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Crohns sykdom

Sist oppdatert: Sist revidert:
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Definisjon:
Kronisk, inflammatorisk sykdom som kan ramme hele GI-tractus. Årsaken er ukjent men mikrobiota i tarm har stort forskningsfokus. Arv disponerer og røyking forverrer sykdomsforløp
Forekomst:
Insidensen i Norge er ca. 7 per 100.000 per år, høyest i aldersgruppen fra 20-30 år. Det foreligger en kraftig økning i forekomst hos barn
Symptomer:
Avhenger av lokalisasjon og alvorlighetsgrad. Magesmerter, intermitterende løs avføring, vekttap.
Funn:
Ved palpasjon kan man finne lokalisert ømhet/smerter. Vekststagnasjon hos barn, diaré og vekttap hos voksne
Diagnostikk:
Kalprotectin i feces er vanligvis forhøyet. Inflammasjonsparametre som CRP og SR kan være forhøyet
Behandling:
Tar sikte på å indusere og opprettholde remisjon. Kortikosteroider og biologisk behandling. Eksklusiv enteral ernæring brukes fortsatt hos barn
  1. Veauthier B, Hornecker JR. Crohn's Disease: Diagnosis and Management. Am Fam Physician. 2018;98(11):661-669. 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. DOI: 10.1093/ecco-jcc/jjy113 DOI  
  3. Buer LCT, Moum BA. Inflammatorisk tarmsykdom – diagnostikk og behandling. Indremedisineren, publisert 10.08.2016. indremedisineren.no  
  4. Kalla R, Ventham NT, Satsangi J, et al. Crohn's disease. BMJ. 2014;349:g6670. doi: 10.1136/bmj.g6670 DOI  
  5. 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  
  6. Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med 2009; 361: 2066-78. New England Journal of Medicine  
  7. Takeuchi K, Smale S, Premchand P, et al. Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2006; 4: 196-202. PubMed  
  8. Marks DJ, Rahman FZ, Sewell GW, Segal AW. Crohn's disease: an immune deficiency state. Clin Rev Allergy Immunol. 2010 Feb;38(1):20-31. doi: 10.1007/s12016-009-8133-2. DOI  
  9. Yamamato T. The clinical value of faecal calprotectin and lactoferrin measurement in postoperative Crohn's disease. United European Gastroenterology Journal 2015; 3: 5-10. doi:10.1177/2050640614558106 DOI  
  10. 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  
  11. 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  
  12. Jahnsen J, Røseth AG, Aadland A. Måling av kalprotektin i feces. Tidsskr Nor Legeforen 2009; 129: 743-5. Tidsskrift for Den norske legeforening  
  13. 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)  
  14. 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  
  15. Dajti E, Frazzoni L, Iascone V, et al. Systematic review with meta-analysis: Diagnostic performance of faecal calprotectin in distinguishing inflammatory bowel disease from irritable bowel syndrome in adults. Aliment Pharmacol Ther 2023; 58: 1120-1131. pmid:37823411 PubMed  
  16. 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
  17. 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  
  18. 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  
  19. 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 ;24(1):26-33. doi: 10.1007/s00330-013-2973-0. DOI  
  20. Reese G, Woodfield G, Patel PH. Crohn's disease. BMJ Best Practice, last updated Feb 2018.
  21. Benchimol EI, Seow CH, Steinhart AH, Griffiths AM. Traditional corticosteroids for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2008; 16: CD006792. pmid:18425970 PubMed  
  22. Townsend CM, Parker CE, MacDonald JK, et al. Antibiotics for induction and maintenance of remission in Crohn`s disease. Cochrane Database Syst Rev. 2019 Feb 7;2:CD012730. doi: 10.1002/14651858.CD012730.pub2. DOI  
  23. 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  
  24. Steinhart AH, Ewe K, Griffiths AM et al. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2008, Issue 4. The Cochrane Library  
  25. Anisdahl K, Svatun Lirhus S, Medhus AW, Moum B, Melberg HO, Høivik ML. First-line biologic treatment of inflammatory bowel disease during the first 12 months after diagnosis from 2010 to 2016: a Norwegian nationwide registry study. Scand J Gastroenterol. 2021;56(10):1163-1168. PubMed  
