Crohn's Disease – Disease for Immunologists, Proctologists, Gastroenterologists or Rheumatologists?

Abstract

Crohn's Disease (CD) most commonly affects the terminal portion of the small intestine and the large intestine. CD can also affect any other part of the gastrointestinal tract, from mouth to anus. Inflammation of the intestines is usually not continuous, areas inflammation (foci of inflamed bowel) interspersed with normal areas intestines (segmental lesion). Depending on the severity of the inflammation the inner layer of the intestinal wall (mucosa) may turn red (erythematous) and swollen (edematous) with ulcers of different sizes and shapes (aphthae’s, superficial, deep, longitudinal), and the mucous membrane can have the appearance of a "cobblestone pavement". These lesions extend throughout the thickness intestinal wall and can lead to complications such as stenosis of the intestinal lumen and / or germination in other organs (penetration), resulting in abscesses (infiltration of intestinal contents into the abdominal cavity) or fistulas (channels that connect the intestinal cavity with the skin or neighboring organs, for example, the bladder, or with other intestinal loops and through which they enters the contents of the intestine). In addition, in a significant number of patients, CD can affect various parts of the body outside the digestive tract, usually the skin, joints, and eyes.These extra-intestinal manifestations may also occur before the development of typical intestinal symptoms of CD (see below), and sometimes they cause more anxiety and more difficult to treat than intestinal symptoms.