Updates in the diagnosis and management of small-bowel Crohn's disease

Abstract

Crohn's disease (CD) can affect any part of the GI tract, but small bowel (SB) involvement is present in 80% of patients with CD; 30% have exclusive SB disease [1] presenting a diagnostic challenge due to the inaccessibility of standard endoscopic techniques.

Accurate assessment of treatment response [2] and regular monitoring are crucial to prevent surgery and to identify patients at risk of relapse and/or complications before the onset of clinical symptoms [3]. Ileocolonoscopy (IC) is considered the gold standard for evaluating mucosal healing (MH) in CD, but it is invasive and costly [4] and only allows visualization of the terminal ileum (TI). The CALM study has demonstrated that C-reactive protein (CRP) and faecal calprotectin (FCP) can be effective surrogate markers of MH and help guide treatment [5]. Nonetheless, their efficacy is limited [6] as approximately 30% of patients do not present with elevated CRP levels during relapse [7] and the correlation between FCP and active SB disease is weak [8].

Thus, CD requires a multidisciplinary approach. We aim to provide an overview of recent advances in the diagnosis and management of small bowel CD.