J Am Coll Radiol 2010;7:94-102

ACR Appropriateness Criteria on Crohn's Disease

James E. Huprich, MD, Max Paul Rosen, MD, MPH, Jeff L Fidler, MD Spencer B. Gay, MD, Thomas H. Grant, DO, Frederick L. Greene, MD, Tasneem Lalani, MD, Frank H. Miller, MD, Don C. Rockey, MD Gary S. Sudakoff, MD, Richard Gunderman, MD, PhD, Brian D. Coley, MD

SUMMARY OF LITERATURE REVIEW

Crohn's disease (CD) is a chronic inflammatory disease involving the gastrointestinal tract. The etiology is unknown, but evidence suggests that a genetic predisposition combined with an abnormal interaction between the gut and enteric microorganisms may play a role in the pathogenesis. Patients usually present with the abrupt or insidious onset of abdominal pain and diarrhea, frequently accompanied by fever and weight loss. The small intestine and colon are most commonly affected, but any  portion of the bowel from mouth to anus may be involved. The small bowel is affected alone in about a third of patients, the colon alone in 20% to 30% of patients, and combined involvement of the colon and the small bowel is seen in 40% to 50% of patients. The severity of symptoms, frequency of complications, and likelihood of intestinal resection due to CD are typically greater in patients with ileocolic involvement than in those with disease limited to the small bowel or colon alone [1]. Characteristic pathologic findings of CD in the gut include transmural granulomatous inflammation, deep ulcers that may progress to sinus tracts and fistulas, strictures that may lead to intestinal obstruction, and discontinuous involvement, with skip areas between diseased segments. Extraintestinal manifestations are common and include arthritis, cholelithiasis, ocular manifestations, dermatologic abnormalities, and, in children, growth retardation [2].