  26. Lirhus SS, Høivik ML, Moum B, Melberg HO. Regional differences in anti-TNF-α therapy and surgery in the treatment of inflammatory bowel disease patients: a Norwegian nationwide cohort study. Scand J Gastroenterol. 2018 Aug;53(8):952-957. PubMed  
  27. To N, Gracie DJ, Ford AC. The Importance of Smoking Cessation in Improving Disease Course in Crohn's Disease. Am J Gastroenterol. 2016;111(8):1198. PubMed  
  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. Narula N, Dhillon A, Zhang D, Sherlock ME, Tondeur M, Zachos M. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2018, Issue 4. The Cochrane Library  
  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. 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  
  34. Syversen SW, Jørgensen KK, Goll GL, et al. Effect of Therapeutic Drug Monitoring vs Standard Therapy During Maintenance Infliximab Therapy on Disease Control in Patients With Immune-Mediated Inflammatory Diseases A Randomized Clinical Trial. JAMA 2021; 326: 2375-2384. pmid:34932077 PubMed  
  35. Rezaie A, Kuenzig ME, Benchimol EI, Griffiths AM, Otley AR, Steinhart AH, Kaplan GG, Seow CH. Budesonide for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD000296. DOI: 10.1002/14651858.CD000296.pub4 DOI  
  36. Kuenzig ME, Rezaie A, Seow CH, et al. Budesonide for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2014 ;8:CD002913. doi: 10.1002/14651858.CD002913.pub3 DOI  
  37. Ford AC, Peyrin-Biroulet L. Opportunistic infections with anti-tumor necrosis factor-alpha therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol 2013 May 7. pmid:23649185. PubMed  
  38. 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 ;148(1):64-76.e2; quiz e14. doi: 10.1053/j.gastro.2014.09.031.
  39. Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Gastroenterology. 1995 Jun;108(6):1617-21. . pmid:7768364 PubMed  
  40. Herfarth H, Barnes EL, Valentine JF, et al. Methotrexate Is Not Superior to Placebo in Maintaining Steroid-Free Response or Remission in Ulcerative Colitis. Gastroenterology. 2018;155(4):1098-1108.e9.
  41. Conway R, Low C, Coughlan RJ, et al. Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials. BMJ. 2015 Mar 13;350:h1269. doi: 10.1136/bmj.h1269.
  42. Stidham RW, Lee TC, Higgins PD, et al. Systematic review with network meta-analysis: the efficacy of anti-TNF agents for the treatment of Crohn's disease. Aliment Pharmacol Ther. 2014 Jun;39(12):1349-62. doi: 10.1111/apt.12749. DOI  
  43. 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  
  44. Tøttrup A. Laparoskopisk kirurgi ved inflammatorisk tarmsygdom. Ugeskr Læger 2010; 172: 2287. PubMed  
  45. 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  
  46. 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  
  47. 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 ;149:1716-30. doi: 10.1053/j.gastro.2015.08.055. PMID:26381892 PubMed  
  48. 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  
  49. Nørgård B, Pedersen L, Christensen LA, Sørensen HT. Therapeutic drug use in women with Crohn`s disease and birth outcomes: a danish nationwide cohort study. Am J Gastroenterol 2007; 102: 1406-13. PubMed  
  50. Grimstad T, Norheim KB. Utmattelse ved inflammatorisk tarmsykdom. Tidsskr Nor Lægeforen 2016; 136: 1721-24. pmid:27830906 PubMed  
  51. 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  
  52. 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. PubMed  
  53. 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  
  54. 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  
  • Bjørn Moum, professor i gastroenterologi, Oslo Universitetssykehus

Tidligere fagmedarbeidere

  • Terje Johannessen, professor i allmennmedisin, Trondheim
  • Kurt Østhuus Krogh, spesialist i barnesykdommer, Redaksjonsmedarbeider NHI/ overlege Barne- og ungdomsklinikken, St. Olavs Hospital
  • Jan H. Dybdahl, overlege, dr.med., Medisinsk avdeling, St. Olavs Hospital, Trondheim