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Management of regional enteritis

Abstract

Regional enteritis (Crohn’s disease) is an uncommon chronic inflammation of unknown cause involving one or more parts of the gut.1–3 The affected parts are often thickened: the mucosa is usually ulcerated and there may be adhesions and fistulae. This can cause diarrhoea, steatorrhoea, pain, and acute and chronic obstruction. Malabsorption occurs in extensive involvement of the small bowel or in the ‘blind loop’ syndrome due to strictures, fistulae or by-pass operations, and in addition protein may be lost in the bowel. The fistulae may occur between loops of bowel, and anal fistulae are common. These disorders can cause malaise, fever, anaemia, weight loss, hypoproteinaemia and electrolyte disturbance. Growth may be arrested. Skin lesions, arthropathy and iritis may develop. The first attack may occur at any age, and the disease usually runs a chronic and unpredictable course. However, acute ileitis, diagnosed surgically, does not usually recur,4–6 and it may be a different condition.6

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