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The management of chronic Crohn's disease.

Ulster Medical Society
Publication Date
  • Research Article
  • Biology
  • Medicine


THE MANAGEMENT OF CHRONIC CROHN'S DISEASE JAMES KYLE, M.Ch., F.R.C.S., F.R.C.S.(l.) Department of Surgery, Woodend Hospital, Aberdeen IN NEARLY all patients, Crohn's disease runs a chronic course, usually extending over many years. The thirty-fourth President of the United States, Dwight D. Eisenhower, had the disease for 46 years (Heaton et al, 1964). Without definitive treatment, there is no real evidence that the inflammatory process will ever cease spontaneously and the patient become permanently symptom-free. Progression of Crohn's disease of the colon can often be seen in serial barium enema examina- tions. It is much more difficult to obtain strictly comparable films of small intestinal changes but progression probably does occur in some untreated patients (Marshak and Linder, 1970). Often, however, it appears that the disease remains active in a short length of lower ileum for years without spreading proximally. Recurrences after inadequate surgical treatment are well known. The very chronic nature of Crohn's disease is a major factor in planning the treatment of any patient in whom the diagnosis has been made. DIAGNOSIS The diagnosis of Crohn's disease rests on four main pillars: (i) clinical history and findings; (ii) radiological investigations; (iii) macroscopic appearances, and (iv) histological findings. At least two out of the four must be presented to support the diagnosis. The appearances on X-ray may not always correspond with the clinical state of the patient. When multiple sections are cut, the classical epithelioid cell granulomas and the giant cells will be seen on histological examination in two- thirds of resected or biopsy specimens; their absence does not rule out Crohn's disease. Today more emphasis is placed on the transmural extent of the inflamma- tion and to fissure formation and rather less on Hadfield's (1939) classical criteria. While the diagnosis is usually straightforward, in a quarter of all patients it may only be possible to make the correct diagnosis af

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