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Recent advances in clinical practice: a systematic review of isolated colonic Crohn's disease: the third IBD?
Sreedhar Subramanian1, Anders Ekbom2, Jonathan M Rhodes1
1Institute of Translational Medicine, University of Liverpool, The Henry Wellcome Laboratory, Liverpool, UK.
Insights
Isolated colonic Crohn's disease may be a distinct condition. It presents differently, with unique microbiota and treatment responses, warranting separate study.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Genetics
- Microbiome Research
Background:
- Isolated colonic Crohn's disease (ICCD) presents unique genetic and clinical characteristics.
- Its classification remains debated, often grouped with small intestinal Crohn's disease or ulcerative colitis (UC).
- Understanding ICCD's distinct epidemiology, pathophysiology, and treatment is crucial.
Purpose of the Study:
- To systematically review the epidemiology, pathophysiology, and treatment of ICCD.
- To evaluate ICCD's potential as a separate entity from other inflammatory bowel diseases.
- To identify key differences and similarities between ICCD, ileal Crohn's disease, and UC.
Main Methods:
- Systematic literature review of epidemiological, pathophysiological, and treatment data for ICCD.
- Comparative analysis of ICCD characteristics against small intestinal Crohn's disease and UC.
- Review of diagnostic challenges and differential diagnoses for ICCD.
Main Results:
- ICCD shows a higher incidence in females (65%) and older patients compared to other Crohn's disease sites.
- Its associated microbiota is intermediate between ileal Crohn's disease and UC.
- No response to mesalazine was observed, but a potential better response to anti-tumour necrosis factor agents was noted.
- Diagnostic differentiation from UC and other conditions like ischemic colitis is challenging.
Conclusions:
- ICCD exhibits distinct features supporting its consideration as a separate condition.
- Further research, including dedicated clinical trials and cohort studies, is essential.
- Separate assessment of ICCD is recommended to refine understanding and management strategies.
Abstract:
The genetics of isolated colonic Crohn's disease place it approximately midway between Crohn's disease with small intestinal involvement and UC, making a case for considering it as a separate condition. We have therefore systematically reviewed its epidemiology, pathophysiology and treatment. Key findings include a higher incidence in females (65%) and older average age at presentation than Crohn's disease at other sites, a mucosa-associated microbiota between that found in ileal Crohn's disease and UC, no response to mesalazine, but possibly better response to antitumour necrosis factor than Crohn's disease at other sites. Diagnostic distinction from UC is often difficult and also needs to exclude other conditions including ischaemic colitis, segmental colitis associated with diverticular disease and tuberculosis. Future studies, particularly clinical trials, but also historical cohorts, should assess isolated colonic Crohn's disease separately.
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