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Crohn disease of appendix — Clinical Guidelines

Overview

Crohn disease is a chronic inflammatory condition affecting any part of the gastrointestinal tract, characterized by periods of remission and exacerbation. It can involve extraintestinal manifestations and requires multidisciplinary management. 2 6 7

Diagnosis

Clinical Presentation: Episodic flares and remissions, symptoms vary by affected segment.

Laboratory Tests: Elevated inflammatory markers, anemia, and nutritional deficiencies.

Imaging: CT enterography, MR enterography for assessing disease extent and complications. 6

Endoscopy and Histology: Essential for confirming diagnosis and assessing disease activity.

Differential Diagnosis: Includes other inflammatory bowel diseases and infections. 2

Management

First-Line Treatments:

- Aminosalicylates: For mild disease. - Immunomodulators: Azathioprine, 6-mercaptopurine. - Biologics: Infliximab, adalimumab, risankizumab, upadacitinib for moderate-to-severe disease. 1 3

Adjunctive Therapies:

- Nutritional Support: Exclusive enteral nutrition (EEN) particularly in pediatric patients. 5 9 - Surgical Intervention: For complications like strictures, fistulas, and perforations. 4 10

Special Populations

Pediatrics: Exclusive enteral nutrition (EEN) recommended for inducing remission. 5 9

Comorbidities: Management requires consideration of coexisting autoimmune conditions and nutritional deficiencies. 7 8

Key Recommendations

Use exclusive enteral nutrition (EEN) as a first-line treatment for inducing remission in pediatric Crohn disease. (Evidence: Strong 5 9)

Consider biologic agents like risankizumab and upadacitinib for achieving clinical remission in moderate-to-severe Crohn disease. (Evidence: Moderate 1 3)

Employ advanced imaging techniques such as CT enterography and MR enterography for comprehensive assessment of disease extent and complications. (Evidence: Moderate 6)

References

1 Rowan C. In moderate-to-severe Crohn disease, upadacitinib increased clinical remission at 12 and 52 wk. Annals of internal medicine 2023. link 2 Moore MM, Gee MS, Iyer RS, Chan SS, Ayers TD, Bardo DME et al.. ACR Appropriateness Criteria® Crohn Disease-Child. Journal of the American College of Radiology : JACR 2022. link 3 Oliver D, Talley NJ. In active Crohn disease, risankizumab increased clinical remission and endoscopic response at 12 wk. Annals of internal medicine 2022. link 4 Slavu I, Alecu L, Tulin A, Mihaila D, Braga V, Voiosu T et al.. Reintervention Rate Following Emergency Surgery for Crohn Disease. Chirurgia (Bucharest, Romania : 1990) 2018. link 5 Van Limbergen J, Haskett J, Griffiths AM, Critch J, Huynh H, Ahmed N et al.. Toward enteral nutrition for the treatment of pediatric Crohn disease in Canada: a workshop to identify barriers and enablers. Canadian journal of gastroenterology & hepatology 2015. link 6 Kim DH, Carucci LR, Baker ME, Cash BD, Dillman JR, Feig BW et al.. ACR Appropriateness Criteria Crohn Disease. Journal of the American College of Radiology : JACR 2015. link 7 Ferrara LR, Saccomano SJ. Crohn disease: recognition is key. The Nurse practitioner 2012. link 8 Rosmaninho A, Sanches M, Fernandes IC, Pinto-Almeida T, Vilaça S, Oliveira A et al.. Letter: Pellagra as the initial presentation of Crohn disease. Dermatology online journal 2012. link 9 Stewart M, Day AS, Otley A. Physician attitudes and practices of enteral nutrition as primary treatment of paediatric Crohn disease in North America. Journal of pediatric gastroenterology and nutrition 2011. link 10 Colletti RB, Baldassano RN, Milov DE, Margolis PA, Bousvaros A, Crandall WV et al.. Variation in care in pediatric Crohn disease. Journal of pediatric gastroenterology and nutrition 2009. link 11 Rypens F, Dubois J, Garel L. The place of interventional radiology in Crohn disease in children. Pediatric radiology 2007. link 12 Zelhof B, Biyani CS, Anathhanam AJ, Pollock B, Browning AJ. Severe penile edema: an unusual presentation of metastatic Crohn disease. International journal of urology : official journal of the Japanese Urological Association 2006. link 13 Henneberg Holmboe C, Thorlacius-Ussing O, Teglbjaerg PS, Vinter-Jensen L. Inverted Meckel's diverticulum masquerading Crohn disease in the small intestine. Scandinavian journal of gastroenterology 2003. link 14 Levine A, Milo T, Buller H, Markowitz J. Consensus and controversy in the management of pediatric Crohn disease: an international survey. Journal of pediatric gastroenterology and nutrition 2003. link 15 Reimers TM, Vance MD, Young RJ. Teaching self-administration of nasogastric tube insertion to an adolescent with Crohn disease. Journal of applied behavior analysis 1995. link 16 Yue NC, Jones B. Crohn disease: prone-angled compression view in radiographic evaluation. Radiology 1993. link 17 Goodman P, Raval B, Potter GD. Spontaneous free perforation of the ileum in Crohn disease: CT demonstration. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 1989. link90289-9) 18 Boag GS, Nolan RL. Sonographic features of urinary bladder involvement in regional enteritis. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 1988. link 19 Glick SN, Teplick SK, Goodman LR, Clearfield HR, Shanser JD. Development of lymphoma in patients with Crohn disease. Radiology 1984. link 20 Handelsman JC, Fishbein RH, Bayless T, Burbige E. Salvage after anastomotic leak in Crohn disease. Utilization of a new, simple diverting ileostomy. Archives of surgery (Chicago, Ill. : 1960) 1976. link

Crohn disease of appendix