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By Norton Greenberger, Richard Blumberg, Robert Burakoff

Awesome the fitting stability among comprehensiveness and simplicity of use, this well known access within the present sequence supplies high-yield insurance of the complete spectrum of gastroenterology and hepatology in a streamlined, constant presentation.

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Localization of Crohn disease within the gastrointestinal tract. l i f qu Ileocolonic 35 (26–48) Small bowel only 28 (11–48) Colon only 32 (19–51) Gastroduodenala 1–4 Perianala 18 (14–20) (%) a Typically in conjunction with disease elsewhere. with Crohn disease have inflammation localized to the terminal ileum and cecum (Table 3–1). Isolated small bowel or colonic involvement is also common. Crohn disease of the esophagus, stomach, or duodenum is rare, and virtually unheard of in the absence of small bowel or colonic disease.

Pain and drainage of purulent or fecal material are characteristic of perianal fistulae. Fistulae from the gut may cause a variety of symptoms, depending on the sites of origin and other organ(s) involved: gut—diarrhea, weight loss; skin—drainage; vagina—drainage; bladder—pneumaturia. Stricturing disease causes obstructive symptoms of pain, abdominal distention, nausea, and vomiting. Extraintestinal manifestations are frequently encountered with Crohn disease (as with ulcerative colitis) and are discussed in more detail below.

Clinical epidemiology of inflammatory bowel disease: incidence, prevalence and environmental influences. Gastroenterology. 2004;126:1504–1517. [PMID: 15168363] Strober W, Fuss IJ, Blumberg RS. The immunology of mucosal models of inflammation. Annu Rev Immunol. 2002;20:495–549. [PMID: 11861611] Tuvlin JA, Raza SS, Bracamonte S, et al. Smoking and inflammatory bowel disease: trends in familial and sporadic cohorts. Inflamm Bowel Dis. 2007;13:573–579. [PMID: 17345609] GENERAL PRINCIPLES OF THE GUTASSOCIATED LYMPHOID TISSUES The normal intestine has an enormous surface area that is exposed to a wide variety of exogenous, especially bacterial, antigens (Figure 2–2).

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