Hepatol. 2010 Jul. 8(7):600-9. [Medline].
Biogen Idec Elan. TYSABRI (natalizumab) Safety Update: (17 August 2012). Available at http://www.tapp.com.au/members/Tysabri_Safety_Update_160812.pdf. Accessed: December 14, 2012.
FDA. FDA Drug Safety Communication: New risk factor for progressive multifocal leukoencephalopathy (PML) associated with Tysabri (natalizumab) [safety announcement]. January 20, 2012. Available at http://www.fda.gov/Drugs/DrugSafety/ucm288186.htm. Accessed: December 14, 2012.
Sandborn WJ, Colombel JF, Enns R, et al. Natalizumab induction and maintenance therapy for Crohn's disease. N Engl J Med. 2005 Nov 3. 353(18):1912-25. [Medline].
Targan SR, Feagan BG, Fedorak RN, et al, for the International Efficacy of Natalizumab in Crohn's Disease Response and Remission (ENCORE) Trial Group. Natalizumab for the treatment of active Crohn's disease: results of the ENCORE Trial. Gastroenterology. 2007 May. 132(5):1672-83. [Medline].
Sandborn WJ, Feagan BG, Rutgeerts P, et al. Vedolizumab as induction and maintenance therapy for Crohn's disease. N Engl J Med. 2013 Aug 22. 369(8):711-21. [Medline].
Brooks M. FDA clears ustekinumab (Stelara) for Crohn's disease. Medscape Medical News. Available at http://www.medscape.com/viewarticle/869259. September 26, 2016; Accessed: September 30, 2016.
Johnson & Johnson. FDA approves STELARA (ustekinumab) for treatment of adults with moderately to severely active Crohn’s disease. Available at https://www.jnj.com/media-center/press-releases/fda-approves-stelara-ustekinumab-for-treatment-of-adults-with-moderately-to-severely-active-crohns-disease. September 26, 2016; Accessed: September 30, 2016.
Sandborn W, Gasink C, Blank M, et al. O-001 A multicenter, double-blind, placebo-controlled phase 3 study of ustekinumab, a human IL-12/23P40 mAB, in moderate-severe Crohn's disease refractory to anti-TFNα: UNITI-1. Inflamm Bowel Dis. 2016 Mar. 22 suppl 1:S1. [Medline].
Feagan B, Gasink C, Lang Y, et al. A multicenter, randomized, double-blind, placebo-controlled phase 3 study of ustekinumab, a human monoclonal antibody to IL-12/23P40, in patients with moderately- to severely-active Crohn's disease who are naive or non-refractory to anti-TNF (UNITI-2). Presented at: American College of Gastroenterology 2015 Annual Scientific Meeting; Honolulu, Hawaii; October 16-21, 2015. [Full Text].
Sanborn W, Feagan BG, Gasink C, et al. A phase 3 randomized, multicenter, double-blind, placebo-controlled study of ustekinumab maintenance therapy in moderate-severe Crohn's disease patients: results from IM-UNITI [abstract 768]. Presented at: Digestive Disease Week; San Diego, California; May 23, 2016. [Full Text].
Iborra M, Beltran B, Fernandez-Clotet A, et al. Real-world short-term effectiveness of ustekinumab in 305 patients with Crohn's disease: results from the ENEIDA registry. Aliment Pharmacol Ther. 2019 Aug. 50 (3):278-88. [Medline]. [Full Text].
McSharry K, Dalzell AM, Leiper K, El-Matary W. Systematic review: the role of tacrolimus in the management of Crohn's disease. Aliment Pharmacol Ther. 2011 Dec. 34(11-12):1282-94. [Medline].
Solomon MJ, McLeod RS, O’Connor BI, Steinhart H, Greenberg GR, Cohen Z. Combination of ciprofloxacin and metronidazole in severe perianal Crohn’s disease. Can J Gastroenterol. 1993. 7:571-3.
Borrelli O, Cordischi L, Cirulli M, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol. 2006 Jun. 4(6):744-53. [Medline].
Harpavat M, Keljo DJ, Regueiro MD. Metabolic bone disease in inflammatory bowel disease. J Clin Gastroenterol. 2004 Mar. 38(3):218-24. [Medline].
Heuschkel R. Enteral nutrition in Crohn disease: more than just calories. J Pediatr Gastroenterol Nutr. 2004 Mar. 38(3):239-41. [Medline].
Razack R, Seidner DL. Nutrition in inflammatory bowel disease. Curr Opin Gastroenterol. 2007 Jul. 23(4):400-5. [Medline].
Whitten KE, Rogers P, Ooi CY, Day AS. International survey of enteral nutrition protocols used in children with Crohn's disease. J Dig Dis. 2012 Feb. 13(2):107-12. [Medline].
Markowitz J, Markowitz JE, Bousvaros A, et al. Workshop report: prevention of postoperative recurrence in Crohn's disease. J Pediatr Gastroenterol Nutr. 2005 Aug. 41(2):145-51. [Medline].
Ewe K, Herfarth C, Malchow H, Jesdinsky HJ. Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulfasalazine prophylaxis: a multicenter trial. Digestion. 1989. 42(4):224-32. [Medline].
Alos R, Hinojosa J. Timing of surgery in Crohn's disease: a key issue in the management. World J Gastroenterol. 2008 Sep 28. 14(36):5532-9. [Medline].
Simillis C, Yamamoto T, Reese GE, et al. A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn's disease. Am J Gastroenterol. 2008 Jan. 103(1):196-205. [Medline].
Shen B. Managing medical complications and recurrence after surgery for Crohn's disease. Curr Gastroenterol Rep. 2008 Dec. 10(6):606-11. [Medline].
Cobb WS IV. Finney pyloroplasty. Ponsky JR, Rosen MJ, eds. Atlas of Surgical Techniques for the Upper Gastrointestinal Tract and Small Bowel. Philadelphia, Pa: Saunders Elsevier; 2010. 97-103.
