Unifying Concepts

Lennard-Jones Diagnostic Criteria of Crohn’s Disease (CD)

Once the clinical suspicion is established, the diagnosis is based on the combination of clinical, biochemical, endoscopic, histological and/or radiological criteria.

Lennard-Jones diagnostic criteria

Clinical criteria

  • Recurrent abdominal pain
  • Diarrhoea
  • Weight loss
  • Abdominal mass
  • Fever or low-grade fever
  • Perianal disease
  • Fistulas
  • Extraintestinal manifestations

Radiological criteria

  • Mucosal changes: aphthous ulcers, linear or rosebush thorn ulcers, longitudinal ulcers, inflammatory polyps, oedema of circular fold of small intestine
  • Changes in calibre: stenosis, dilation, fistulas, asymmetry of lesions

Endoscopic criteria

  • Colonic involvement: aphthous ulcers, deep or serpiginous linear ulcerations, cobblestone appearance, stenosis, fistulous orifices, pseudopolyps and polyps; characteristically segmental lesions, of variable extension with mostly preserved rectum
  • Ileal involvement: aphthous ulcers, ulcers and/or stenosis

Anatomo-pathological criteria

  • Major: transmural inflammation, non-caseating granulomas, lymphoid aggregates without germinal centre
  • Minor: intermittent inflammation, inflammation of the submucosa with conserved epithelial architecture, mucus retention with minimal inflammation, fissures

Defined disease: granulomas and other criteria or absence of granulomas and 3 criteria.
Probable disease: absence of granulomas and 2 criteria.



  1. Reinisch S, Schweiger K, Pablik E, Collet-Fenetrier B, Peyrin-Biroulet L, Alfaro I, Panés J, Moayyedi P, Reinisch W. An index with improved diagnostic accuracy for the diagnosis of Crohn’s disease derived from the Lennard-Jones criteria. Aliment Pharmacol Ther. 2016 Sep;44(6):601-11. [Medline]
  2. Ballester Ferré MP, Boscá-Watts MM, Mínguez Pérez M. Crohn’s disease. Med Clin (Barc). 2018 Jul 13;151(1):26-33. [Medline]


Created Sep 27, 2019.

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