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Crohns sjukdom

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Kronisk inflammatorisk sjukdom med segmentell, transmural inflammation som kan påverka alla avsnitt av magtarmkanalen.
Förekomst:
Incidensen i Sverige är cirka 10 per 100 000 per år och är högst i åldersgruppen 15–40 år.
Symtom:
Beror på lokalisation och allvarlighetsgrad av inflammationen. Typiska symtom är buksmärtor, diarré, perianala besvär och viktminskning.
Kliniska fynd:
Olika kliniska bilder. Vid kronisk inflammatorisk sjukdom finns ofta fokal palpationsömhet i höger nedre kvadrant. Intestinal obstruktion, fistelbildning, perianal sjukdom och extraintestinala manifestationer (hud, ögon, leder, lever, osteoporos, tillväxthämning hos barn) kan förekomma.
Diagnostik:
Kalprotektin i avföring är vanligtvis förhöjt. CRP kan vara förhöjt. Endoskopi med biopsier och bildundersökningar kan bekräfta diagnosen.
Behandling:
Behandlingen inriktas på näringstillstånd, symtomkontroll och specifik läkemedelsbehandling för att minska sjukdomsaktivitet och komplikationer.
  1. Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician 2011; 84: 1365-75. pmid:22230271 PubMed  
  2. Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. Journal of Crohn's and Colitis, Volume 13, Issue 2, February 2019, Pages 144–164K . academic.oup.com  
  3. Behandlingsrekommendation läkemedelsbehandling vid inflammatorisk tarmsjukdom. Läkemedelsverket (2021) www.lakemedelsverket.se  
  4. Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007; 5: 1424-9. PubMed  
  5. Kalla R, Ventham NT, Satsangi J, et al. Crohn's disease. BMJ. 2014 Nov 19;349:g6670. doi: 10.1136/bmj.g6670. DOI  
  6. Suryaprasad AG, Prindiville T. The biology of TNF blockade. Autoimmun Rev 2003; 2: 346-57. PubMed  
  7. Halme L, Paavola-Sakki P, Turunen U, et. al. Family and twin studies in inflammatory bowel disease. World J Gastroenterol 2009; 12: 3668-72. PubMed  
  8. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347: 417-29. PubMed  
  9. Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med 2009; 361: 2066-78 New England Journal of Medicine  
  10. Hanauer SB, Sanborn W. The management of Crohn's disease in adults. Am J Gastroenterol 2001; 96: 635-43. pmid:11280528 PubMed  
  11. Feagan BG. Maintenance therapy for inflammatory bowel disease. Am J Gastroenterol 2003; 98: 6-17. PubMed  
  12. Yamamato T. The clinical value of faecal calprotectin and lactoferrin measurement in postoperative Crohn's disease. 2015;3(1):5-10
  13. de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743-752. PubMed  
  14. Holtman GA, Lisman-van Leeuwen Y, Reitsma JB, et al. Noninvasive tests for inflammatory bowel disease: A meta-analysis. Pediatrics 2016; 137:1-11. doi: 10.1542/peds.2015-2126 DOI  
  15. Tibble J, Teahon K, Thjodleifsson B, Roseth A, Sigthorsson G, Bridger S, Foster R, Sherwood R, Fagerhol M, Bjarnason I. A simple methood for assessing intestinal inflammation in Crohns's disease. Gut 2000; 47: 506-13 Gut  
  16. SBU Kommenterar 2014-09-04: Bestämning av kalprotektin i feces kan skilja mellan inflammatorisk tarmsjukdom och icke-inflammatoriska tarmbesvär. www.sbu.se  
  17. van Rheenen PF, de Vijver EV, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341: c3369. BMJ (DOI)  
  18. Yang Z, Clark N, Park KT. Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease in adults and children. Clin Gastroenterol Hepatol 2014; 12: 253-62. pmid:23883663 PubMed  
  19. Kennedy NA, Jones G-R, Plevris N, et al. Association between level of fecal calprotectin and progression of Crohn's disease. Clinical Gastroenterology and Hepatology Available online 14 February 2019. doi:10.1016/j.cgh.2019.02.017 DOI
  20. Nationell riklinje Kapselenteroskopi 2023. Svensk Gastroenterologisk Förening svenskgastroenterologi.se  
  21. Solem CA, Loftus EV Jr, Fletcher JG, et al. Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 2008; 68: 255-66. PubMed  
  22. Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008; 247: 64-79. Radiology  
  23. Wang H, Zhao J, Zhu W, et al. Ultrasound as a diagnostic tool in detecting active Crohn's disease: a meta-analysis of prospective studies. Eur Radiol. 2014 Jan;24(1):26-33. doi: 10.1007/s00330-013-2973-0.