Angel CA. Finney pyloroplasty. Townsend CM Jr, Evers BM, eds. Atlas of General Surgical Techniques. Philadelphia, Pa: Saunders Elsevier; 2010. Chapter 24.
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. [Medline].
Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn's strictures: a prospective longterm analysis. Gut. 1995 Apr. 36(4):577-80. [Medline].
Garcia JC, Persky SE, Bonis PA, Topazian M. Abscesses in Crohn's disease: outcome of medical versus surgical treatment. J Clin Gastroenterol. 2001 May-Jun. 32(5):409-12. [Medline].
Berg DF, Bahadursingh AM, Kaminski DL, Longo WE. Acute surgical emergencies in inflammatory bowel disease. Am J Surg. 2002 Jul. 184(1):45-51. [Medline].
Kiran RP, Nisar PJ, Church JM, Fazio VW. The role of primary surgical procedure in maintaining intestinal continuity for patients with Crohn's colitis. Ann Surg. 2011 Jun. 253(6):1130-5. [Medline].
Kamm MA, Ng SC. Perianal fistulizing Crohn's disease: a call to action. Clin Gastroenterol Hepatol. 2008 Jan. 6(1):7-10. [Medline].
Bode M, Eder S, Schurmann G. [Perianal fistulas in Crohn's disease--biologicals and surgery: is it worthwhile?]. Z Gastroenterol. 2008 Dec. 46(12):1376-83. [Medline].
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. [Medline].
Liu CD, Rolandelli R, Ashley SW, Evans B, Shin M, McFadden DW. Laparoscopic surgery for inflammatory bowel disease. Am Surg. Dec 1995. 61(12):1054-6.
Sardinha TC, Wexner SD. Laparoscopy for inflammatory bowel disease: pros and cons. World J Surg. 1998 Apr. 22(4):370-4. [Medline].
Georgeson KE, Cohen RD, Hebra A, et al. Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease: a new gold standard. Ann Surg. 1999 May. 229(5):678-82; discussion 682-3. [Medline]. [Full Text].
Lowney JK, Dietz DW, Birnbaum EH, Kodner IJ, Mutch MG, Fleshman JW. Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn's disease compared with conventional surgery? A long-term, follow-up study. Dis Colon Rectum. 2006 Jan. 49(1):58-63. [Medline].
Chen HH, Wexner SD, Iroatulam AJ, et al. Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus. Dis Colon Rectum. 2000 Jan. 43(1):61-5. [Medline].
Eshuis EJ, Polle SW, Slors JF, et al. Long-term surgical recurrence, morbidity, quality of life, and body image of laparoscopic-assisted vs. open ileocolic resection for Crohn's disease: a comparative study. Dis Colon Rectum. 2008 Jun. 51(6):858-67. [Medline].
Eshuis EJ, Bemelman WA, van Bodegraven AA, et al. Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial). BMC Surg. 2008 Aug 22. 8:15. [Medline].
[Guideline] Farraye FA, Melmed GY, Lichtenstein GR, Kane SV. ACG clinical guideline: preventive care in inflammatory bowel disease. Am J Gastroenterol. 2017 Feb. 112 (2):241-58. [Medline]. [Full Text].
[Guideline] Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr. 113 (4):481-517. [Medline]. [Full Text].
[Guideline] Bruining DH, Zimmermann EM, Loftus EV Jr, et al. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Gastroenterology. 2018 Mar. 154 (4):1172-94. [Medline].
Experts offer guidance on cross-sectional enterography in Crohn’s disease. Reuters Health Information. Available at https://www.medscape.com/viewarticle/891631. January 23, 2018; Accessed: July 26, 2019.
Willeman T, Jourdil JF, Gautier-Veyret E, Bonaz B, Stanke-Labesque F. A multiplex liquid chromatography tandem mass spectrometry method for the quantification of seven therapeutic monoclonal antibodies: Application for adalimumab therapeutic drug monitoring in patients with Crohn's disease. Anal Chim Acta. 2019 Aug 27. 1067:63-70. [Medline].
Khan KJ, Ullman TA, Ford AC, et al. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr. 106(4):661-73. [Medline].
Feagan BG, Rutgeerts PJ, Sands BE, et al. Induction therapy for ulcerative colitis: results of GEMINI I, a randomized, placebo-controlled, double-blind, multicenter phase 3 trial [abstract 943b]. Gastroenterology. 2012. 142(5):S160-61.
Sakuraba A, Keyashian K, Correia C, et al. Natalizumab in Crohn's disease: results from a US tertiary inflammatory bowel disease center. Inflamm Bowel Dis. 2013 Mar. 19(3):621-6. [Medline].
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. [Medline]. [Full Text].
Valentine JF, Fedorak RN, Feagan B, et al. Steroid-sparing properties of sargramostim in patients with corticosteroid-dependent Crohn's disease: a randomised, double-blind, placebo-controlled, phase 2 study. Gut. 2009 Oct. 58(10):1354-62. [Medline].
[Guideline] Feuerstein JD, Nguyen GC, Kupfer SS, Falck-Ytter Y, Singh S, for the American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on therapeutic drug monitoring in inflammatory bowel disease. Gastroenterology. 2017 Sep. 153 (3):827-34. [Medline]. [Full Text].
Satta R, Pes GM, Rocchi C, Pes MC, Dore MP. Is probiotic use beneficial for skin lesions in patients with inflammatory bowel disease?. J Dermatolog Treat. 2019 Sep. 30 (6):612-6. [Medline].

