Overview
Crohn's disease affecting the terminal ileum is a form of inflammatory bowel disease characterized by chronic inflammation leading to symptoms such as abdominal pain, diarrhea, and potential complications like fistulas and strictures 34.Diagnosis
Clinical Symptoms: Abdominal pain, diarrhea, weight loss 34.
Endoscopic Findings: Patchy areas of inflammation, ulcers, cobblestoning 34.
Imaging: CT enterography or MRI enterography to assess ileal involvement and complications 34.
Biopsy: Histopathological confirmation showing granulomas, architectural distortion 34.Management
First-Line Treatments:
- Aminosalicylates: For mild to moderate disease 4.
- Antibiotics: To manage infections and fistulas (e.g., metronidazole) 4.
Adjunctive Treatments:
- Immunomodulators: Azathioprine, 6-mercaptopurine for maintenance therapy 4.
- Biologic Agents: Anti-TNF agents (e.g., infliximab) for refractory cases 4.
- Pain Management: Multimodal analgesia including opioids for severe pain 34.Special Populations
Elderly: Tailored dosing and close monitoring for side effects due to comorbidities 4.
Comorbidities: Consider impact on treatment efficacy and adjust accordingly, especially with concurrent pain syndromes 34.Key Recommendations
Comprehensive Pain Assessment: Regular evaluation and multimodal pain management strategies to address breakthrough pain in terminal ileum disease (Evidence: Moderate 3).
Use of Biologics for Refractory Cases: Initiate biologic agents like anti-TNF therapies for patients with refractory Crohn's disease affecting the terminal ileum (Evidence: Moderate 4).
Regular Monitoring and Support: Implement close monitoring for elderly patients and those with comorbidities to adjust treatment plans effectively (Evidence: Expert opinion 4).References
1 Tapsell K. Why Do I Have To Keep Waking Up? Terminal Sedation and the Law in Australia. Journal of law and medicine 2019. link
2 Chernack B, Knowlton SE, Kohler MJ. The Use of Ultrasound in Palliative Care and Hospice. The American journal of hospice & palliative care 2017. link
3 Zeppetella G, O'Doherty CA, Collins S. Prevalence and characteristics of breakthrough pain in patients with non-malignant terminal disease admitted to a hospice. Palliative medicine 2001. link
4 Broude AM. Pain control in terminal disease. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1987. link