BIOMEDICAL 28 THE SCIENTIST
SCIENCE History
MEDICAL EPONYMS PT. 7(2):
CROHN’S DISEASE
This is the second instalment of the seventh article in a series of short biographies of persons whose names are directly used for diseases, conditions or syndromes familiar to those in clinical pathology laboratories.
I IMAGE: SUPPLIED BY NATIONAL INSTITUTES OF HEALTH
n the previous article on Crohn’s disease (CD), published in the January issue of the Biomedical Scientist, the main focus was to briefly review advances in knowledge of CD from around the 16th century to the 1980s. Here we review more recent developments in our knowledge of clinical features, aetiology, investigations and treatment options.
Current perspectives CD is an idiopathic chronic regional enteritis commonly affecting the terminal ileum in 40–50% of cases, with 30–40% affecting small intestine and colon. There is transmural thickening and inflammation of discontinuous sections of intestine and in some cases non-necrotising granulomas with epithelioid histiocytes.
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Patients may present with a history of cramping abdominal pain, diarrhoea with intestinal fistula and intramural abscesses. A pattern of periods of remission and relapses when symptoms flare may become apparent. A differential diagnosis between CD and ulcerative colitis is essential due to the choice of treatment options available. This involves an understanding of clinical, radiological, endoscopic, and pathological features of CD.
Epidemiology There is a wide range of prevalence of around 26-199 cases/100,000 persons. CD is more common in white people living in Western industrialised countries. There is a steady increase in cases of unknown cause and although CD may occur at any age it is more common in
two age groups – between 13 and 20 years and 60 and 70 years, with a slight increase in females.
Aetiology Even 90 years after Crohn’s landmark publication, the exact cause of CD is not known but a number of risk factors have been identified, such as family history, smoking, diet and ethnicity. It has been proposed that there are multifactorial causes, notably that the immune response of the intestinal mucosa becomes defective and there are possible changes in the balance of bacteria in the gut flora. Professor John Hunter at Addenbrooke’s Hospital suggests that there is a reduction in lactobacilli and bifidobacteria with an increase in facultative anaerobes. In addition, abnormal fermentation of food digests may damage the intestinal
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