  24. Potthast S, Rieber A, von Tirpitz C, Wruk D, Adler G, Brambs HJ. Ultrasound and magnetic resonance imaging in Crohn's disease: a comparison. Eur Radiol 2002; 12: 1416 - 22. PubMed  
  25. Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1430-8. PMID: 18054751 PubMed  
  26. Nationell riktlinje 2020 På uppdrag av Svensk Gastroenterologisk Förenings styrelse Fertilitet, graviditet och amning vid inflammatorisk tarmsjukdom. Hämtad 2020-10-15 svenskgastroenterologi.se  
  27. Cosnes J, Beaugerie L, Carbonnel F et al. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 2001;120:1093-9. Gastroenterology  
  28. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57: 2171-7. pmid:22661250 PubMed  
  29. Buchanan E, Gaunt WW, Cardigan T et al. The use of exclusive enteral nutrition for induction of remission in children with Crohn's disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther 2009; 30: 501-7. pmid:19549288 PubMed  
  30. Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database of Syst Rev 2007; 1: CD000542. doi:10.1002/14651858.CD000542.pub2 DOI  
  31. Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn's disease. Cochrane Database of Syst Rev 2007; 3: CD005984. doi:10.1002/14651858.CD005984.pub2 DOI  
  32. Zhan YL, Zhan YA, Dai SX. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin Nutr. 2017 May 24. pmid:28587774 PubMed  
  33. Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis. 2017 Feb;11(2):135-149. PubMed  
  34. Singh S, Garg SK, Pardi DS, et al. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn's disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015 Jan;148(1):64-76.e2; quiz e14. doi: 10.1053/j.gastro.2014.09.031.
  35. Tøttrup A. Laparoskopisk kirurgi ved inflammatorisk tarmsygdom. Ugeskr Læger 2010; 172: 2287. Ugeskrift for Læger  
  36. Schwartz DA, Wiersema MJ, Dudiak KM et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology 2001;121:1064-72. Gastroenterology  
  37. Singh S, Ding N S, Mathis K L, et al (2015). Systematic review with meta-analysis: faecal diversion for management of perianal Crohn's disease. Alimentary Pharmacology & Therapeutics, 42: 783–792. doi: 10.1111/apt.13356 DOI  
  38. Ringerike T, Elvsaas I-KØ, Coll P, et al. TNFα-hemmere ved inflammatorisk tarmsykdom. Rapport fra Kunnskapssenteret - Systematisk oversikt nr. 32 2008. www.kunnskapssenteret.no  
  39. Prefontaine E, Sutherland LR, MacDonald JK, Cepoiu M. Azathioprine or 6-mercaptopurine for maintenance of remission in Crohn's disease. Cochrane Database of Syst Rev 2008; 1: CD000067. doi:10.1002/14651858.CD000067.pub2 DOI  
  40. Gisbert JP, Gomollon F, Mate J, Pajares JM. Role of 5-aminosalicylic acid (5-ASA) in treatment of inflammatory bowel disease. A systematic review. Dig Dis Sci 2002; 47: 471 - 88. PubMed  
  41. Torres J, Bonovas S, Doherty G, et al. ECCO Guidelines on Therapeutics in Crohn's Disease: medical treatment. European Crohn’s and Colitis Organisation (ECCO), 2019. outlook.office365.com  
  42. Moum B. Prognose og behandling ved kronisk inflammatorisk tarmsykdom. Tidsskr Nor Lægeforen 2001; 121: 318-21. Tidsskrift for Den norske legeforening  
  43. Torres J, Boyapati RK, Kennedy NA, et al. Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease. Gastroenterology. 2015 Dec;149(7):1716-30 PubMed  
  44. Lofthus EV, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther 2002; 16: 51-60. PubMed  
  45. Grimstad T, Norheim KB, Isaksen K et al. Fatigue in Newly Diagnosed Inflammatory Bowel Disease. J Crohns Colitis 2015; 9: 725-30. pmid:25994356 PubMed  
  46. Hovde O, Kempski-Monstad I, Smastuen MC, et al. Mortality and causes of death in Crohn`s disease: results from 20 years of follow-up in the IBSEN study. Gut. 2013 Jun 6. PMID: 23744613. PMID: 23744613 PubMed  
  47. Olén O, Askling J, Sachs MC et al. Mortality in adult-onset and elderly-onset IBD: a nationwide register-based cohort study 1964-2014. Gut 2019. Epub. 317572 pmid:31092591 PubMed  
  48. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in Crohn's disease: a Scandinavian population-based cohort study published online ahead of print, 2020 Feb 13. Lancet Gastroenterol Hepatol. 2020;S2468-1253(20)30005-4. PMID: 32066530 PubMed  
  49. Ewe K, Herfarth C, Malchow H, Jesdinsky HJ. Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulphasalazine prophylaxis: a multicenter trial. Digestion 1989; 42: 224-32. PubMed  
  50. Melek J, Sakuraba A. Efficacy and safety of medical therapy for low bone mineral density in patients with inflammatory bowel disease: a meta-analysis and systematic review. Clin Gastroenterol Hepatol 2014; 12: 32-44. doi: 10.1016/j.cgh.2013.08.024 DOI  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet
  • Bjørn Moum, professor i gastroenterologi, Oslo Universitetssykehus