Media Gallery

Colonoscopic image of a large ulcer and inflammation of the descending colon in a 12-year-old boy with Crohn disease.
Laparoscopic view depicts creeping fat along the mesentery of the terminal ileum.
On this laparoscopic photograph, the mesentery of the terminal ileum is being coagulated with a sealing device (LigaSure; Valley Lab, Boulder, Colo). Note that the ligation of the mesentery proceeds near the border of the ileum rather than at the base of the mesentery.
This postoperative photograph depicts incisions used for laparoscopic ileocolectomy in a 14-year-old male adolescent with obstruction of terminal ileum. Note 2-cm incision in right lower abdomen, through which the specimen was extracted and extracorporeal anastomosis performed. 12-mm umbilical incision is nicely hidden in the depths of the umbilicus. 5-mm incision is visible in left lower abdomen, and another is in left suprapubic region just above the top of the pants.
Colonic granuloma in patient with Crohn disease. Hematoxylin-eosin staining. Image courtesy of Dr E. Ruchelli.
Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.
Double-contrast barium enema study demonstrates marked ulceration, inflammatory changes, and narrowing of right colon in patient with Crohn colitis.
Cobblestoning in Crohn disease. Spot view of the terminal ileum from a small bowel follow-through study demonstrates linear longitudinal and transverse ulcerations that create a cobblestone appearance. Also, note the relatively greater involvement of the mesenteric side of the terminal ileum and the displacement of the involved loop away from the normal small bowel secondary to mesenteric inflammation and fibrofatty proliferation.
Crohn disease of terminal ileum. Small bowel follow-through study demonstrates the string sign in terminal ileum. Also, note pseudodiverticula of the antimesenteric wall of terminal ileum, secondary to greater distensibility of this less-involved wall segment.
Spot view of the terminal ileum from a small bowel follow-through study in a patient with Crohn disease demonstrates the string sign, consistent with narrowing and stricturing. Also, note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.
Enterocolic fistula in patient with Crohn disease. Double-contrast barium enema study demonstrates multiple fistulous tracts between terminal ileum and right colon adjacent to the ileocecal valve (so-called double-tracking of ileocecal valve).
Active small bowel inflammation in a patient with Crohn disease. This CT scan demonstrates small bowel wall thickening, mesenteric inflammatory stranding, and mesenteric adenopathy.
This computed tomography scan from a patient with terminal ileal Crohn disease shows an enteroenteral fistula (arrow) between loops of diseased small intestine.
A teenaged patient with Crohn disease underwent contrast-enhanced upper gastrointestinal CT with small-bowel follow-through. Several loops of small bowel are in the pelvis. Note loop of distal bowel with thickened wall (solid arrow), which is contrasted with less-involved loop of bowel in which intestinal wall is not thickened at all (dotted arrow).
CT scan depicts Crohn disease in fundus of stomach.
MRI demonstrates inflamed terminal ileum in 10-year-old girl with Crohn disease.
Granuloma in mucosa of a patient with Crohn disease.

of 17

Author

Leyla J Ghazi, MD Assistant Professor, Department of Medicine, Associate Program Director, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine

Leyla J Ghazi, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Specialty Editor Board

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Chief Editor

Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy