[Crohn disease. Diagnosis and treatment]

Crohn's disease was the topic of a meeting of gastroenterologists in Bergen last year with the purpose of working out consensus guidelines for diagnosis and treatment of this chronic disease. The most important diagnostic procedures are radiology, gastrointestinal endoscopy and histopathology. Transmural, segmental involvement is characteristic, whereas granulomas are found in only 25% of biopsy specimens. Corticosteroids are effective in active Crohn's disease located to all parts of the intestine, whereas sulfasalazine and metronidazole are most effective in Crohn's colitis. Azathioprine and 6-mercaptopurine should be reserved for patients with chronic active disease that is unresponsive to steroids or requires higher doses. Azathioprine also has a prophylactic effect. Surgery is indicated in patients whose quality of life is diminished in spite of adequate medical treatment, in patients with bowel or ureter stenosis, fistula or abscess, and in patients with acute perforation or toxic dilatation. Limited resection is recommended, and stricture plasty can be alternative to extensive resection.