Crohn's is a variety of Inflammatory Bowel Disease, characterised by ulcers, thickening, fibrous scarring and pathological channels (fistulae). It typically involves at least the last part of the small bowel (distal ileum) but commonly progresses to more widespread bowel involvement. Usual symptoms are fever, diarrhea, weight loss, and cramping abdominal pain.
The cause remains unknown and search for clues remains vigorous[7], [8]. Its incidence and prevalence in different populations may have increased in recent decades[9], [10], [11]. The risk factors for increased rates of recurrence have been well-researched[12].
PRACTICE POINT Crohn's is a disease with
unknown cause, |
Medical treatment aims to reduce the severity of symptoms and maintenance drugs may significantly reduce recurrence rates[13]. The cornerstone remains corticosteroid therapy, which has many complications, including Avascular Necrosis. Various alternative drugs may supplement corticosteroids, particularly in disease affecting the colon[14] and new approaches are being explored[8], [15].
PRACTICE POINT Corticosteriod drugs and
prophylactic |
Surgical excision of bowel is usually necessary to prevent or reduce potentially life-threatening complications and to improve quality of life[14], [16]. Surgery may reduce recurrence rates[12], [17], but for a minority repeat surgery will be required[18].
Crohn's Disease is a relatively common source of medical malpractice enquiry because the disease is often relentlessly progressive. Clients understandably question why medical and surgical treatment seems to have little fundamental impact.
PRACTICE POINT Disease characteristics
which increase the
|
Preventative operative intervention is recommended because surgical complications and death are much less common than following emergency operation[19]. Inevitably, a minority of patients will be worse in the short- and medium-term after such elective surgery, and some will understandably attribute the deterioration to substandard care.
PRACTICE POINT Although activities of
daily living are often |
Actuarial analysis[20] shows prognosis is better than was previous thought. Slightly higher death-rates from all causes are comparable with those of healthy unskilled manual labourers.
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